FAKTOR EKSENTRIK LINGKUNGAN RUMAH YANG BERHUBUNGAN DENGAN KEJADIAN PNEUMONIA PADA BALITA DI WILAYAH PUSKESMAS I BANJARNEGARA TAHUN 2004

Infeksi Saluran Pernafasan Akut merupakan salah satu penyebab kematian terbesar pada anak dinegara berkembang.Di Indonesia dari sekitar 450.000 kematian balita yang terjadi setiap tahun 150.000 diantaranya disebabkan oleh ISPA terutama karena Pneumonia.Jumlah kasus Pneumonia di Puskesmas I Banjarnegara sejak tahun 2002 sampai bulan Mei 2004 menduduki peringkat pertama diantara Puskesmas lainnya diwilayah Banjarnegara.Faktor resiko kejadian Pneumonia terdiri dari faktor intrinsik meliputi pemberian ASI,status gizi dan status imunisasi,keadaannya diwilayah Puskesmas I Banjarnegara baik yang telah memenuhi target,sedangkan faktor eksentrik belum ada datanya. Penelitian ini menggunakaan metode kasus kontrol.Analisa data dilakukan dengan SPSS 10 menggunakan tabel 2x2,CI=95% dan alfa=0,0005 serta dihitung besarnya kekuatan hubungan dengan menghitung nilai Odds Ratio. Berdasarkan analisa didapatkan hasil sebagai berikut:ada hubungan antarakontruksi rumah dengan kejadian Pneumonia (tidak permanen-semi permanen)p=0,004 OR=6,857 CI(95%)=1,826-25,754 dan tidak permanen-permanen p=0,01 OR=8,750 C1(95%)=2,319-33,020),ada hubungan antar jenis lantai dengan kejadian Pneumonia (p=0,0001 OR=4,235 CI(95%)=1,196-5,614)ada hubungan antar percahayaan rumah dengan kejadian Pneumonia (p=0,0001 OR=22 CI(95%)=7,848-61,670)ada hubungan antar keberadaan asap dapur dengan kejadian Pneumonia (p=0,00001 OR=(5,612 CI(95%)=2,696-11,681),ada hubungan antara jenis bahan bakar dengan kejadian pneumonia(p=0,0001 OR+41,250 CI(95%)=13,263-128,293),ada hubungan antara fentilasi rumah dengan kejadian pneumonia (p=0,0001 OR=11,500 CI(95%)=5,006-26,418. Berdasarkan kesimpulan yang didapat penulis menyarankan perbaikan lingkungan perumahan untuk mengurangi resiko terkena pneumonia pada balita,misalnyaberupa pembuatan ventilasi/jendela,penggunaan genting kaca,pembuatan penyekat antara dapur dengan ruang lain,dengan tetap memperhatikan status ekonomi masyarakat. Kata Kunci: pneumonia,balita,faktor eksentrik lingkungan rumah THE ASSOCIATION BETWEEN ENVIRONMENTAL FACTOR EXTRINSIC OF HOUSE WITH PNEUMONIA OCCURENCE ON CHILDREN UNDER FIVE YEARS IN THE WORKING AREA OF COMMUNITY HEALT CENTER OF BANJARNEGARA I IN YEARS 2004 Acute Respiratory Infection represents one of the biggest death cause of childrent in developing country.In indonesia from about 450.000 death on children under 5 years old that happenedevery year 150.000 among other things because of Acute Respiratory Infection especially of pneumonia .According to survey of health of pneumonia Domestic represent the second death cause and become the first one in the year 1992.The amount of pneumonia Case in comunity Health center of Banjarnegara I since year 2002 up to May 2004 occupying first grade among other Community Health center of Banjarnegara District.Risk factor of pneumonia occurence consisted by intrinsic an extrinsic factor .Intrinsic factor cover the best feeding nutrient status and imunization status,its circumstance in region of good community Health Center of Banjarnegara I and have fulfiled the goals,for the extrinsic factor not yet been god its data.This resears used a case control method.Data analyzing was done by SPSS 10 by using table 2x2,CI=95% and alfa=0,05 was also calculated the levelof relation strength by calculating value of Odds Ratio.Fromresearch showed that was corelation between house contruction with the pneumonia occurence (p=0,01),there was corelation between floor type with the pneumonia occurence(0,001 OR=4,235 CI(95%)=2,000-8,967),there was corelation between house dencity with pneumonia occurence (p=0,014 OR=2,591CI(95%)=1,196-5,614),there was corelation between house illumination with the pneumonia occurence (p=0,001 OR=22 CI(95%)=7,484-61,670),ther was corelation between existence of kitchen smoke with the pneumonia occurence (p=0,0001 OR=5,612 CI(95%)=2,696-11,681),there was corelation between foel type with the pneumonia occurence (p=0,0001 OR=4,008 CI(95%)=1,932-8,313),there was corelation between humidity with the pneumonia occurence (p=0,0001 OR=4,008 CI(95%)=1,932-8,313),there was corelation between humidity with the pneumonia occurence (p=0,0001 OR=41,250 CI(95%)=13,263-128,293),there was corelation between house ventilation with the pneumonia occurence (p=0,0001 OR=11,500 CI(95%)=6,006-26,418).In conclition,it suggest the environmental housing repair to decrease pneumonia risk on childrent under 5 years,for example making ventilation/window,use glass tile,makingisulator between kitchen with other room,but steel concidering econmic status of society. Keyword : pneumonia,children under 5 years,environmental factor extrinsic of hous

Diagnosis and management of pneumonia in the emergency department.

Pneumonia is a condition that is often treated by emergency physicians. This article reviews the diagnosis and management of pneumonia in the emergency department and highlights dilemmas in diagnostic testing, use of blood and sputum cultures, hospital admission decisions, infection control, quality measures for pneumonia care, and empiric antimicrobial therapy

FAKTOR RISIKO PNEUMONIA PADA ANAK UMUR 1-3 TAHUN DI WILAYAH PUSKESMAS KEMRANJEN I KABUPATEN BANYUMAS TAHUN 2005

Infeksi saluran pernafasan akut merupakan salah satu penyebab kematian terbesar pada anak di negara sedang berkembang. Di Indonesia dari sekitar 450.000 kematian balita yang terjadi setiap tahun 150.000 diantaranya disebabkan oleh ISPA terutama karena pneumonia. Kasus pneumonia di Puskesmas I Kemranjen sejak tahun 2002 sampai tahun 2004 termasuk ke 10 besar penyakit. Penelitian ini bertujuan untuk mengetahui keterkaitan faktor risiko intrinsik (status gizi, status imunisasi, jenis kelamin dan pemberian ASI) dan faktor ekstrinsik (tipe rumah, ventilasi, jenis bahan bakar, kepadatan hunian, pendidikan ibu, umur ibu) dengan kejadian pneumonia pada umur 1-3 tahun di wilayah kerja Puskesmas Kemranjen I. Penelitian ini dilaksanakan dari Bulan Januari sampai Maret 2005 dengan menggunakan metode kasus kontrol. Lokasi penelitian adalah wilayah Puskesmas Kemranjen I. Analisa data dilakukan dengan SPSS 10 menggunakan tabel 2x2, Cl 95% dan alfa= 0,05 serta dihitung besarnya kekuatan hubungan dengan menghitung nilai Odds ratio Berdasarkan analisis didapatkan hasil sebagai berikut: lama pemberian ASI, 1 tahun berisiko dengan kejadian pneumonia pada anak umur 1-3 tahun dengan nilai p=0,46 dan OR=2,741 pada Cl (95%) = 1,107-6,787; tipe rumah non permanen dengan kejadian pneumonia pada anak umur 1-3 tahun dengan nilai p=0,001 dan OR=7,295 pada Cl (95%)= 2,245-23,706; luas ventilasi/jendela rumah < 10% dari luas lantai rumah berisiko dengankejadian pneumonia pada anak umur 1-3 tahun denga nilai p=0,001 dan OR=8,603pada Cl (95%)= 3,27-22,598; pemakaian kayu bakar berisiko dengan kejadian pneumonia pada anak umur 1-3 tahun dengan nilai p=0,003 dan OR=4,205 pada Cl (95%)= 2,21,704-10,377; kepadatan hunian rumah <0,7 berisiko dengan kejadian pneumonia pada anak umur 1-3 tahun dengan nilai p=0,005 dan OR=4,046 pada Cl (95%)= 1,605-10,201. kejadian pneumonia didominasi oleh faktor eksterm yaitu tipe rumah, ventilasi rumah, kepadatan hunian, pemakaian jenis bahan bakar dan faktor intern yaitu lama pemberian ASI. Berdasarkan kesimpulan yang didapat penulis menyarankan agar kegiatan pamantauan kasus pneumonia dilaksanakan secara rutin, menggunakan hasil penelitian ini sebagai dasar untuk membuat desain kegiatan pencegahan dan pemberantasan pneumonia. Melakukan penyuluhan secara berkala untuk meningkatkan pengetahuan orang tua balita tantang ISPA dan pneumonia serta pencegahan kasus pneumonia dengan penekanan pada perbaikan lingkungan perumahan. Kata Kunci: pneumonia, anak umur 1-3 tahun, faktor intrinsik dan ekstrinsi

Impact of pneumococcal conjugate vaccination: a retrospective study of hospitalization for pneumonia in North-East Italy

Introduction. Pneumonia remains a common reason for hospitalizing infants and the elderly worldwide, and streptococcal infection is often responsible. The aim of this study was to assess the burden of pneumonia in a large general population. Methods. All pneumonia-related hospitalizations from 2004 to 2013 in north-east Italy were identified from the hospital records with a first-listed diagnosis on discharge of bacterial pneumonia, or a first-listed diagnosis on discharge of meningitis, septicemia or empyema associated with a secondary diagnosis of bacterial pneumonia. We identified major comorbidities, calculated agespecific case-fatality rates (CFR), and estimated the related cost to the health care system. Results. Of the 125,722 hospitalizations identified, 96.9% were cases of pneumonia, 2.4% of septicemia, 0.4% of meningitis, and 0.3% of empyema; 75.3% of hospitalizations involved 65 65-yearolds. The overall CFR was 12.4%, and it increased with age, peaking in people over 80 (19.6%). The mean annual pneumonia-associated hospitalization rate was 204.6 per 100,000 population, and it peaked in 0- to 4-year-old children (325.6 per 100,000 in males, 288.9 per 100,000 in females), and adults over 65 (844.9 per 100,000 in males, 605.7 per 100,000 in females). Hospitalization rates dropped over the years for the 0-4 year-olds, and rose for people over 80. The estimated overall annual cost of these pneumonia-related hospitalizations was approximately \u20ac 41 million. Conclusions. This study shows that the burden on resources for pneumonia-related hospitalization is an important public health issue. Prevention remains the most valuable tool for containing pneumonia, and vaccination strategies can help in the primary prevention of infection, possibly reducing the number of cases in all age groups

IL-17 can be protective or deleterious in murine pneumococcal pneumonia

Streptococcus pneumoniae is the major bacterial cause of community-acquired pneumonia, and the leading agent of childhood pneumonia deaths worldwide. Nasal colonization is an essential step prior to infection. The cytokine IL-17 protects against such colonization and vaccines that enhance IL-17 responses to pneumococcal colonization are being developed. The role of IL-17 in host defence against pneumonia is not known. To address this issue, we have utilized a murine model of pneumococcal pneumonia in which the gene for the IL-17 cytokine family receptor, Il17ra, has been inactivated. Using this model, we show that IL-17 produced predominantly from γδ T cells protects mice against death from the invasive TIGR4 strain (serotype 4) which expresses a relatively thin capsule. However, in pneumonia produced by two heavily encapsulated strains with low invasive potential (serotypes 3 and 6B), IL-17 significantly enhanced mortality. Neutrophil uptake and killing of the serotype 3 strain was significantly impaired compared to the serotype 4 strain and depletion of neutrophils with antibody enhanced survival of mice infected with the highly encapsulated SRL1 strain. These data strongly suggest that IL-17 mediated neutrophil recruitment to the lungs clears infection from the invasive TIGR4 strain but that lung neutrophils exacerbate disease caused by the highly encapsulated pneumococcal strains. Thus, whilst augmenting IL-17 immune responses against pneumococci may decrease nasal colonization, this may worsen outcome during pneumonia caused by some strains

Physical exercise and cardiac death due to pneumonia in male teenagers [Iznenadna smrt zbog upalće pluća za vrijeme tjelovježbe u trojice mladića]

From 1998 to 2008 we noticed 3 cardiac deaths in male teenagers aged 18-19 during or after physical exercise. The first was working at the site recreatively, the second was engaged in soccer recreatively and the third was professional soccer player. One felt general tiredness and was exhausted of a heavily physical effort, the other after physical exercise became septic and the third was without symptoms. One died suddenly during physical exercise at the field and two died in the hospital. At the forensic autopsy the first had bilateral bacterial pneumonia, possible high-altitude non-cardiogenic pulmonary edema and cerebral edema. The second had bilateral bacterial pneumonia, adult respiratory distress syndrome, disseminated intravascular coagulation, suprarenal bleeding, cerebral edema, hypoplastic right coronary artery and myocardial fibrosis. The third had bilateral bacterial pneumonia, fibrinous pericarditis, cerebral contusion with edema, thickenning of the left ventricle 20 mm and hypoplastic ascending aorta. In Croatia the death rate among athletes reached 0.15/ 100,000, in athletes suffered of acute pneumonia 0.28/ 100,000, in others who practice exercise recreatively 0.57/ 100,000 (p = 0.0068), in all males who practice exercise recreatively 0.75/ 100,000 (p = 0.0014). Physical exercise is contraindicated in acute respiratory tract infections. Every such case has to be treated by physician. When to start with physical training after bacterial pneumonia depends on disappearing of clinical and X-ray signs of pneumonia, normalization of erythrocite sedimentation rate and of white cell count

Impact of Pneumococcal Conjugate Vaccines on Pneumonia Hospitalizations in High- and Low-Income Subpopulations in Brazil.

BackgroundPneumococcal conjugate vaccines (PCVs) are being used worldwide. A key question is whether the impact of PCVs on pneumonia is similar in low- and high-income populations. However, most low-income countries, where the burden of disease is greatest, lack reliable data that can be used to evaluate the impact. Data from middle-income countries that have both low- and high-income subpopulations can provide a proxy measure for the impact of the vaccine in low-income countries.MethodsWe evaluated the impact of PCV10 on hospitalizations for all-cause pneumonia in Brazil, a middle-income country with localities that span a broad range of human development index (HDI) levels. We used complementary time series and spatiotemporal methods (synthetic controls and hierarchical Bayesian spatial regression) to test whether the decline in pneumonia hospitalizations associated with vaccine introduction varied across the socioeconomic spectrum.ResultsWe found that the declines in all-cause pneumonia hospitalizations in children and young and middle-aged adults did not vary substantially across low and high HDI subpopulations. Moreover, the estimated declines seen in infants and young adults were associated with higher levels of uptake of the vaccine at a local level.ConclusionsThese results suggest that PCVs have an important impact on hospitalizations for all-cause pneumonia in both low- and high-income populations

Community Case Management of Fever Due to Malaria and Pneumonia in Children Under Five in Zambia: A Cluster Randomized Controlled Trial

In a cluster randomized trial, Kojo Yeboah-Antwi and colleagues find that integrated management of malaria and pneumonia in children under five by community health workers is both feasible and effective. BACKGROUND. Pneumonia and malaria, two of the leading causes of morbidity and mortality among children under five in Zambia, often have overlapping clinical manifestations. Zambia is piloting the use of artemether-lumefantrine (AL) by community health workers (CHWs) to treat uncomplicated malaria. Valid concerns about potential overuse of AL could be addressed by the use of malaria rapid diagnostics employed at the community level. Currently, CHWs in Zambia evaluate and treat children with suspected malaria in rural areas, but they refer children with suspected pneumonia to the nearest health facility. This study was designed to assess the effectiveness and feasibility of using CHWs to manage nonsevere pneumonia and uncomplicated malaria with the aid of rapid diagnostic tests (RDTs). METHODS AND FINDINGS. Community health posts staffed by CHWs were matched and randomly allocated to intervention and control arms. Children between the ages of 6 months and 5 years were managed according to the study protocol, as follows. Intervention CHWs performed RDTs, treated test-positive children with AL, and treated those with nonsevere pneumonia (increased respiratory rate) with amoxicillin. Control CHWs did not perform RDTs, treated all febrile children with AL, and referred those with signs of pneumonia to the health facility, as per Ministry of Health policy. The primary outcomes were the use of AL in children with fever and early and appropriate treatment with antibiotics for nonsevere pneumonia. A total of 3,125 children with fever and/or difficult/fast breathing were managed over a 12-month period. In the intervention arm, 27.5% (265/963) of children with fever received AL compared to 99.1% (2066/2084) of control children (risk ratio 0.23, 95% confidence interval 0.14–0.38). For children classified with nonsevere pneumonia, 68.2% (247/362) in the intervention arm and 13.3% (22/203) in the control arm received early and appropriate treatment (risk ratio 5.32, 95% confidence interval 2.19–8.94). There were two deaths in the intervention and one in the control arm. CONCLUSIONS. The potential for CHWs to use RDTs, AL, and amoxicillin to manage both malaria and pneumonia at the community level is promising and might reduce overuse of AL, as well as provide early and appropriate treatment to children with nonsevere pneumonia.United States Agency for International Development (GHSA-00-00020-00) with Boston University; President's Malaria Initiativ

HIV infection is associated with elevated biomarkers of immune activation in Ugandan adults with pneumonia.

IntroductionPneumonia is an important cause of morbidity and mortality in persons living with human immunodeficiency virus (HIV) infection. How immune activation differs among HIV-infected and HIV-uninfected adults with pneumonia is unknown.MethodsThe Inflammation, Aging, Microbes, and Obstructive Lung Disease (I AM OLD) Cohort is a prospective cohort of adults with pneumonia in Uganda. In this cross-sectional analysis, plasma was collected at pneumonia presentation to measure the following 12 biomarkers: interleukin 6 (IL-6), soluble tumor necrosis factor receptors 1 and 2 (sTNFR-1 and sTNFR-2), high sensitivity C-reactive protein (hsCRP), fibrinogen, D-dimer, soluble CD27 (sCD27), interferon gamma-inducible protein 10 (IP-10), soluble CD14 (sCD14), soluble CD163 (sCD163), hyaluronan, and intestinal fatty acid binding protein. We asked whether biomarker levels differed between HIV-infected and HIV-uninfected participants, and whether higher levels of these biomarkers were associated with mortality.ResultsOne hundred seventy-three participants were enrolled. Fifty-three percent were HIV-infected. Eight plasma biomarkers-sTNFR-1, sTNFR-2, hsCRP, D-dimer, sCD27, IP-10, sCD14, and hyaluronan-were higher among participants with HIV infection, after adjustment for pneumonia severity. Higher levels of 8 biomarkers-IL-6, sTNFR-1, sTNFR-2, hsCRP, IP-10, sCD14, sCD163, and hyaluronan-were associated with increased 2-month mortality.ConclusionsAs in other clinical contexts, HIV infection is associated with a greater degree of immune activation among Ugandan adults with pneumonia. Some of these are also associated with short-term mortality. Further study is needed to explore whether these biomarkers might predict poor long-term outcomes-such as the development of obstructive lung disease-in patients with HIV who have recovered from pneumonia