By : Hendra Arif
1. Definisi
Merupakan kebutuhan kebutuhan dasar manusia berupa ekspresi perasaan dua orang individu secara pribadi yang saling menghargai, memperhatikan dan menyayangi sehingga terjadi sebuah hubungan timbal balik antara kedua individu tersebut. (Alimul Hidayat, Azis A. 2006)
2. Tinjauan Seksual dari beberapa aspek (Alimul Hidayat, Azis A. 2006)
i. Aspek Biologis
Aspek ini memandang dari segi biologi seperti pandangan anatomi dan fisiologi dari sitem reproduksi (seksual), kemampuan organ seks dan adanya hormonal dari sistem syaraf yang berfungsi atau berhubungan dengan kebutuhan seksual.
ii. Aspek Psikologis
Aspek ini merupakan pandangan terhadap identitas jenis kelamin, sebuah perasaan dari diri sendiri terhadap kesadaran identitasnya, serta memandang gambaran seksual atau bentuk konsep diri yang lain.
iii. Aspek Sosial Budaya
Aspek ini merupakan pandangan budaya atau keyakinan yang berlaku di masyarakat terhadap kebutuhan seksual serta perlakuanya di masyarakat.
3. Faktor- Faktor yang Mempengaruhi Seksualitas (Potter & Perry, 2005).
i. Faktor Fisik
Merupakan faktor yang menyebabkan penurunan keinginan seksual karena alasan fisik tersebut.Aktivitas seksual dapat menyebabkan nyeri dan ketidaknyamanan. Penyakit minor dan keletihan ,medikasi, citra tubuh.
ii. Faktor Hubungan
Masalah dalam berhubungan dapat mengalihkan perhatian seseorang dari keinginan seks. Setelah , kemesraan hubungan telah memudar , pasangan mungkin mendapati bahwa mereka dihadapkan pada perbedaan yang angat besar dalam nilai atau gaya hidup mereka.Penurunan minat dalam aktifitas seksual dapat mengakibatkan kecemasan , hanya karena harus mengatakan kepada pasangan prilaku seksual apa yang diterima dan menyenangkan.
iii. Faktor Gaya Hidup
Faktor gaya hidup seperti penggunaan atau penyalahgunaan alkohol atau tidak punya waktu untuk mencurahkan perasaan dalam berhubungan, dapat mempengaruhi keinginan seksual.dan ini terbukti bahwa efek negative alcohol terhadap seksualitas melebihi euphoria yang mungkin dihasilkan pada awalnya.
iv. Faktor Harga Diri
Tingkat harga diri seseorang juga dapat menyebabkan konflik yang melibatkan seksualitas.Jika harga diri seksual tiak prnah dipelihara dengan mengembangkan perasaan yang kuat tentang seksual- diri dan dengan mempelajari ketrampilan seksual, seksulitas mungkin menyebabkan perasaan negative dan tekanan perasaan seksual.
4. Faktor- faktor yang mempengaruhi masalah seksual (Alimul Hidayat, Azis A. 2006).
Terdapat beberapa faktor yang dapat mempengaruhi gangguan dalam fungsi seksual, diantaranya antara lan :
a. Tidak adanya panutan / Role Model
b. Gangguan struktur dan fungsi tubuh, seperti adanya trauma, obat, kehamilan atau abnormalitas genitalia.
c. Kurang pengetahuan atau informasi yang salah mengenai masalah seksual
d. Penganiayaan secara fisik
e. adanya penyimpangan psikoseksual Konflk terhadap nilai
f. Konflk terhadap nilai
g. Kehilangan pasangan karena perpisahan atu kematian.
.5. Perubahan Pengaruh Umum Penuaan Fungsi seksual pria (Pudjiastuti,2003).
a. Terjadi penurunan sirkulasi testoteron, tetapi jarang menyebabkan gangguan fungsi seksual pada lansia yang sehat.
b. Ereksi penis memerlukan waktu lebih lama dan mungkin tidak sekeras sebelumnya, perangsangan langsung dari penis sering dilakukan.
c. Ukuran testis tidak bertambah, elevasinya lambat dan cenderung turun.
d. Kelenjar penis tampak menurun
e. Kontrol ejakulasi meningkat, ejakulasi lambat dan cenderung turun.
f. Dorongan seksual jarang terjadi pada pria diatas usia 50 tahun
g. Tingkat orgasme menurun atau hilang
h. Kekuatan ejakulasi menurun, sehingga orgasme kurang semangat
i. Ejakulasi selama orgasme terdiri dari satu atau dua kontraksi pengeluaran sedangkan pada orang muda dapat terjadi 4 kontraksi besar dan diikuti kecil sampai beberap detik.
j. Ejakulasi dikelurkan tanpa kekuatan penuh, dan mengandung sedikit sel sperma.
k. Penurunan tonus otot menyebabkan spasme pada organ genital eksterna yang tidak biasa , frekuensi kontraksi sfingter selama orgasme menurun.
l. Setelah ejakulasi, penurunan ereksi dan testis lebih cepat terjadi.
m. Kemampuan ereksi setelah ejakulasi semakin panjang, pada umumnya 12 sampai 48 jam setelah ejakulasi.
n. Pada klimaksnya hubungan seksual masih memberikan kepuasan yang kuat.
6. Perubahan Pengaruh Penuaan Fungsi seksual Wanita (Pudjiastuti, 2003 )
a. Lubrikasi vagina memerlukan waktu lebih lama
b. Pengembangan dinding vagina berkurang pada panjang dan lebarnya.
c. Dinding vagina menjadi lebih tipis dan mudah teritasi
d. Selama hubungan seksual sering terjadi iritasi pada kandung kemih dan .Uretra.
e. Sekresi vagina berkurang keasamanya, meningkat kemungkinan terjadinya infeksi.
f. Penurunan elevasi uterus
g. Atrofi labia mayora dan ukuran klitoris menurun.
h. Fase orgasme lebih pendek
i. Fase resolusi lebih cepat.
7. Siklus Respon Seksual (Alimul Hidayat, Azis A. 2006 ).
i. Tahap suka cita, Merupakan tahap awal dalam respon seksual pada wanita ditandai dengan banyaknya lender pada daerah vagina, dinding vagina, mengalami ekspansi atau menebal meningkatnya efektifitas klitoris/sensitivitas, putting susu menegang, dan ukuran buah dada meningkat. Pada laki-laki ditandai dengan ketegangan atau ereksi pada penis dan penebalan atau dan payudara wanita selama rangsangan seksual, pada wanita reaksi ini menyebabkan lubrikasi vaginal, tumescrnce (pembengkakan) klitoris, labia minora dan mayora, perbesaran sepertiga bagian luar vagina. Pada pria vasokongesti menyebabkan ereksi penis.
ii. Tahap kestabilan, pada tahap ini wanita mengalami retraksi dibawah klitoris, adanya lender yang banyak dari vagina dan labia mayora, elevasi dari servik dan uterus, serta meningkatnya otot-otot pernapasan, pada laki-laki ditandai dengan meningkatnya ukuran gland penis dan tekanan otot pernapasan.
iii. Tahap orgasme (puncak). Tahap puncak dalam siklus seksual pada wanita ditandai adanya kontraksi yang tidak disengaja dari uterus, dan otot-otot lainnya, terjadi hiperventilasi dan meningkatnya denyut nadi, pada laki-laki ditandai dengan relaksasi dapa spinchter kandung kencing, hiperventilasi dan meningkatnya denyut nadi. Pada laki-laki ditandai dengan relaksasi pada spinchter kandung kencing, hiperventilasi, dan meningkatnya denyut nadi.
iv. Tahap resolusi (peredaan). Merupakan tahap terahir dalam siklus respon seksual, pada wanita ditandai, adanya relaksasi dari dinding vagina secara berangsur-angsur, perubahan warna dari labia mayora, pernafasan nadi, tekanan darah, otot-otot berangsur-angsur kembali normal, pada laki-laki ditandai dengan menurunnya denyut pernapasan, dan denyut nadi serta melemasnya penis.
Menurut Master dan Johnson (1966) dalam (Perry & Potter 2005). Telah mendefinisikan siklus respon seksual dengan fase-fase excitemen, plateu, prgasme, resolusi, fase-fase ini adalah akibat dari vasokontriksi dan miotonia yang merupakan respon fisiologis dasar dari rangsangan seksual, vasokongesti adalah pengumpulan darah dalam alat genital dan payudara wanita selama rangsangan seksual . Pada wanita rangsangan ini menyebabkan lubrikasi vagina, Tumenscence ( pembengkakan) klitoris, labia minora, dan mayora , perbesaran sepertiga bagian luar vagina , pada pria vasokongesti menyebabkan ereksi penis
8. Berkurangnya Hasrat Seksual (libido)
Kurangnya libido biasa dialami oleh laki-laki dan perempuan pada beberapa tahap di dalam kehidupan mereka, meskipun hal itu hanya sementara dan terjadi pada waktu- waktu sakit fisik.Hampir penyakit, keadaan sakit atau luka fisik apapun bisa menyebabkan menurunya libido, seperti obat-obatan yang digunakan untuk penyembuhanya, atau mungkin alkohol.
Sebab – sebab psikologis untuk libido yang menurun banyak sekali, mulai dari penyakit- penyakit, seperti depresi, sampai stres, yang bisa disebabkan oleh banyak hal yang berbeda- beda. Pekerjaan, keluarga dan kesulitan- kesulitan keuangan bisa menyebabkan berbagai tingkat stress dan kelelahan yang sangat sering.Semua bentuk kekhawatiran dan ketidaknyamanan dalam sebuah hubungan bisa juga menyebabkan menurunya libido. Seseorang mungkin mengkhawatirkan tingkat kedekatan emosional yang dirasakan oleh pasangan atau meragukan ketertarikan atau kemampuan dirinya untuk mencapai kepuasan (Nash, Barbara. 2006).
9. Masalah- masalah laki-laki dalam hubungan seksual
Sebagian dari hilangnya libido yang dibicarakan di atas, para lelaki biasanya mengalami satu atau dua kesulitan lainya di dalam kejantanan seksual. Masalahnya antara lain (Nash, Barbara.2006 )
a. Impotensi, dimana didefinisikan sebagai ketidakmampuan untuk melakukan hubungan sekual dikarenakan kegagalan dalam mencapai atau menghasilkan ereksi. Impotensi juga menggambarkan situasi dimana sebuah ereksi bisa dicapai tetapi ada kegagalan untuk mencapai orgasme atau ejakulasi.
Penyebab terjadinya impotensi :
1. Psikogenis, yang dihasilkan dari stress, kekhawatiran, ketakutan, atau trauma emosional lainya
Menurut Master dan Johnson (1966) dalam (Perry & Potter 2005). Telah mendefinisikan siklus respon seksual dengan fase-fase excitemen, plateu, prgasme, resolusi, fase-fase ini adalah akibat dari vasokontriksi dan miotonia yang merupakan respon fisiologis dasar dari rangsangan seksual, vasokongesti adalah pengumpulan darah dalam alat genital seksual laki-laki yang sering dilaporkan.
b. Kegagalan mencapai orgasme, pada laki - laki , mencapai orgasme menggambarkan situasi dimana awal ketegangan seksual menghasilkan sebuah ereks , tetapi ini berhenti sebelum klimaks dicapai.
10. Masalah- masalah perempuan dalam berhubungan seksual
Beberapa masalah dapat diketahui penyebab bersifat fisik, psikologis dan emosional ( Nash, Barbara , 2006 )
i. Kegagalan orgasme, hal ini bisa diakibatkan kurangnya rangsangan dan tekhnik yang kurang atau masalah- masalah psikologis.
ii. Viginismus, adalah sebuah kontraksi otot yang tiba-tiba dan tidak dingaja disekitar mulut vagina, yang sering melibatkan otot-otot perut juga otot-otot kedua pantat dan kedua paha yang terjadi selama percintaan dan mencegah penetrasi. Penyebab viginismus antara lain :pengalaman seks yang traumatis , namun faktor-faktor psikologis yang lebih tidak kentara misalnya : kesalahan atau perasan bahwa seks memalukan, kotor atau tidak menyenangkan
iii. Frigiditas , menggambarkan kurangnya hasrat yang komplit untuk seks dan sering seseorang merasakan perubahan pada ide sesks dan mungkin tidak suka disentuh. Penyebabnya dapat muncul dari pengalaman seksual yang traumatis yang lebi dini missal: pelecehan pada masa kecil atau pemerkosaan.
iv. Hubungan seksual yang menyakitkan (Dispareunia)
Hubungan seksual yang menyakitkan bisa disebabkan oleh berbagi hal ada faktor fisik dan psikologis.rasa sakit lokalisasi di daerah terbatas pada vagina, atau panggul dan perut bagian dalam. Vagina kering karena kurangnya foreplay dan ketegangan seksual bisa menyebabkan rasa sakit dan ini bisa menjadi masalah selama dan sesudah menopause dikarenakan hilangnya hormon - hormon.
11. Solusi terhadap masalah pemenuhan kebutuhan seksual pada lansia ( Pudjiastuti, 2003).
Sikap dan posisi hubungan seksual
Dimana dapat meningkatkan partisipasi seksual pada lansia sebagai
berikut :
a. Memahami perubahan normal yang berhubungan dengan lansia
b. Meningkatkan komunikasi pada masalah non-seksual sama baiknya dengan masalah komunikasi seksual.
c. Menikmati setiap kejadian. Jangan terburu – buru , kurangi ketakutan.
d. Menggunakan posisi seperti miring atau duduk yang tidak terlalu banyak menumpu dalam kontraksi otot lengan secara isometrik.
e. Gunakan posisi yang tidak menekan sendi, tengkurap yang menimbulkan nyeri.
f. Gunakan latihan kegel untuk meningkatkan tonus otot dan kontraksi vagina selama aktifitas seksual. Pria dan wanita dapat memperoleh keuntungan dari latihan.kegel dapat meningkatkan kekuatan kontraksi tot sfingter uretra dan sfingter ani.latihan kegel harus dilakukan beberapa kali sehari dengan mengkontraksikan otot pubokoksigeus 20- 30 kali.
g. Lakukan stimulasi oral genital
h. Stimulasi organ genital secara secara manual.
i. Gunakan vibrator sendiri atau dengan pasangan.
j. Lakukan masturbasi sendiri atau degan pasangan.
k. Konsultasi dengan dokter apabila ada masalah impotensi.
l. Gunakan tekhnik stuffing yaitu masukkan penis ke vagina sebelum ereksi penuh tercapai. Penis biasanya akan menjadi lebih keras/ tegang sebagai hasil dari stimulasi selama berada dalam vagina.
m. Coba nikmati sentuhan dan masase. Gunakan krim atau minyak untuk lebih menyenangkan , saling memberikan perhatian dalam berhubungan seksual. Dan mengurangi ketakutan pada pria.
n. Gunakan pelumas separti K- Jelly selama hubungan seksual atau masturbasi.
o. Lakukan pelukan, ciuman, usapan , rayuan, dan canda.
p. Lakukan gaya hidup yang sehat, yaitu : cukup istirahat, olahraga secukupnya jangan merokok, makan minum yang berlebihan.
q. Ciptakan suasana yang romantis ( lampu, pakaian, bunga, lokasi, perjalanan dan pujian).
r. Perhatikan kebersihan diri (mandi, mencukr rambut, kuku, kumis. Gigi dll). Jaga penampilan diri agar pasangan tertarik.
Sumber :
.
1. Alimul Hidayat, Azis A. (2006). Pengantar Kebutuhan dasar Manusia . Jakarta: Salemba Medika
2. Pudjiastuti, Sri Surini. (2003). Fisioterapi Pada Lansia. Jakarta: EGC Pudjiastuti, Sri Surini. (2003). Fisioterapi Pada Lansia. Jakarta: EGC
3. Nash, Barbara . (2006). Panduan Kesehatan Seksual. Jakarta: Prestasi Pustaka karya
4. Potter & Perry. (2005). Buku Ajar Fundamental Keperawatan. Jakarta: EGC
Sabtu, 23 Agustus 2008
Putting Typhoid Vaccination on the Global Health Agenda
By : Denise DeRoeck, M.P.H., Luis Jodar, Ph.D., and John Clemens, M.D.
Although typhoid fever, caused by infection with Salmonella enterica serovar Typhi (often called S. typhi), long ago ceased to be a public health problem in industrialized countries, it is still a substantial cause of illness and death in many developing countries. According to the World Health Organization (WHO), there are 16 million to 33 million cases and 500,000 to 600,000 deaths from typhoid fever annually,1 though one study conservatively estimated that 22 million cases and 216,000 related deaths occurred in 2000.2 This death rate is not much lower than the estimated 270,000 annual deaths from cervical cancer, caused largely by the human papillomavirus (HPV), and is considerably greater than mortality from meningococcal meningitis and Japanese encephalitis.3 But whereas there has been considerable international momentum behind introducing vaccines against HPV and meningococcus, vaccination against typhoid fever has largely fallen off the international radar screen.
Among the major reasons for this apparent neglect is a sense of complacency inspired by the introduction, beginning several decades ago, of relatively inexpensive antibiotics that initially reduced the rate of typhoid-related deaths substantially; unfortunately, these drugs have progressively become ineffective, since the bacterium has developed resistance to them. Another key factor is that the burden of typhoid fever is unknown and is probably underestimated in most developing countries, owing to the difficulty of differentiating the disease from other febrile illnesses, the infrequency of appropriate confirmatory laboratory testing, the reliance in many countries on private health care providers or on self-treatment with antibiotics, and the generally poor disease-reporting systems in developing countries. And unlike dengue fever and meningococcal meningitis, which occur in epidemics that command the attention of the media and political leaders, typhoid fever is largely an endemic illness. Finally, whereas policymakers have prioritized vaccines that reduce the rates of illness and death among children under 5 years of age, typhoid fever has long been considered a disease of school-aged children.
In industrialized countries, typhoid fever, which is spread by the fecal–oral route by means of contaminated water or food, was largely controlled through the improvement of water and sanitation systems. However, the development of such infrastructure requires huge investments and is unlikely to reach slums and other high-risk areas in developing countries for many years to come.
Vaccination can provide a near-term solution, as demonstrated in Thailand, where mass vaccination of schoolchildren with injectable, inactivated, whole-cell vaccines in the 1970s and 1980s led to sharp decreases in the incidence of typhoid fever and is credited with largely controlling the disease. However, because of their high rates of side effects, these older-generation vaccines have generally been abandoned as public health tools.
Fortunately, two newer-generation typhoid vaccines, which have been available for approximately two decades, have proved extremely safe. Vi polysaccharide is a subunit vaccine administered parenterally in a single dose; it was found in studies to confer about 70% protection, lasting at least 3 years, and is licensed for use in persons 2 years of age or older. The orally administered, live attenuated Ty21a vaccine, licensed for use in persons 2 years of age or older, is given in three or four doses and confers 53 to 96% protection, depending on the vaccine formulation and the context of the evaluation.4 Protection for 7 years after administration has been shown. The continued high incidence of typhoid fever in many regions, along with the rise and spread of drug-resistant strains, led the WHO in 2000 to recommend immunizing school-aged children with these newer vaccines in areas where typhoid fever is a substantial public health problem and particularly where antibiotic-resistant S. typhi strains are prevalent. But so far, only two countries — China and Vietnam — have incorporated typhoid vaccination into their routine immunization programs, and only in a limited fashion.
However, a number of recent developments and new data have strengthened the case for refocusing attention on typhoid vaccination. Standardized, prospective, population-based disease-surveillance studies supported by the Bill and Melinda Gates Foundation and conducted by the Diseases of the Most Impoverished (DOMI) Program at five sites in large Asian countries (Hechi, China; Kolkata [formerly Calcutta], India; North Jakarta, Indonesia; Karachi, Pakistan; and Hue, Vietnam) revealed high typhoid rates among children in the three urban slums (Karachi, Kolkata, and North Jakarta). At these sites, annual rates of blood-culture–confirmed typhoid fever among children 5 to 15 years of age ranged from 180 cases per 100,000 to 494 cases per 100,000, and the true incidence may be twice as high, since the sensitivity of blood cultures is only around 50%.
The DOMI studies, in which we participated, highlight the complexity of epidemiologic patterns of typhoid and other causes of enteric fever. Although typhoid fever is generally considered a disease of school-aged children, high rates were also seen among children younger than 5 years at the Karachi, Kolkata, and North Jakarta sites. Moreover, the incidence can vary considerably even within a single country. In Vietnam, a countrywide analysis showed that 90% of typhoid cases are confined to one third of provinces — rural areas with poor water and sanitation systems (see map inset). In many other countries, the disease predominantly affects urban slums. The DOMI studies also showed that enteric fever due to another serovar of S. enterica, S. Paratyphi A, traditionally considered to be of minor importance epidemiologically, is occurring at increasing rates in several Asian countries and is becoming resistant to multiple antibiotics. S. Paratyphi A was responsible for 64% of culture-proven cases of enteric fever in Hechi, 24% of those in Kolkata, and 15% of those in Karachi.5
These findings have important implications for typhoid and enteric-fever immunization strategies. First, since the currently available typhoid vaccines cannot be given to infants, school-based vaccination is a sensible option in countries where preschoolers are at relatively low risk, whereas in many areas of South and Southeast Asia where typhoid fever is highly endemic, a dual strategy of school- and community-based vaccination for 2-to-5-year-olds may be required. In those areas, a typhoid vaccine that can be given to infants through the WHO Expanded Program on Immunization would be ideal, once vaccines effective in this age group become available. Vi-protein–conjugate vaccines seem promising in this regard, although they are still years away from commercial availability. Second, in most countries, vaccination in geographically targeted, high-risk populations, rather than universal immunization, will most cost-effectively control the disease. And finally, future vaccine strategies for Asia will need to focus on S. paratyphi as well as S. typhi.
The DOMI studies also documented the continued rise and spread of antibiotic-resistant strains of S. typhi. Strains resistant to all three first-line antibiotics (ampicillin, chloramphenicol, and trimethoprim–sulfamethoxazole) accounted for 65% of isolates tested in Karachi. Resistance to nalidixic acid — a marker of reduced sensitivity to fluoroquinolones — was found in 44 to 57% of isolates tested in Hue, Kolkata, and Karachi. Clearly, as resistance grows, so will the difficulty and cost of treating the disease, and the occurrence of serious sequelae.
Vi vaccine has become increasingly available and inexpensive, as more high-quality producers from developing countries have acquired the technology to produce it. Indian producers have recently offered the vaccine to public-sector programs for $0.50 or less per dose. Moreover, demonstration projects conducted by DOMI in nearly 200,000 persons at the five sites have found community- and school-based immunization with Vi to be feasible and acceptable.
Given this evidence, policymakers in Pakistan and Indonesia plan to introduce targeted typhoid vaccination with Vi vaccine, beginning with school-based pilot projects. However, if typhoid fever is to be controlled globally, the international health community will need to increase the priority and sense of urgency accorded to the control of this disease
Source Information
The NEW ENGLAND JOURNAL of MEDICINE
References
1. Initiative for Vaccine Research. Typhoid fever. (Accessed August 23, 2007, at http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html.)
2. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ 2004;82:346-353. [ISI][Medline]
3. GAVI Alliance home page. (Accessed August 23, 2007, at http://www.gavialliance.org.)
4. Acosta CJ, Galindo CM, Deen JL, et al. Vaccines against cholera, typhoid fever and shigellosis for developing countries. Expert Opin Biol Ther 2004;4:1939-1951. [CrossRef][ISI][Medline]
5. Ochiai RL, Wang X, von Seidlein L, et al. Salmonella paratyphi A rates, Asia. Emerg Infect Dis 2005;11:1764-1766. [ISI][Medline]
Although typhoid fever, caused by infection with Salmonella enterica serovar Typhi (often called S. typhi), long ago ceased to be a public health problem in industrialized countries, it is still a substantial cause of illness and death in many developing countries. According to the World Health Organization (WHO), there are 16 million to 33 million cases and 500,000 to 600,000 deaths from typhoid fever annually,1 though one study conservatively estimated that 22 million cases and 216,000 related deaths occurred in 2000.2 This death rate is not much lower than the estimated 270,000 annual deaths from cervical cancer, caused largely by the human papillomavirus (HPV), and is considerably greater than mortality from meningococcal meningitis and Japanese encephalitis.3 But whereas there has been considerable international momentum behind introducing vaccines against HPV and meningococcus, vaccination against typhoid fever has largely fallen off the international radar screen.
Among the major reasons for this apparent neglect is a sense of complacency inspired by the introduction, beginning several decades ago, of relatively inexpensive antibiotics that initially reduced the rate of typhoid-related deaths substantially; unfortunately, these drugs have progressively become ineffective, since the bacterium has developed resistance to them. Another key factor is that the burden of typhoid fever is unknown and is probably underestimated in most developing countries, owing to the difficulty of differentiating the disease from other febrile illnesses, the infrequency of appropriate confirmatory laboratory testing, the reliance in many countries on private health care providers or on self-treatment with antibiotics, and the generally poor disease-reporting systems in developing countries. And unlike dengue fever and meningococcal meningitis, which occur in epidemics that command the attention of the media and political leaders, typhoid fever is largely an endemic illness. Finally, whereas policymakers have prioritized vaccines that reduce the rates of illness and death among children under 5 years of age, typhoid fever has long been considered a disease of school-aged children.
In industrialized countries, typhoid fever, which is spread by the fecal–oral route by means of contaminated water or food, was largely controlled through the improvement of water and sanitation systems. However, the development of such infrastructure requires huge investments and is unlikely to reach slums and other high-risk areas in developing countries for many years to come.
Vaccination can provide a near-term solution, as demonstrated in Thailand, where mass vaccination of schoolchildren with injectable, inactivated, whole-cell vaccines in the 1970s and 1980s led to sharp decreases in the incidence of typhoid fever and is credited with largely controlling the disease. However, because of their high rates of side effects, these older-generation vaccines have generally been abandoned as public health tools.
Fortunately, two newer-generation typhoid vaccines, which have been available for approximately two decades, have proved extremely safe. Vi polysaccharide is a subunit vaccine administered parenterally in a single dose; it was found in studies to confer about 70% protection, lasting at least 3 years, and is licensed for use in persons 2 years of age or older. The orally administered, live attenuated Ty21a vaccine, licensed for use in persons 2 years of age or older, is given in three or four doses and confers 53 to 96% protection, depending on the vaccine formulation and the context of the evaluation.4 Protection for 7 years after administration has been shown. The continued high incidence of typhoid fever in many regions, along with the rise and spread of drug-resistant strains, led the WHO in 2000 to recommend immunizing school-aged children with these newer vaccines in areas where typhoid fever is a substantial public health problem and particularly where antibiotic-resistant S. typhi strains are prevalent. But so far, only two countries — China and Vietnam — have incorporated typhoid vaccination into their routine immunization programs, and only in a limited fashion.
However, a number of recent developments and new data have strengthened the case for refocusing attention on typhoid vaccination. Standardized, prospective, population-based disease-surveillance studies supported by the Bill and Melinda Gates Foundation and conducted by the Diseases of the Most Impoverished (DOMI) Program at five sites in large Asian countries (Hechi, China; Kolkata [formerly Calcutta], India; North Jakarta, Indonesia; Karachi, Pakistan; and Hue, Vietnam) revealed high typhoid rates among children in the three urban slums (Karachi, Kolkata, and North Jakarta). At these sites, annual rates of blood-culture–confirmed typhoid fever among children 5 to 15 years of age ranged from 180 cases per 100,000 to 494 cases per 100,000, and the true incidence may be twice as high, since the sensitivity of blood cultures is only around 50%.
The DOMI studies, in which we participated, highlight the complexity of epidemiologic patterns of typhoid and other causes of enteric fever. Although typhoid fever is generally considered a disease of school-aged children, high rates were also seen among children younger than 5 years at the Karachi, Kolkata, and North Jakarta sites. Moreover, the incidence can vary considerably even within a single country. In Vietnam, a countrywide analysis showed that 90% of typhoid cases are confined to one third of provinces — rural areas with poor water and sanitation systems (see map inset). In many other countries, the disease predominantly affects urban slums. The DOMI studies also showed that enteric fever due to another serovar of S. enterica, S. Paratyphi A, traditionally considered to be of minor importance epidemiologically, is occurring at increasing rates in several Asian countries and is becoming resistant to multiple antibiotics. S. Paratyphi A was responsible for 64% of culture-proven cases of enteric fever in Hechi, 24% of those in Kolkata, and 15% of those in Karachi.5
These findings have important implications for typhoid and enteric-fever immunization strategies. First, since the currently available typhoid vaccines cannot be given to infants, school-based vaccination is a sensible option in countries where preschoolers are at relatively low risk, whereas in many areas of South and Southeast Asia where typhoid fever is highly endemic, a dual strategy of school- and community-based vaccination for 2-to-5-year-olds may be required. In those areas, a typhoid vaccine that can be given to infants through the WHO Expanded Program on Immunization would be ideal, once vaccines effective in this age group become available. Vi-protein–conjugate vaccines seem promising in this regard, although they are still years away from commercial availability. Second, in most countries, vaccination in geographically targeted, high-risk populations, rather than universal immunization, will most cost-effectively control the disease. And finally, future vaccine strategies for Asia will need to focus on S. paratyphi as well as S. typhi.
The DOMI studies also documented the continued rise and spread of antibiotic-resistant strains of S. typhi. Strains resistant to all three first-line antibiotics (ampicillin, chloramphenicol, and trimethoprim–sulfamethoxazole) accounted for 65% of isolates tested in Karachi. Resistance to nalidixic acid — a marker of reduced sensitivity to fluoroquinolones — was found in 44 to 57% of isolates tested in Hue, Kolkata, and Karachi. Clearly, as resistance grows, so will the difficulty and cost of treating the disease, and the occurrence of serious sequelae.
Vi vaccine has become increasingly available and inexpensive, as more high-quality producers from developing countries have acquired the technology to produce it. Indian producers have recently offered the vaccine to public-sector programs for $0.50 or less per dose. Moreover, demonstration projects conducted by DOMI in nearly 200,000 persons at the five sites have found community- and school-based immunization with Vi to be feasible and acceptable.
Given this evidence, policymakers in Pakistan and Indonesia plan to introduce targeted typhoid vaccination with Vi vaccine, beginning with school-based pilot projects. However, if typhoid fever is to be controlled globally, the international health community will need to increase the priority and sense of urgency accorded to the control of this disease
Source Information
The NEW ENGLAND JOURNAL of MEDICINE
References
1. Initiative for Vaccine Research. Typhoid fever. (Accessed August 23, 2007, at http://www.who.int/vaccine_research/diseases/diarrhoeal/en/index7.html.)
2. Crump JA, Luby SP, Mintz ED. The global burden of typhoid fever. Bull World Health Organ 2004;82:346-353. [ISI][Medline]
3. GAVI Alliance home page. (Accessed August 23, 2007, at http://www.gavialliance.org.)
4. Acosta CJ, Galindo CM, Deen JL, et al. Vaccines against cholera, typhoid fever and shigellosis for developing countries. Expert Opin Biol Ther 2004;4:1939-1951. [CrossRef][ISI][Medline]
5. Ochiai RL, Wang X, von Seidlein L, et al. Salmonella paratyphi A rates, Asia. Emerg Infect Dis 2005;11:1764-1766. [ISI][Medline]
Pengetahuan Proses Persiapan, Pengolahan dan Penyimpanan Bahan Makanan Yang Sudah Jadi
1. Proses Persiapan
Pada proses produksi yang perlu diperhatikan untuk menjaga keamanan makanan adalah proses persiapan, pada proses persiapan merupakan tahap awal atau titik awal dari proses untuk mendapatkan makanan jadi, untuk itu pada tahap ini perlu sekali dilakukan pengamanan bahan makanan.Pengamanan makanan meliputi pengamanan untuk mempertahankan zat gizi pada makanan dan pengamanan makanan terhadap bahaya patogen, menurut Karen Eich Drummond, 1996 ada beberapa tips untuk mempertahankan zat gizi pada makanan yaitu :
a. Pilihlah bahan makanan yang segar dengan kwalitas yang bagus.
b. Untuk sayuran dan buah pilihlah yang bermutu dilihat dari warna, ukuran dan tekstur.
c. Simpan buah dan sayur pada almari pendingin ( kecuali pisang hijau, kentang, dan jamur) untuk menghambat enzym yang bisa membuat buah dan sayuran kehilangan zat gizi. Enzym sangat aktif pada suhu yang hangat.
d. Jangan menyimpan bahan makanan terlalu lama karena menyebabakan kehilangan zat gizi. Simpan makanan kaleng pada suhu rendah.
e. Ketika menyimpan makanan tutup rapat untuk menurunkan kontak langsung dengan udara.
f. Cuci sayuran secara cepat dan jangan merendam sayur dalam air.
g. Saat memasak kentang atau syuran jangan kupas kulitnya karena sebagian zat gizi akan hilang ketika pengupasan dan pemotongan sayuran. Pada umumnya sebelum memasak adalah cara pengolahan yang bagus untuk mempertahankan zat gizi. Metoda ini cepat dan menggunakan sedikit air atau bahkan tidak menggunakan air sama sekali, pada waktu perebusan sayuran dengan menggunakan air yang banyak dan waktu yang lama akan banyak menghilangkan kandungan zat gizinya.
h. Suhu penggorengan bisa merusak vitamin pada sayuran.
i. Jangan pernah menggunakan baking soda untuk memperbaiki rupa sayuran karena membuat zat gizi pada sayuran hilang.
j. Gunakan kaldu sayuran dan daging untuk pembuatan sop.
k. Persiapan makanan dengan serba tertutup sampai penyajian.
l. Jangan memakai gelas tanpa corak karena cahaya bisa merusak ribovlafin yang terkandung didalamnya. Faktor yang bisa merusak vitamin dan sering merusak warna, aroma dan tekstur makanan.
m. Kupas kulit pada buah-buahan seminim mungkin karena jika seluruh kulit dikupas banyak vitamin dan mineral yang hilang bersama kulit buah, karena vitamin dan mineral banyak tersimpan dibawah kulit buah-buahan.
n. Mengukus cara pengolahan yang bagus untuk memperhatikan zat gizi. Metode ini cepat dan menggunakan sedikit air atau bahkan tidak menggunakan air sama sekali, pada perebusan sayuran dengan menggunakan air banyak dan waktu yang lama akan banyak menghilangkan kandungan zat gizinya .
2. Proses Pengolahan
Pada proses pengolahan hal yang penting yang harus diperhatikan untuk menghindari terjadinya kontaminasi silang adalah penjamah makanan, cara pengolahan makanan, dan tempat pengolahan makanan.
3. Penyimpanan Makanan Jadi
Setelah proses pengolahan selesai sebelum makanan siap dikonsumsi maka disimpan pada tempat tersendiri untuk menghindari terjadinya cemaran. Menurut Kep Menkes No.715/Menkes/SK/V/2003 tentang persyaratan hygiene sanitasi penyimpanan makanan terolah adalah:
a. Penyimpanan makanan terolah sebaiknya tertutup dan disimpan pada suhu ±10ºC.
b. Penyimpanan makanan jadi:
1) Terlindung dari debu, bahan kimia berbahaya, serangga dan hewan.
2) Makanan cepat busuk disimpan dalam suhu panas 65,5ºC atau lebih atau disimpan dalam suhu dingin 4ºC.
Makanan cepat busuk untuk penggunaan dalam waktu lama (lebih dari 6 jam) disimpan dalam suhu -5ºC sampai -1ºC.
4. Penyimpanan Makanan
Kualitas makanan yang telah diolah sangat dipengaruhi oleh suhu, dimana terdapat titik-titik rawan perkembangan bakteri pathogen/pembusukan pada suhu yang sesuai dengan kondisinya. Namun demikian di dalam perkembangan bakteri tersebut masih pula ditentukan oleh jenis makanan yang sesuai dengan kata lain jenis makan yang cocok sebagai media pertumbuhanny. Oleh karena itu mutlak diperlukan suatu metode penyimpanan makanan yang harus mempertimbangkan kesesuaian antara suhu penyimpanan dengan jenis makanan yang akan disimpan.
Prinsip dari tehnik penyimpanan makanan terutama ditujukan kepada:
a. Mencegah pertumbuhan dan perkembangan bakteri latent.
b. Mengawetkan makanan dan mengurangi pembusukan.
Hal-hal lain yang perlu diperhatikan dalam penyimpanan makanan adalah:
a. Makanan yang disimpan diberi tutup terutama makanan kaleng, yang telah dibuka atau hasil olahan dari dapur (cooking food).
b. Lantai/meja yang digunakan untuk menyimpan makanan sebelumnya harus dibersihkan.
c. Makanan tidak boleh disimpan dekat dengan saluran air limbah (selokan).
d. Makanan yang disajikan sebelum diolah (timun, tomat) harus dicuci dengan air hangat lebih dahulu.
e. Makanan yang dipak dengan karton jangan disimpan dekat air atau tempat yang basah.
Teknik penyimpanan makanan didasarkan pada pengaturan suhu, dibedakan:
a. Penyimpanan Dingin (Refrigerated Storage)
Dalam pendinginan makanan, kemungkinan pertambahan bakteri tidak terjadi. Makanan yang dingin harus disimpan pada alat pendingin pada suhu 0ºF (-17,8°C)
Pada suhu antara 0-7,2ºC kadang-kadang bakteri pembusukan bakteri psikopilik dapat bertambah. Meskipun bakteri-bakteri tersebut tidak pathogen namun dapat mengurangi kualitas. Bakteri yang patogen dapat tahan pada tempat penyimpanan dingin.
Faktor-faktor yang mempengaruhi dalam penyimpanan dingin untuk makanan olahan.
1) Suhu
Berdasarkan klasifikasi dari F.G. Winanrno digolongkan menjadi 3 yaitu
a) Penyimpanan sejuk
(1) antara 15-25ºC
(2) untuk minuman keras, umbi-umbian, sayuran
b) Pendinginan
(1) pada suhu < 5,6ºC.
(2) Dapat menghambat pertumbuhan mikroba-psikrofilik dan mencegah pertumbuhan mikroba patogen.
(3) Botulinium tipe E dapat memproduksi racun pada suhu 3,3ºC.
c) Penyimpanan beku
Dengan penyelupan bahan kedalam refrigerant.
Kontak langsung dengan refrigerant.
Dengan menggunakan udara dingin (-17,8º sampai -34,4ºC)
2) Kelembaban
Kelembaban relatif dari alat pendingi akan berpengaruh pada perubahan bentuk makanan yang disimpan terutam perubahan moisture dan wujud. Ruangan pendinginan memerlukan kondisi kelembaban yang besar dapat menyebabkan bahan berkeringat dan terjadinya pertumbuhan jamur.
Pengaruh suhu penyimpanan pada kelembaban maksimum yang didasarkan untuk pendinginan daging adalah:
Suhu penyimpanan (0ºC) RH(%)
4 75
2 88
0 92
b. Penyimpanan panas (Hot Storage)
1) Fasilitas alat penyimpanan makanan panas harus ditempatkan pada rungan yang nyaman sehingga menjamin ketepatan suhu penyimpanan.
2) Makanan yang disimpan tidak boleh mencapai suhu kritis (danger zone) 140ºF (60ºC), karena pada suhu tersebut memungkinkan pertumbuhan bakteri pengganggu.
Daftar Pustaka
Almatsier, Sunita (2004). Penuntun Diet di Instalasi gizi perjan RS Dr. Cipto mangunkusumo dan ASDI. Jakarta : Gramedia
Auliana,Rizqie (2001). Gizi dan Pengolahan Pangan. Yogyakarta : Adicita
Budiyanto, Moch. Agus Krisno (2002). Dasar-dasar Ilmu Gizi. Malang :UMM
Halami, Sri (2007). Skripsi : Hubungan Kebersihan Penjamah Dan Peralatan Pengolahan dengan Kandungan Bakteri Pada Makanan Hasil Olahan Jasa Boga Bojanasari Di Sanan Kulon Kab . Blitar. Kediri : STIKes SMH
KepMenKes RI (2003). Persyaratan Hygiene Sanitasi Rumah Makan dan Restoran. Http : /www.depkes.go.id
Khomson A.(2000). Pangan dan Gizi untuk Kesehatan. Jakarta : Rajagrafindo
Kus Irianto dan Kusno Waluyo, 2004. Gizi dan Pola Hidup Sehat.Bandung : Yrama Widya
Sudigdo Sastroasmoro dan Sofyan Ismail(1995). Dasar-Dasar Metodologi Penelitian Klinis. Jakarta : UI
Soenardi, Tuti ( 2005). Meningkatkan Mutu Makanan Rumah Sakit (Kuliner) ASDI cabang Bandung. Bandung
Tasyana, Estin(2006). Skripsi : Pengaruh Pengetahuan, Sikap Higieni Personal Terhadap Mutu Makanan. Malang : Unibraw
Tomy Suprapto dan Fahrianoor. (2004). Komunikasi Penyuluhan Dalam Teori dan Praktek. Yogyakarta : Arti Bumi Intaran
Pada proses produksi yang perlu diperhatikan untuk menjaga keamanan makanan adalah proses persiapan, pada proses persiapan merupakan tahap awal atau titik awal dari proses untuk mendapatkan makanan jadi, untuk itu pada tahap ini perlu sekali dilakukan pengamanan bahan makanan.Pengamanan makanan meliputi pengamanan untuk mempertahankan zat gizi pada makanan dan pengamanan makanan terhadap bahaya patogen, menurut Karen Eich Drummond, 1996 ada beberapa tips untuk mempertahankan zat gizi pada makanan yaitu :
a. Pilihlah bahan makanan yang segar dengan kwalitas yang bagus.
b. Untuk sayuran dan buah pilihlah yang bermutu dilihat dari warna, ukuran dan tekstur.
c. Simpan buah dan sayur pada almari pendingin ( kecuali pisang hijau, kentang, dan jamur) untuk menghambat enzym yang bisa membuat buah dan sayuran kehilangan zat gizi. Enzym sangat aktif pada suhu yang hangat.
d. Jangan menyimpan bahan makanan terlalu lama karena menyebabakan kehilangan zat gizi. Simpan makanan kaleng pada suhu rendah.
e. Ketika menyimpan makanan tutup rapat untuk menurunkan kontak langsung dengan udara.
f. Cuci sayuran secara cepat dan jangan merendam sayur dalam air.
g. Saat memasak kentang atau syuran jangan kupas kulitnya karena sebagian zat gizi akan hilang ketika pengupasan dan pemotongan sayuran. Pada umumnya sebelum memasak adalah cara pengolahan yang bagus untuk mempertahankan zat gizi. Metoda ini cepat dan menggunakan sedikit air atau bahkan tidak menggunakan air sama sekali, pada waktu perebusan sayuran dengan menggunakan air yang banyak dan waktu yang lama akan banyak menghilangkan kandungan zat gizinya.
h. Suhu penggorengan bisa merusak vitamin pada sayuran.
i. Jangan pernah menggunakan baking soda untuk memperbaiki rupa sayuran karena membuat zat gizi pada sayuran hilang.
j. Gunakan kaldu sayuran dan daging untuk pembuatan sop.
k. Persiapan makanan dengan serba tertutup sampai penyajian.
l. Jangan memakai gelas tanpa corak karena cahaya bisa merusak ribovlafin yang terkandung didalamnya. Faktor yang bisa merusak vitamin dan sering merusak warna, aroma dan tekstur makanan.
m. Kupas kulit pada buah-buahan seminim mungkin karena jika seluruh kulit dikupas banyak vitamin dan mineral yang hilang bersama kulit buah, karena vitamin dan mineral banyak tersimpan dibawah kulit buah-buahan.
n. Mengukus cara pengolahan yang bagus untuk memperhatikan zat gizi. Metode ini cepat dan menggunakan sedikit air atau bahkan tidak menggunakan air sama sekali, pada perebusan sayuran dengan menggunakan air banyak dan waktu yang lama akan banyak menghilangkan kandungan zat gizinya .
2. Proses Pengolahan
Pada proses pengolahan hal yang penting yang harus diperhatikan untuk menghindari terjadinya kontaminasi silang adalah penjamah makanan, cara pengolahan makanan, dan tempat pengolahan makanan.
3. Penyimpanan Makanan Jadi
Setelah proses pengolahan selesai sebelum makanan siap dikonsumsi maka disimpan pada tempat tersendiri untuk menghindari terjadinya cemaran. Menurut Kep Menkes No.715/Menkes/SK/V/2003 tentang persyaratan hygiene sanitasi penyimpanan makanan terolah adalah:
a. Penyimpanan makanan terolah sebaiknya tertutup dan disimpan pada suhu ±10ºC.
b. Penyimpanan makanan jadi:
1) Terlindung dari debu, bahan kimia berbahaya, serangga dan hewan.
2) Makanan cepat busuk disimpan dalam suhu panas 65,5ºC atau lebih atau disimpan dalam suhu dingin 4ºC.
Makanan cepat busuk untuk penggunaan dalam waktu lama (lebih dari 6 jam) disimpan dalam suhu -5ºC sampai -1ºC.
4. Penyimpanan Makanan
Kualitas makanan yang telah diolah sangat dipengaruhi oleh suhu, dimana terdapat titik-titik rawan perkembangan bakteri pathogen/pembusukan pada suhu yang sesuai dengan kondisinya. Namun demikian di dalam perkembangan bakteri tersebut masih pula ditentukan oleh jenis makanan yang sesuai dengan kata lain jenis makan yang cocok sebagai media pertumbuhanny. Oleh karena itu mutlak diperlukan suatu metode penyimpanan makanan yang harus mempertimbangkan kesesuaian antara suhu penyimpanan dengan jenis makanan yang akan disimpan.
Prinsip dari tehnik penyimpanan makanan terutama ditujukan kepada:
a. Mencegah pertumbuhan dan perkembangan bakteri latent.
b. Mengawetkan makanan dan mengurangi pembusukan.
Hal-hal lain yang perlu diperhatikan dalam penyimpanan makanan adalah:
a. Makanan yang disimpan diberi tutup terutama makanan kaleng, yang telah dibuka atau hasil olahan dari dapur (cooking food).
b. Lantai/meja yang digunakan untuk menyimpan makanan sebelumnya harus dibersihkan.
c. Makanan tidak boleh disimpan dekat dengan saluran air limbah (selokan).
d. Makanan yang disajikan sebelum diolah (timun, tomat) harus dicuci dengan air hangat lebih dahulu.
e. Makanan yang dipak dengan karton jangan disimpan dekat air atau tempat yang basah.
Teknik penyimpanan makanan didasarkan pada pengaturan suhu, dibedakan:
a. Penyimpanan Dingin (Refrigerated Storage)
Dalam pendinginan makanan, kemungkinan pertambahan bakteri tidak terjadi. Makanan yang dingin harus disimpan pada alat pendingin pada suhu 0ºF (-17,8°C)
Pada suhu antara 0-7,2ºC kadang-kadang bakteri pembusukan bakteri psikopilik dapat bertambah. Meskipun bakteri-bakteri tersebut tidak pathogen namun dapat mengurangi kualitas. Bakteri yang patogen dapat tahan pada tempat penyimpanan dingin.
Faktor-faktor yang mempengaruhi dalam penyimpanan dingin untuk makanan olahan.
1) Suhu
Berdasarkan klasifikasi dari F.G. Winanrno digolongkan menjadi 3 yaitu
a) Penyimpanan sejuk
(1) antara 15-25ºC
(2) untuk minuman keras, umbi-umbian, sayuran
b) Pendinginan
(1) pada suhu < 5,6ºC.
(2) Dapat menghambat pertumbuhan mikroba-psikrofilik dan mencegah pertumbuhan mikroba patogen.
(3) Botulinium tipe E dapat memproduksi racun pada suhu 3,3ºC.
c) Penyimpanan beku
Dengan penyelupan bahan kedalam refrigerant.
Kontak langsung dengan refrigerant.
Dengan menggunakan udara dingin (-17,8º sampai -34,4ºC)
2) Kelembaban
Kelembaban relatif dari alat pendingi akan berpengaruh pada perubahan bentuk makanan yang disimpan terutam perubahan moisture dan wujud. Ruangan pendinginan memerlukan kondisi kelembaban yang besar dapat menyebabkan bahan berkeringat dan terjadinya pertumbuhan jamur.
Pengaruh suhu penyimpanan pada kelembaban maksimum yang didasarkan untuk pendinginan daging adalah:
Suhu penyimpanan (0ºC) RH(%)
4 75
2 88
0 92
b. Penyimpanan panas (Hot Storage)
1) Fasilitas alat penyimpanan makanan panas harus ditempatkan pada rungan yang nyaman sehingga menjamin ketepatan suhu penyimpanan.
2) Makanan yang disimpan tidak boleh mencapai suhu kritis (danger zone) 140ºF (60ºC), karena pada suhu tersebut memungkinkan pertumbuhan bakteri pengganggu.
Daftar Pustaka
Almatsier, Sunita (2004). Penuntun Diet di Instalasi gizi perjan RS Dr. Cipto mangunkusumo dan ASDI. Jakarta : Gramedia
Auliana,Rizqie (2001). Gizi dan Pengolahan Pangan. Yogyakarta : Adicita
Budiyanto, Moch. Agus Krisno (2002). Dasar-dasar Ilmu Gizi. Malang :UMM
Halami, Sri (2007). Skripsi : Hubungan Kebersihan Penjamah Dan Peralatan Pengolahan dengan Kandungan Bakteri Pada Makanan Hasil Olahan Jasa Boga Bojanasari Di Sanan Kulon Kab . Blitar. Kediri : STIKes SMH
KepMenKes RI (2003). Persyaratan Hygiene Sanitasi Rumah Makan dan Restoran. Http : /www.depkes.go.id
Khomson A.(2000). Pangan dan Gizi untuk Kesehatan. Jakarta : Rajagrafindo
Kus Irianto dan Kusno Waluyo, 2004. Gizi dan Pola Hidup Sehat.Bandung : Yrama Widya
Sudigdo Sastroasmoro dan Sofyan Ismail(1995). Dasar-Dasar Metodologi Penelitian Klinis. Jakarta : UI
Soenardi, Tuti ( 2005). Meningkatkan Mutu Makanan Rumah Sakit (Kuliner) ASDI cabang Bandung. Bandung
Tasyana, Estin(2006). Skripsi : Pengaruh Pengetahuan, Sikap Higieni Personal Terhadap Mutu Makanan. Malang : Unibraw
Tomy Suprapto dan Fahrianoor. (2004). Komunikasi Penyuluhan Dalam Teori dan Praktek. Yogyakarta : Arti Bumi Intaran
Demam Berdarah Dengue
Oleh : Hendra Arif Wibowo
1. Pengertian
Penyakit Demam Berdarah Dengue (DBD) merupakan salah satu penyakit akut yang ditandai dengan panas mendadak selama 2-7 hari tanpa sebab yang jelas disertai dengan manifestasi perdarahan dan kadang–kadang disertai dengan berak darah, muntah darah, kesadaran menurun atau rejatan (syok). (Ditjen PPM dan PLP, 1996 :21). Menurut Satari (2004), Demam Berdarah Dengue merupakan penyakit infeksi yang berakibat fatal. Sedangkan menurut Hiswani (2003), penyakit demam berdarah dengue adalah penyakit infeksi virus, terutama menyerang pada anak-anak dengan ciri-ciri demam tinggi mendadak dengan manifestasi pendarahan dan bertendensi menimbulkan shock yang menyebabkan kematian.
2. Penyebab infeksi
Penyebab penyakit ini adalah virus dengue, virus ini termasuk kelompok arthopode borne virus, famili Togaviridae dan termasuk genus Flavivirus dengue. Terbagi empat macam / serotipe yaitu:
a. Dengue 1 (DEN – 1), diisolasi oleh Sabin pada tahun 1944.
b. Dengue 2 (DEN – 2), diisolasi oleh Sabin pada tahun 1944.
c. Dengue 3 (DEN – 3), diisolasi oleh Sather.
d. Dengue 4 (DEN – 4), diisolasi oleh Sather. (Hiswani.2003).
Akibat infeksi virus dengue dapat menimbulkan bermacam-macam gejala seperti di bawah ini:
a. Asymtomatis.
b. Mild Undifferentiated Febrile Illnes.
c. Dengue Fever ( demam dengue ).
d. Dengue haemorrhagic Fever ( DHF-DBD ).
e. Dengue Shock Syndrome ( DSS ). (Hiswani.2003).
Virus DEN termasuk dalam kelompok virus yang relatif labil terhadap suhu dan faktor kimia lain serta masa viremia yang pendek, sehingga keberhasilan dan identifikasi virus sangat bergantung kepada kecepatan dan ketepatan pengambilan. Virus DEN virionnya tersusun oleh suatu untaian genom RNA dikelilingi oleh nukleokapsid, ditutupi oleh suatu envelope (selubung) dari lipid yang mengandung 2 protein, yaitu selubung protein (E) dan protein membran (M).(Soegijanto, 2004).
3. Tanda dan Gejala Klinik
Untuk mendignosa penyakit DBD ini dipakai patokan kriteria klinik WHO (1999) sebagai berikut:
a. Demam mendadak tanpa penyebab yang jelas serta disertai penurunan aktifitas dan nafsu makan.
b. Timbul perdarahan baik di gigi, mulut, hidung, kulit, atau tinja.
c. Demam yang disertai kemerahan di wajah dan leher serta muntah.
d. Tiba-tiba terjadi penurunan suhu tubuh setelah beberapa waktu penderita mengalami demam. Gejala ini diiringi dengan rasa gelisah, sakit perut, dan badan lemas.
Kriteria untuk diagnosis laboratorium, satu atau lebih dari hal-hal berikut :
a. Isolasi virus dengue dari serum, plasma, leukosit ataupun otopsi
b. Ditemukannya anti bodi IgG ataupun AgM yang meningkatkan titernya mencapai empat kali lipat terhadap satu atau lebih antigen dengue dalam spesimen serta berpadangan.
c. Dibuktikan adanya virus dengue dari jaringan otopsi dengan cara immunokimiawi atau dengan cara immuno-flouresens, ataupun di dalam spesimen serum dengan uji ELISA
d. Dibuktikan dengan keberadaan gambaran genomic sekuen virus dari jaringan otopsi, sediaan serum atau cairan serbro spinal (CSS), dengan uji Polymerase Chain Reaction (PCR). (Anonim, 2007)
Kewaspadaan menegakkan diagnosis dini penyakit ini sangat penting oleh karena:
a. Satu dari tiga penderita Demam Berdarah Dengue akan jatuh ke dalam renjatan.
b. Angka kematian yang tinggi sekitar 30 %, diakibatkan renjatan,merupakan gambaran yang menakutkan dan memerlukan penatalaksanaan secara khusus.
c. Penderita yang jatuh ke dalam renjatan pada waktu sedang dirawat, mempunyai prognosis yang lebih baik. (Pasaribu, 1992)
4. Derajat Penyakit
Pembagian derajat DBD menurut WHO (1999)
a. Derajat I
Demam disertai dengan gejala konstitusional non-spesifik; satu-satunya manifestasi perdarahan adalah tes tourniket dan/atau mudah memar.
b. Derajat II
Perdarahan spontan selain manifestasi pasien pada derajat I, biasanya pada bentuk perdarahan kulit atau perdarahan lain.
c. Derajat III
Gagal sirkulasi dimanifestasikan dengan nadi cepat dan lemah, serta penyempitan tekanan nadi atau hipotensi dengan adanya kulit dingin dan lembab serta gelisah.
d. Derajat IV
Syok hebat dengan tekanan darah atau nadi tidak terdeteksi.
5. Patofisiologi
Patofisiologi primer DBD dan DSS adalah peningkatan akut permeabilitas vaskuler yang mengarah ke kebocoran plasma ke dalam ruangan ekstravaskuler, sehingga menimbulkan hemokosentrasi dan penurunan tekanan darah. Volume plasma turun lebih dari 20% pada kasus-kasus berat, hal ini didukung penemuan post-mortem meliputi efusi serosa, efusi pleura, hemokonsentrasi dan hipoproteinemi.
Tidak terjadi lesi destruksi nyata pada vaskuler, menunjukkan bahwa perubahan sementara fungsi vaskuler diakibatkan suatu mediator kerja singkat. Jika penderita sudah stabil dan mulai sembuh, cairan ekstravasasi diabsorbsi dengan cepat, menimbulkan penurunan hematokrit. Perubahan hematokrit pada DBD dan DSS melibatkan 3 faktor yaitu perubahan vaskuler, trombositopeni, dan kelainan koagulasi. Hampir semua penderita DBD mengalami peningkatan fragilitas vaskuler dan trombositopeni, dan banyak di antara penderita menunjukkan kuagulogram yang abnormal. .( Soegijanto, 2004)
6. Patogenesis
Virus dengue masuk ke dalam tubuh manusia lewat gigitan nyamuk Aedes aegypti atau Aedes albopictus. Organ sasaran dari virus ini adalah organ hepar, nodus limfaticus, sumsum tulang serta paru-paru. Data dari penelitian menunjukkan bahwa sel-sel monosit dan makrofag mempunyai peranan besar pada infeksi ini. Dalam peredaran darah, virus tersebut akan difagosit oleh sel monosit perifer. ( Soegijanto, 2004)
Virus DEN mampu bertahan hidup dan mengadakan multifikasi di dalam sel tersebut. Infeksi virus dengue dimulai dengan menempelnya virus genomnya masuk ke dalam sel dengan bantuan organel-organel sel, genom virus membentuk komponen-komponennya, baik komponen antara maupun komponen struktural virus. Setelah komponen strukutral dirakit, virus dilepaskan dari dalam sel. Proses perkembangbiakan virus DEN terjadi di sitoplasma sel. ( Soegijanto, 2004)
Semua Flavivirus memiliki kelompok epitop pada selubung protein yang menimbulkan cross reaction atau reaksi silang pada uji serologis, hal ini menyebabkan diagnosi pasti dengan uji serologi sulit ditegakkan. Kesulitan ini dapat terjadi di antara keempat serotipe virus DEN. Infeksi oleh satu serotipe DEN menimbulkan imunitas protektif terhadap serotipe virus tersebut, tetapi tidak ada cross protektif terhadap serotipe virus yang lain.( Soegijanto, 2004)
7. Penularan Penyakit DBD
Penularan DBD terjadi melalui gigitan nyamuk Aedes aegypti atau Aedes albopictus betina yang sebelumnya telah membawa virus dalam tubuhnya dari penderita demam berdarah lain. Nyamuk Aedes aegypti berasal dari Brasil dan Ethiopia dan sering menggigit manusia pada waktu pagi dan siang. Nyamuk penular DBD ini terdapat hampir di seluruh pelosok Indonesia, kecuali di tempat-tempat dengan ketinggian lebih dari 1000 meter di atas permukaan laut. (Depkes RI, 2005)
Penyakit demam berdarah biasanya menyerang anak-anak, tapi sekarang tidak lagi mengenal golongan usia, semua golongan umur bisa mengalaminya, terutama anak usia muda. Sebab, nyamuk aedes aegypti biasa menyerang anak-anak sekolah dan perkantoran. (Banjarmasin Pos, 2007). Penyakit DBD sering terjadi di daerah tropis, dan muncul pada musim penghujan. Virus ini muncul akibat pengaruh musim / alam serta perilaku manusia.(Depkes RI, 2004).
8. Masa Penularan Penyakit DBD
Masa penularan penyakit DBD biasanya terjadi disekitar musim hujan. Namun masing-masing daerah pola musiman ini berbeda-beda, bahkan untuk wilayah yang sama musim penularan dapat berbeda dari tahun ke tahun. Kadang-kadang pada awal atau akhir musim hujan, atau kadang-kadang sesudah musim hujan. Yang jelas penyakit ini dapat datang sewaktu-waktu. Oleh karena itu masyarakat harus selalu waspada terhadap tanda-tanda penyakit demam berdarah.
Pada hari-hari pertama sakit, tanda-tanda penyakit demam berdarah sangat sulit dibedakan dengan influenza atau penyakit infeksi virus lain. Sering kali hanya ada demam atau panas saja yang timbul secara mendadak, badan lemah, lesu, kadang-kadang ada bintik-bintik merah diikuti seperti bekas gigitan nyamuk. Untuk membedakan dapat dilakukan dengan cara merenggangkan kulit disekitar bintik merah itu. Jika bintik merah tidak hilang dengan perenggangan kulit ini, hal ini merupakan salah satu tanda penyakit demam berdarah.
Sebagian besar penderita akan sembuh tanpa obat-obat khusus. Tetapi pada sebagian penderita, bisa bertambah parah yaitu jika terjadi pendarahan di semua jaringan tubuh. Pendarahan ini bisa tampak dari luar berupa pendarahan dari mulut, hidung, atau bahkan muntah darah dan berak darah. Tetapi kadang-kadang pendarahan ini tidak tampak, yaitu bila pendarahannya terjadi pada alat-alat dalam tubuh seperti otak, limpa dan ginjal. Proses menjadi parah ini berlangsung cepat, bisa dalam beberapa jam atau beberapa hari. Kemudian bisa menimbulkan shock dan kematian. Keadaan kritis ini biasanya terjadi pada hari ke 3 atau hari ke 5 sakit, atau bisa lebih awal.
Sayangnya sampai saat ini belum ditemukan cara pemeriksaan yang bisa meramalkan penderita-penderita mana yang akan menjadi parah. Oleh karena itu pada dasarnya semua penderita penyakit demam berdarah dengue perlu dirawat inap, agar dapat diobservasi dan pemeriksaan laboratorium secara teratur, dengan maksud bila terjadi keadaan memburuk dapat segera diberikan tindakan pertolongan yang diperlukan. Karena sifatnya yang akut inilah, maka jika terdapat tanda-tanda penyakit demam berdarah, masyarakat diharapkan untuk memeriksakan kepada dokter, rumah sakit atau puskesmas.
(Hiswani, 2003).
9. Tempat Potensial bagi Penularan DBD
Penularan DBD dapat terjadi di semua tempat yang terdapat nyamuk penularnya. Berdasarkan teori infeksi sekunder, seseorang dapat terserang jika mendapat infeksi ulangan dengan virus dengue tipe yang berlainan dengan infeksi sebelumnya, misalnya infeksi pertama dengan virus Dengue-1, infeksi kedua dengan Dengue-2. Infeksi dengan salah satu tipe virus dengue saja, paling berat hanya akan menimbulkan demam dengue (DD).
Oleh karena itu tempat yang potensial untuk terjadinya penularan DBD adalah :
a. Wilayah yang banyak kasus DBD (endemis).
b. Tempat-tempat umum merupakan tempat “berkumpulnya” orang-orang yang datang dari berbagai wilayah, sehingga kemungkinan terjadinya pertukaran beberapa tipe virus dengue cukup besar. Tempat-tempat tersebut antara lain :
1) Sekolah
a) Anak / murid sekolah berasal dari berbagai wilayah.
b) Merupakan kelompok umur yang paling susceptible terserang DBD.
2) Rumah sakit / Puskesmas dan sarana pelayanan kesehatan yang lainnya. Orang datang dari berbagai wilayah dan kemungkinan diantaranya adalah penderita DBD, DD atau carier virus dengue.
3) Tempat umum lainnya, seperti : hotel, pertokoan, pasar, restoran, dan tempat ibadah.
c. Pemukiman baru di pinggir kota
Karena di lokasi ini penduduknya berasal dari berbagai wilayah, maka kemungkinan diantaranya terdapat penderita atau carier yang membawa virus dengue yang berlainan dari masing – masing lokasi asal.
(Depkes RI, 2005)
10. Mekanisme Penularan Virus Dengue
Seseorang yang di dalam darahnya mengandung virus dengue merupakan sumber penular demam berdarah dengue (DBD). Virus dengue berada dalam darah selama 4-7 hari mulai 1-2 hari sebelum demam.
Bila penderita DBD digigit nyamuk penular, maka virus dalam darah akan ikut terisap ke dalam lambung nyamuk, selanjutnya virus akan memperbanyak diri dan tersebar di berbagai jaringan tubuh nyamuk termasuk di dalam kelenjar liurnya. Kira-kira 1 (satu) minggu setelah menghisap darah penderita, nyamuk tersebut siap untuk menularkan kepada orang lain (masa inkubasi ekstrinsik). Virus ini akan tetap berada dalam tubuh nyamuk sepanjang hidupnya. Oleh karena itu nyamuk Aedes aegypti yang telah menghisap virus dengue menjadi penular (infektif) sepanjang hidupnya. Penularan ini terjadi karena setiap kali nyamuk menusuk (menggigit), sebelum menghisap darah akan mengeluarkan air liur melalui saluran alat tusuknya (proboscis), agar darah yang diisap tidak membeku. Bersama air liur inilah virus dengue dipindahkan nyamuk dari nyamuk ke orang lain. (Depkes RI, 2005).
11. Akibat Penularan Virus Dengue
a. Orang yang terinfeksi virus dengue, maka dalam tubuhnya akan terbentuk zat anti (riteria) yang spesifik sesuai dengan tipe virus dengue yang masuk. Gejala dan tanda yang timbul ditentukan oleh reaksi antara zat anti yang ada dalam tubuh dengan antigen yang ada dalam virus dengue yang baru masuk.
b. Orang yang terinfeksi virus dengue untuk pertama kali, umumnya hanya menderita demam dengue (DD) atau demam yang ringan dengan gejala dan tanda yang tidak spesifik atau bahkan tidak memperlihatkan tanda-tanda sakit sama sekali (asimptomatis). Penderita DD biasanya akan sembuh sendiri dalam waktu 5 hari pengobatan.(Depkes RI, 2005).
12. Penyebaran Penyakit DBD
Seperti diketahui bahwa penyakit DBD disebabkan oleh virus dengue. Dewasa ini dikenal 4 type virus dengue di Indonesia, yaitu virus dengue type 1, 2, 3, dan 4. Menurut teori infeksi sekunder, seseorang yang hanya terkena infeksi satu macam virus dengue saja tidak akan jatuh sakit, kecuali hanya merasa demam ringan. Namun bila orang tersebut terinfeksi oleh 2 macam virus dengue, barulah yang bersangkutan akan menderita sakit DBD.
Penyebaran berbagai tipe virus dengue ini dari suatu wilayah ke wilayah lain dibawa oleh orang-orang yang terinfeksi virus dengue yang berpindah tempat dari suatu tempat ke tempat yang lain. Ditempat yang baru melalui gigitan nyamuk penular DBD seperti Aedes aegypti dan Aedes albopictus menyebarkannya kepada orang lain disekitarnya. Penyebaran virus akan mudah terjadi di daerah yang padat penduduknya.
Dari data yang ada dewasa ini subdit arbovirosis Ditjen PPM-PLP, diketahui bahwa dari 301 Dati II yang ada di Indonesia , 255 buah Dati II telah terjangkit DBD . Ini artinya menunjukkan bahwa 84,7 % Dati II diseluruh Indonesia telah diramba virus dengue dan cepat atau lambat , sisa Dati II yang belum terjamah virus DBD pasti akan terjamah juga karena tidak ada manusia yang kebal virus DBD.(Hiswani, 2003).
13. Sejarah Perkembangan Demam Berdarah Dengue di Indonesia.
Di Indonesia penyakit demam berdarah dengue mulai dikenal pada tahun1968. Sejak awal masuknya penyakit ini di Indonesia hingga tahun 1974 upaya pemberantasan belum diprogramkan dan upaya pemberantasannya dimasukkan dalam program pemberantasan penyakit lain-lain. Kegiatan pokok pemberantasannya meliputi penemuan kasus, pengobatan penderita serta penyemprotan dilokasi kasus DBD..
Mulai tahun 1974 s/d 1980 dibentuk subdit Arbovirosis pada Direktorat Jenderal PPM-PLP dan kegiatan pemberantasannya mulai diprogramkan yang meliputi: pengamatan, pengobatan penderita. Demikian pula dengan yang menangani pemberantasan penyakit DBD Dati-I dan Dati-II. Pada tahun 1980 s/d 1985 program kegiatan DBD dikembangkan dengan melaksanakan abatisasi massal bagi kota-kota dengan endemisitas DBD tinggi yang meliputi seluruh wilayah Indonesia. Abatisasi massal telah dipertajam sasarannya sejak tahun1985 s/d 1989, melalui stratifikasi desa endemis dan non-endemis. Di desa abatisasi terhadap tempat-tempat penampungan air yang ditemukan jentik nyamuk Aedes aegypti.
Tahun 1992 sampai dengan sekarang, stratifikasi desa disempurnakan manjadi 3 strata yaitu: endemis, sporadis dan potensial/bebas. Tugas dan fungsi subdit Arbovirosis semakin jelas dengan terbitnya SK Menkes No. 581 tahun 1992 yang menetapkan bahwa upaya pemberantasan DBD dilakukan melalui kegiatan pencegahan, penemuan, pelaporan penderita, pengamatan penyakit dan penyelidikan epidemiologi, penanggulangan seperlunya dan penyuluhan kepada masyarakat.(Hiswani, 2003).
14. Taksonomi Nyamuk Aedes aegypti
Nyamuk Aedes aegypti L. (Diptera : Culicidae) disebut black-white mosquito, karena tubuhnya ditandai dengan pita atau garis-garis putih keperakan diatas dasar hitam. Di Indonesia nyamuk ini sering disebut sebagai salah satu dari nyamuk-nyamuk rumah. .( Soegijanto, 2004).
Menurut Richard dan Davis (1977) dalam Soegijanto(2004), kedudukan nyamuk Ae. Aegypti dalam klasifikasi hewan adalah sebagai berikut :
Filum : Arthropoda
Kelas : Insecta
Bangsa : Diptera
Suku : Culicidae
Marga : Aedes
Jenis :Aedes aegypti L
15. Ciri-Ciri Nyamuk Ae. Aegypti
a. Badan kecil, warna hitam dengan bintik-bintik putih
b. Pertumbuhan telur sampai dewasa ± 10 hari
c. Menggigit/menghisap darah pada siang hari
d. Senang hinggap pada pakaian yang bergantungan dalam kamar
e. Bersarang dan bertelur di genangan air jernih di dalam dan di sekitar rumah yang agak gelap dan lembab, bukan di got/comberan
f. Hidup di dalam dan di sekitar rumah
g. Di dalam rumah: bak mandi, tampayan, vas bungan, tempat minum burung, perangkap semut dan lain-lain.
h. Di luar rumah: drum, tangki penampungan air, kaleng bekas, ban bekas, botol pecah, potongan bambu, tempurung kelapa, dan lain-lain. (Chemika, 2004)
16. Masa Pertumbuhan dan Perkembangan Nyamuk Ae. Aegypti
Menurut Soegijanto (2004), masa pertumbuhan dan perkembangan nyamuk Aedes aegypti dapat dibagi menjadi 4 tahap, yaitu telur, larva, pupa, dan dewasa, sehingga termasuk metamorfosis sempurna (holometabola).
a. Telur
Telur nyamuk Ae. Aegypti berbentuk ellips atau oval memanjang, warna hitam, ukuran 0,5-0,8 mm, permukaan poligonal, tidak memiliki alat pelampung, dan diletakkan satu per satu pada benda-benda yang terapung atau pada dinding bagian dalam tempat penampungan air (TPA) yang berbatasan langsung dengan permukaan air. Dilaporkan bahwa dari telur yang dilepas, sebanyak 85 % melekat di dinding TPA, sedangkan 15 % lainnya jatuh ke permukaan air.
b. Larva
Larva nyamuk Ae. Aegypti tubuhnya memanjang tanpa kaki dengan bulu-bulu sederhana yang tersusun bilateral simetris. Larva ini dalam pertumbuhan dan perkembangannya mengalami 4 kali pergantian kulit (ecdysis), dan larva yang terbentuk berturut-turut disebut larva instar I, II, III, dan IV. Larva instar I, tubuhnya sangat kecil, warna transparan, panjang 1-2 mm, duri-duri (spinae) pada dada (thorax) belum begitu jelas, dan corong pernapasan (siphon) belum menghitam. Larva instar II bertambah besar, ukuran 2,5-3,9 mm, duri dada belum jelas, dan corong pernapasan sudah berwarna hitam. Larva instar IV telah lengkap struktur anatominya dan jelas tubuh dapat dibagi menjadi bagian kepala (chepal), dada (thorax), dan perut (abdomen).
Pada bagian kepala terdapat sepasang mata majemuk, sepasang antenna tanpa duri-duri, dan alat-alat mulut tipe pengunyah (chewing). Bagian dada tampak paling besar dan terdapat bulu-bulu yang simetris. Perut tersusun atas 8 ruas. Ruas perut ke-8, ada alat untuk bernapas yang disebut corong pernapasan. Corong pernapasan tanpa duri-duri, berwarna hitam, dan ada seberkas bulu-bulu(tuft). Ruas ke-8 juga dilengkapi dengan seberkas bulu-bulu sikat (brush) di bagian ventral dan gigi-gigi sisir (comb) yang berjumlah 15-19 gigi yang tersusun dalam 1 baris. Gigi-gigi sisir dengan lekukan yang jelas membentuk gerigi. Larva ini tubuhnya langsing dan bergerak sangat lincah, bersifat fototaksis negatif, dan waktu istirahat membentuk sudut hampir tegak lurus dengan bidang permukaan air.
c. Pupa
Pupa nyamuk Ae. Aegypti bentuk tubuhnya bengkok, dengan bagian kepala-dada (cephalotorax) lebih besar bila dibandingkan dengan bagian perutnya, sehingga tampak seperti tanda baca “koma”. Pada bagian punggung (dorsal) dada terdapat alat bernafas seperti terompet. Pada ruas perut ke-8 terdapat sepasang alat pengunyah yang berguna untuk berenang,. Alat pengayuh tersebut berjumbai panjang dan bulu di nomer 7 pada ruas perut ke-8 tidak bercabang. Pupa adalah bentuk tidak makan, tampak gerakannya lebih lincah bila dibandingkan dengan larva. Waktu istirahat posisi pupa sejajar dengan bidang permukaan air.
d. Dewasa
Nyamuk Ae. Aegypti tubuhnya tersusun dari tiga bagian, yaitu kepala, dada dan perut. Pada bagian kepala terdapat sepasang mata majemuk dan antenna yang berbulu. Alat mulut nyamuk betina tipe penusuk-pengisap (piercing-sucking) dan termasuk lebih menyukai manusia (anthropophagus), sedangkan nyamuk jantan bagian mulut lebih lemah sehingga tidak mampu menembus kulit manusia, karena itu tergolong lebih menyukai cairan tumbuhan (phytophagus). Nyamuk betina mempunyai antenna tipe-pilose, sedangkan nyamuk jantan tipe plumose.
Dada nyamuk ini tersusun dari 3 ruas, porothorax, mesothorax, dan metathorax. Setiap ruas dada ada sepasang kaki yang terdiri dari femur (paha), tibia (betis), dan tarsus (tampak). Pada ruas-ruas kaki ada gelang-gelang putih, tetapi pada bagian tibia kaki belakang tidak ada gelang putih. Pada bagian dada juga terdapat sepasang sayap tanpa noda-noda hitam. Bagian punggung (mesontum) ada gambaran garis-garis putih yang dapat dipakai untuk membedakan dengan jenis lain. Gambaran punggung nyamuk Ae. Aegypti berupa sepasang garis lengkung putih (bentuk : lyre) pada tepinya dan sepasang garis submedian di tengahnya (Gambar 2.1)
Perut terdiri dari 8 ruas dan pada ruas-ruas tersebut terdapat bintik-bintik putih. Waktu istirahat posisi nyamuk Ae. Aegypti ini tubuhnya sejajar dengan bidang permukaan yang dihinggapinya. (Soegijanto, 2004)
Gambar 2.1. Nyamuk Aedes aegypti dewasa
17. Ekologi dan Bionomi nyamuk Aedes aegypti
Telur, larva dan pupa nyamuk Ae. Aegypti tumbuh dan berkembang di dalam air. Genangannya yang disukai sebagai tempat perindukan nyamuk ini berupa genangan air yang tertampung di suatu wadah yang biasa disebut kontainer atau tempat penampungan air bukan genangan air di tanah.
Survey yang telah dilakukan di beberapa kota di Indonesia menunjukkan bahwa tempat perindukan yang paling potensial adalah TPA yang digunakan sehari-hari seperti drum, tempayan, bak mandi, bak WC, ember dan sejenisnya. Tempat perindukan tambahan adalah disebut non-TPA, seperti tempat minuman hewan, barang bekas, vas bunga, perangakap semut dan lain-lainnya, sedangkan TPA alamiah seperti lubang pohon, lubang batu, pelepah daun, tempurung kelapa, kulit kerang, pangkal pohon pisang, potongan bambu dan lain-lainnya. Nyamuk Ae. Aegypti lebih tertarik untuk meletakkan telurnya pada TPA berair yang berwarna gelap, paling menyukai warna hitam, terbuka lebar, dan terutama yang terletak di tempat-tempat terlindung sinar matahari langsung.
Nyamuk Ae. Aegypti hidup domestik, lebih menyukai tinggal di dalam rumah daripada luar rumah. Nyamuk betina menggigit dan menghisap darah lebih banyak di siang hari terutama pagi atau sore hari antara pukul 08.00 sampai dengan 12.00 dan 15.00 sampai dengan 17.00. Kesukaan menghisap darah lebih menyukai darah manusia daripada hewan, menggigit dan menghisap darah beberapa kali pada siang hari orang sedang aktif, nyamuk belum menghisap darah beberapa kali karena pada siang hari orang sedang aktif, nyamuk belum kenyang, orang sudah bergerak, nyamuk terbang dan menggigit lagi sampai cukup darah untuk pertumbuhan dan perkembangan telurnya.
Waktu mencari makanan, selain terdorong oleh rasa lapar, nyamuk Ae. Aegypti juga dipengaruhi oleh beberapa faktor, yaitu bau yang dipancarkan oleh inang, temperatur, kelembaban, kadar karbon dioksida, dan warna. Khan dkk.(1996) melaporkan bahwa untuk jarak yang lebih jauh, faktor bau memegangi peranan penting bila dibandingkan dengan faktor lainnya. Kebiasaan istirahat lebih banyak di dalam rumah pada benda-benda yang bergantung, berwarna gelap dan di tempat-tempat lain yang terlindung. (Soegijanto, 2004).
18. Siklus Hidup nyamuk Aedes aegypti
Telur nyamuk Ae aegypti di dalam air dengan suhu 20-400 C akan menetas menjadi larva dalam waktu 1-2 hari. Kecepatan pertumbuhan dan perkembangan larva dipengaruhi beberapa faktor, yaitu temperatur, tempat, keadaan air dan kandungan zat makanan yang ada di dalam tempat perindukan. Pada kondisi optimum, larva berkembang menjadi pupa dalam waktu 4-9 hari, kemudian pupa menjadi nyamuk dewasa dalam waktu 2-3 hari. Jadi pertumbuhan dan perkembangan telur, larva, pupa, sampai dewasa memerlukan waktu kurang lebih 7-14 hari. (Soegijanto, 2004).
19. Perilaku Nyamuk Dewasa
Setelah lahir (keluar dari kepompong), nyamuk istirahat di kulit kepompong untuk sementara waktu. Beberapa saat setelah itu sayap meregang menjadi kaku, sehingga nyamuk mampu terbang mencari mangsa / darah.
Nyamuk Aedes aegypti jantan menghisap cairan tumbuhan atau sari bunga untuk keperluan hidupnya sedangkan yang betina menghisap darah. Nyamuk betina ini lebih menyukai darah manusia daripada binatang ( bersifat antropofilik). Darah (proteinnya) diperlukan untuk mematangkan telur agar jika dibuahi oleh sperma nyamuk jantan dapat menetas. Waktu yang diperlukan untuk menyelesaikan perkembangan telur mulai dari nyamuk menghisap darah sampai telur dikeluarkan biasanya bervariasi antara 3-4 hari. Jangka waktu tersebut disebut satu siklus gonotropik (gonotropic cycle).
Biasanya nyamuk betina mencari mangsanya pada siang hari. Aktifitas menggigit biasanya mulai pagi sampai petang hari, dengan 2 puncak aktifitas antara pukul 09.00-10.00 dan 16.00-17.00. Tidak seperti nyamuk lain, Aedes aegypti mempunyai kebiasaan menghisap darah berulang kali (multiple bites) dalam satu siklus gonotropik, untuk memenuhi lambungnya dengan darah. Dengan demikian nyamuk ini sangat efektif sebagai penular penyakit.
Setelah menghisap darah, nyamuk ini hinggap (beristirahat) di dalam atau kadang-kadang di luar rumah berdekatan dengan tempat perkembangbiakannya. Biasanya di tempat yang agak gelap dan lembab. Di tempat-tempat ini nyamuk menunggu proses pematangan telurnya.
Setelah beristirahat dan proses pematangan telur selesai, nyamuk betina akan meletakkan telurnya di dinding tempat perkembangbiakannya, sedikit di atas permukaan air. Pada umumnya telur akan menetas menjadi jentik dalam waktu + 2 hari setelah terendam air. Setiap kali bertelur nyamuk betina dapat mengeluarkan telur sebanyak 100 butir. Telur itu di tempat yang kering (tanpa air) dapat bertahan berbulan-bulan pada suhu -20 C sampai 420 C, dan bila tempat-tempat tersebut kemudian tergenang air atau kelembabannya tinggi maka telur dapat menetas lebih cepat.(Depkes RI, 2005).
20. Penyebaran Nyamuk Aedes aegypti
Kemampuan terbang nyamuk betina rata-rata 40 meter, maksimal 100 meter, namun secara pasif misalnya karena angin atau terbawa kendaraan dapat berpindah lebih jauh.
Aedes aegypti tersebar luas di daerah tropis dan sub-tropis. Di Indonesia nyamuk ini tersebar luas baik di rumah-rumah maupun di tempat-tempat umum. Nyamuk ini dapat hidup dan berkembang biak sampai ketinggian daerah + 1.000 m dari permukaan air laut. Di atas ketinggian tersebut suhu udara terlalu rendah, sehingga tidak memungkinkan bagi kehidupan nyamuk tersebut.(Depkes RI, 2005).
21. Pengendalian Vektor
Tujuan pengendalian vektor utama adalah upaya untuk menurunkan kepadatan populasi nyamuk Ae. Aegypti sampai serendah mungkin sehingga kemampuan sebagai vektor menghilang. Secara garis besar ada 5 cara pengendalian vektor yaitu dengan cara :
a. Pengendalian cara kimiawi
Di sini digunakan insektisida yang dapat ditujukan terhadap nyamuk dewasa atau larva. Insektisida yang dapat digunakan terhadap nyamuk dewasa Ae.aegypti antara dari golongan organochlorine, organophosphor, carbamate, dan pyrethroid. (Soegijanto, 2004).
Bahan-bahan insektisida tersebut dapat diaplikasikan dalam bentuk penyemprotan (spray) terhadap rumah-rumah penduduk. Insektisida yang dapat digunakan terhadap larva Ae. Aegypti yaitu dari golongan organophosphor (Temephos) dalam bentuk sand granules yang dilarutkan dalam air di tempat perindukannya (abatisasi). (Soegijanto, 2004).
b. Pengendalian cara radiasi
Di sini nyamuk dewasa jantan diradiasi dengan bahan radioaktif dengan dosis tertentu sehingga menjadi mandul. Kemudian nyamuk jantan yang telah diradiasi ini dilepaskan ke alam bebas. Meskipun nanti akan berkopulasi dengan nyamuk betina, tapi nyamuk betina tidak akan dapat menghasilkan telur yang fertil. (Soegijanto, 2004).
c. Pengendalian lingkungan
Di sini dapat digunakan beberapa cara antara lain dengan mencegah nyamuk kontak dengan manusia yaitu memasang kawat kasa pada lubang ventilasi rumah, jendela, dan pintu. Dan yang sekarang digalakkan oleh pemerintah yaitu gerakan 3M yaitu :
1) Menguras tempat penampungan air dengan menyikat dinding bagian dalam dan dibilas paling sedikit seminggu sekali,
2) Menutup rapat tempat penampungan air sedemikian rupa sehingga tidak dapat diterobos oleh nyamuk dewasa,
3) Menanam / menimbun dalam tanah barang-barang bekas atau sampah yang dapat menampung air hujan. (Soegijanto, 2004).
Ada cara lain lagi yang disebut autocidal ovitrap. Di sini digunakan suatu tabung silinder warna gelap dengan garis tengah + 10 cm, salah satu ujung tertutup rapat dan ujung yang lain terbuka. Tabung ini diisi air tawar kemudian ditutup dengan tutup kasa nylon. Nyamuk Ae. Aegypti bertelur di sini dan bila telur menetas menjadi larva dalam air tadi. Bila larva menjadi nyamuk dewasa maka akan tetap terperangkap di dalam tabung tadi. Secara periodik air dalam tabung ditambah untuk mengganti penguapan yang terjadi. (Soegijanto, 2004).
Dari semua cara pengendalian tersebut di atas tidak ada satu pun yang paling unggul. Untuk menghasilkan cara yang efektif maka dilakukan kombinasi dari beberapa cara tersebut di atas. Tapi yang paling penting di atas semua cara-cara tersebut adalah menggugah dan meningkatkan kesadaran masyarakat agar mau memperhatikan kebersihan lingkungannya dan memahami tentang mekanisme terjadinya penularan penyakit DBD sehingga dapat berperan secara aktif menanggulangi penyakit DBD. (Soegijanto, 2004).
d. Pengendalian genetik
Pengendalian genetik telah banyak dilakukan dalam percobaan tetapi belum pernah ditetapkan di lapangan. Salah satu cara pengendalian genetik adalah dengan teknik jantan mandul, yaitu melepas sejumlah besar nyamuk-nyamuk jantan yang sudah dimandulkan. Nyamuk-nyamuk betina hanya kawin satu kali, seumur hidup, sehingga jika nyamuk betina dikawinkan dengan nyamuk jantan mandul tadi, maka tidak akan menghasilkan keturunan. (Soegijanto, 2004).
e. Pengendalian hayati
Pengendalian hayati atau sering disebut pengendalian biologis dilakukan dengan menggunakan kelompok hidup, baik dari golongan mikroorgannisme, hewan invertebrata atau hewan vertebrata. Sebagai pengendalian hayati, dapat berperan sebagai pathogen, parasit atau pemasangan. Beberapa jenis ikan, seperti ikan kepala timah (Panchaxpanchax), ikan gabus (Gambusia affinis) adalah pemangsa yang cocok untuk larva nyamuk. Beberapa jenis golongan cacing Nematoda, seperti Romanomarmis iyengari dan R. Culiciforax merupakan parasit pada larva nyamuk. Sebagai patogen, seperti dari golongan virus, bakteri, fungi atau protozoa dapat dikembangkan sebagai pengendali hayati nyamuk di tempat perindukannya. (Soegijanto, 2004).
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Senin, 18 Agustus 2008
HIPOTENSION
What Is Hypotension?
Hypotension is abnormally low blood pressure. Normal blood pressure is a reading of less than 120/80 mmHg (mmHg = millimeters of mercury, a unit for measuring pressure). Hypotension is blood pressure that is lower than 90/60 mmHg.
Some people have low blood pressure all the time. They have no signs or symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of some event or medical condition. Hypotension is a medical concern only if it causes signs and/or symptoms such as dizziness, fainting, or, in extreme cases, shock.
What Is Blood Pressure?
Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60–70 times a minute in adults at rest), it pumps blood out into the arteries. Your blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic (sis-TOL-ik) pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic (di-a-STOL-ik) pressure.
Blood pressure is always given as these two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mmHg. When the two measurements are written down, the systolic pressure is the first or top number, and the diastolic pressure is the second or bottom number (for example, 120/80). If your blood pressure is 120/80, you say that it is “120 over 80.”
Blood pressure changes during the day. It lowers as you sleep and rises when you wake up. It also can rise when you are excited, nervous, or active.
The body is very sensitive to changes in blood pressure. Special cells in the arteries, called baroreceptors (BAR-o-re-SEP-ters), can sense if blood pressure begins to rise or drop. When the baroreceptors sense a rise or drop in blood pressure, they cause certain responses to occur throughout the body in an attempt to bring the blood pressure back to normal.
For example, if you stand up quickly, the baroreceptors will sense a drop in your blood pressure. They quickly take action to make sure that blood continues to flow to the brain, kidneys, and other important organs. The baroreceptors cause the heart to beat faster and harder. They also cause the small arteries (arterioles) and veins (the vessels that carry blood back to the heart) to narrow.
Most forms of hypotension happen when the body can’t bring blood pressure back to normal or can’t do it fast enough.
Outlook
In a healthy person, hypotension without signs or symptoms is usually not a problem and requires no treatment. Doctors will want to identify and treat any underlying condition that is causing the hypotension, if one can be found. Hypotension can be dangerous if a person falls because of dizziness or fainting.
Shock, a severe form of hypotension, is a life-threatening condition that is often fatal if not treated immediately. Shock can be successfully treated if the cause can be found and the right treatment provided in time.
Types of Hypotension
There are several types of hypotension. One type, chronic asymptomatic hypotension, happens in people who always have low blood pressure. They have no symptoms and need no treatment. Their low blood pressure is normal for them.
Other types of hypotension happen only sometimes, when blood pressure suddenly drops too low. The symptoms and effects on the body can be mild or severe. The three main types of this kind of hypotension are orthostatic hypotension, neurally mediated hypotension (NMH), and severe hypotension associated with shock.
Orthostatic Hypotension
Orthostatic hypotension is low blood pressure that occurs upon standing up from a sitting or lying down position. It can cause a person to feel dizzy, lightheaded or even to faint. It occurs when the body is not able to adjust blood pressure and blood flow fast enough for the change in position. Usually orthostatic hypotension lasts for only a few seconds or minutes after a person stands up. Sometimes a person will need to sit or lie down for a short time while the blood pressure returns to normal.
Orthostatic hypotension can occur in all age groups, but it is more common in older adults, especially those who are frail or in poor health. Orthostatic hypotension can be a symptom of other medical conditions, and treatment generally focuses on treating the underlying condition(s). Some people can have orthostatic hypotension but also have high blood pressure when lying down.
A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal. Postprandial hypotension most commonly affects older adults. It also is more likely to affect those with high blood pressure or diseases such as Parkinson disease.
Neurally Mediated Hypotension
In this form of hypotension, blood pressure drops after a person has been standing for a long time. A person may feel dizzy, faint, or sick to the stomach as a result. NMH also can happen when a person faces an unpleasant, upsetting, or frightening situation.
NMH affects children and young adults more often than other age groups. Children often outgrow this form of hypotension.
Severe Hypotension Associated With Shock
Many times people will say a person has "gone into shock" as a result of an emotionally upsetting experience. But to doctors, the word "shock" has a different meaning. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work properly. It is different from the other forms of hypotension because blood pressure drops much lower, and it is life threatening if not treated immediately. There are many causes of shock, including major loss of blood, certain severe types of infection, severe burns, severe allergic reactions, and poisoning.
Other Names for Hypotension
Low blood pressure
Orthostatic hypotension
Postprandial hypotension
Postural hypotension
Neurally mediated hypotension
Neurogenic orthostatic hypotension
Shock
What Causes Hypotension?
Hypotension is caused by conditions or events that interfere with the body's ability to control blood pressure.
Orthostatic Hypotension
Orthostatic hypotension has many causes. Sometimes, two or more causes combined will result in hypotension.
Dehydration is the most common cause of orthostatic hypotension. Dehydration occurs when the body loses more water than it takes in. People can become dehydrated because of:
Not drinking enough fluids
Fever
Vomiting
Severe diarrhea
Excessive sweating from strenuous exercise
Some medicines used to treat high blood pressure and heart disease can make it more likely that a person will develop orthostatic hypotension. These medicines include:
Diuretics
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Nitrates
Beta blockers
Also, medicines used to treat certain other medical conditions, such as anxiety, depression, erectile dysfunction, and Parkinson disease, can make it more likely that a person will develop orthostatic hypotension.
Other substances that can contribute to orthostatic hypotension include alcohol, barbiturates, and some prescription and over-the-counter medicines, when taken in combination with high blood pressure medicines.
Certain medical conditions can increase a person's chances of having orthostatic hypotension. Some of these conditions are:
Anemia (low red blood cell count).
Heart conditions leading to heart failure, such as a heart attack or viral infection of the heart. These conditions reduce the heart's ability to pump enough blood around the body.
Heart valve disorders.
Severe infections.
Endocrine conditions, such as hypothyroidism (underactive thyroid), hyperthyroidism (overactive thyroid), Addison's disease (adrenal insufficiency), low blood sugar, and diabetes.
Disorders of the central nervous system, such as Parkinson disease, multiple systems atrophy (Shy-Drager syndrome), and amyloidosis.
Pulmonary embolism (a sudden blockage in a lung artery).
Finally, other events or conditions that can contribute to orthostatic hypotension include:
Being out in the heat for a long time
Having to stay in bed for a long time because of a medical condition
Being pregnant
Getting older (the body doesn't manage changes in blood pressure as well as it gets older)
Neurally Mediated Hypotension
Neurally mediated hypotension (NMH) occurs when the brain and heart don't communicate with each other properly. For example, when a person stands for a long time, blood begins to pool in the legs. This causes the person's blood pressure to drop. Instead of telling the brain that blood pressure is low, the body mistakenly tells the brain that blood pressure is high. In response, the brain slows the person's heart rate, which makes the blood pressure drop even further, causing dizziness and other symptoms.
Severe Hypotension Associated With Shock
Severe hypotension associated with shock can be caused by many conditions or events. Some of these conditions and events also are causes of orthostatic hypotension. The difference in shock is that the blood pressure doesn't return to normal by itself, and it is at dangerously low levels. Shock is a medical emergency that must be treated immediately.
Certain severe infections can cause shock. This is known as septic shock. This type of shock can occur when bacteria enter the bloodstream. The bacteria release a toxin (a poison) that leads to a dangerous drop in blood pressure.
Shock can be caused by a severe decrease in the amount of blood or fluids in the body. This is known as hypovolemic shock. Hypovolemic shock can happen as a result of:
Major bleeding on the outside of the body (for example, from an injury)
Major bleeding inside the body (for example, from a ruptured blood vessel)
Significant loss of body fluids from severe burns
Severe inflammation of the pancreas
Severe diarrhea
Severe kidney disease
Excessive use of diuretics
A major decrease in the heart's ability to pump blood can cause shock. This is known as cardiogenic shock. It can be caused by a heart attack, pulmonary embolism, or arrhythmia.
A sudden and extreme relaxation of the muscles of arteries, which leads to dilation (widening) of the arteries and a drop in blood pressure, can cause shock. This is known as vasodilatory shock. It can happen because of:
Severe head injury
Reaction to some medicines
Liver failure
Poisoning
Severe allergic reaction (anaphylactic shock)
Who Is At Risk for Hypotension?
People of all ages can have hypotension, though people of certain ages are more likely to have certain kinds:
Older adults are more likely to have orthostatic and postprandial hypotension.
Children and young adults are more likely to have neurally mediated hypotension.
People who take certain medicines, such as high blood pressure medicines, have a higher risk of hypotension.
People with Parkinson disease and some heart conditions also have a higher risk of hypotension.
What Are the Signs and Symptoms of Hypotension?
Orthostatic Hypotension
The symptoms of orthostatic hypotension happen within a few seconds or minutes of a person standing up after sitting or lying down. They go away if the person sits or lies down again. The signs and symptoms include:
Dizziness or feeling lightheaded
Blurry vision
Confusion
Feeling faint or weak
Fainting
Neurally Mediated Hypotension
The symptoms of neurally mediated hypotension (NMH) happen after a person has been standing for a long time or in response to an unpleasant, upsetting, or frightening situation. Like orthostatic hypotension, the drop in blood pressure with NMH is temporary and usually goes away after the person sits down. The signs and symptoms of NMH are similar to those of orthostatic hypotension.
Severe Hypotension Associated With Shock
In shock, not enough blood flows to the major organs, including the brain.
The early signs and symptoms of reduced blood flow to the brain include lightheadedness, sleepiness, and confusion. In the earliest stages of shock, it may be hard to detect any signs and symptoms. In older people, the first symptom may only be confusion.
As shock worsens, eventually, the person cannot sit up without passing out. If it continues, the person will lose consciousness. Shock is often fatal if not treated.
Some of the other signs and symptoms of shock vary, depending on the cause. When shock is caused by low blood volume (such as from massive bleeding) or poor pumping action by the heart (as in heart failure):
The skin becomes cold and sweaty. It often looks blue or pale. If pressed, the color returns more slowly than normal. A bluish network of lines can be seen under the skin.
The pulse becomes weak and rapid.
The person begins to breathe very quickly.
When shock is caused by extreme widening or stretching of blood vessels (such as in septic shock), a person feels warm and flushed at first. Later, the skin becomes cold and clammy, and the person feels very sleepy.
How Is Hypotension Diagnosed?
Hypotension is diagnosed using a medical history and physical exam to find out:
The type of low blood pressure and how severe it is
Whether an underlying condition is causing the low blood pressure
Specialists Involved
Depending on the type of hypotension, it might be diagnosed and treated by a primary care doctor, or specialists may be involved, especially for the treatment of shock. The type of specialist most commonly involved is a cardiologist. A cardiologist is a doctor who diagnoses and treats heart diseases. Other specialists, including surgeons, nephrologists (kidney specialists), neurologists (brain and nerve specialists), and others may be involved.
Diagnostic Tests and Procedures
If a person is in shock, emergency action is required to find the cause and treat the shock. For other types of hypotension, the doctor may order the following tests:
Tilt table test. This test is used if you have fainting spells for no known reason. You lie on a table that moves from a lying down to an upright position. The doctor checks your reactions to the change in position. The test can be used to diagnose orthostatic hypotension and neurally mediated hypotension (NMH). People who have NMH usually faint during this test. The test can help the doctor identify any underlying neurological condition.
Blood tests. These tests can show whether anemia (low red blood cell count) or low blood sugar is causing the hypotension.
EKG (electrocardiogram). This test measures the rate and regularity of the heartbeat.
Portable EKG monitoring. Wires are attached to your chest with sticky patches and connected to a small battery-operated recorder.
A Holter monitor records all the heart's electrical activity for 24 hours.
An event monitor records selected periods of the heart's electrical activity. You may use this monitor for 1-2 months. When you feel symptoms, you press a button and the device records the heart's electrical activity. The information can be sent over the telephone to the doctor.
Echocardiogram. This test uses sound waves to create a moving picture of your heart. Echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart (coronary artery disease).
Stress Test. Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you are unable to exercise) to make your heart work harder and beat faster while heart tests are performed.
During exercise stress testing, your blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working.
If you are unable to exercise, a medicine can be injected through an intravenous line (IV) into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done.
During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart muscle.
Your doctor also may order two newer tests along with stress testing if more information is needed about how well your heart works. These new tests are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged. PET scanning shows the level of chemical activity in different areas of your heart. This can help your doctor determine if enough blood is flowing to the areas of your heart. A PET scan can show decreased blood flow caused by disease or damaged muscles that may not be detected by other scanning methods.
How Is Hypotension Treated?
Treatment depends on the cause of the hypotension and how severe the signs and symptoms are.
Hypotension in a healthy person that does not cause signs or symptoms usually does not need to be treated. Hypotension that causes signs or symptoms often needs to be treated. Severe hypotension associated with shock is a medical emergency. It can cause death if it is not treated immediately.
A person's response to treatment depends on his or her age and overall health and strength. It also depends on how easily the person can stop, start, or change medicines.
Any person with blood pressure low enough to cause symptoms should immediately sit or lie down, with the feet up above the level of the heart. Low blood pressure symptoms that do not go away very quickly upon sitting or lying down can be a medical emergency, and immediate medical attention is needed.
Treating Orthostatic Hypotension
The goals of treatment are to relieve or improve signs and symptoms and to manage any underlying medical condition causing the hypotension.
Treatment can include:
Making lifestyle changes, such as:
Drinking plenty of fluids, like water
Drinking little or no alcohol
Standing up slowly
Gradually sitting up for longer periods of time if you've had to stay in bed for a long time
Using compression stockings that apply pressure to the lower body. These garments drive blood from the legs to the heart and brain and help blood circulate through the body.
Stopping a medicine or changing the dose if the medicine is causing the hypotension.
Taking medicine to raise blood pressure, reduce signs and symptoms, and treat related conditions. Medicines include ephedrine, phenylephrine, fludrocortisone, beta blockers, and nonsteroidal anti-inflammatory medicines.
Treating Neurally Mediated Hypotension
Treatment for neurally mediated hypotension (NMH) can include:
Making lifestyle changes, such as:
Avoiding situations that trigger symptoms. For example, don't stand for long periods of time, and avoid frightening or upsetting situations.
Drinking plenty of fluids, like water.
Increasing salt intake.
Learning to recognize symptoms that occur before fainting, and taking action to raise blood pressure (crossing the legs and squeezing them together or lying down).
Stopping a medicine or changing the dose if the medicine is causing the hypotension.
Taking medicines, such as fludrocortisone, to treat the hypotension if symptoms are very bad.
Children with NHM often outgrow it.
Treating Severe Hypotension Associated With Shock
Shock is a life-threatening emergency that usually requires treatment in a hospital or by emergency medical personnel. The goals of treating shock are to restore blood flow to the organs as quickly as possible, to prevent organ damage, and to find and reverse the cause of the shock.
Restoring blood flow to the organs often requires that special fluids or blood be given directly into the bloodstream through a needle. Medicines can be given to raise the blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments such as antibiotics or surgery may be required.
Living With Hypotension
Hypotension can often be successfully treated, and many people with hypotension live normal, healthy lives.
If you have hypotension, it's important to try and prevent or minimize symptoms, such as dizzy spells and fainting. Steps to take may include the following:
Get up slowly after sitting or lying down if you have orthostatic hypotension.
Don't stand for long periods of time if you have neurally mediated hypotension.
Eat small, low-carbohydrate meals if you have postprandial hypotension.
Drink plenty of fluids, like water.
Drink little or no alcohol.
Increase salt intake, if appropriate.
Use compression stockings.
Get regular exercise, as appropriate for your state of health.
Learn to take your own blood pressure to find out what's normal for you.
Keep a record of blood pressure readings done by health professionals.
Key Points
Hypotension is abnormally low blood pressure. Normal blood pressure is a reading of less than120/80 mmHg. Hypotension is blood pressure that is lower than 90/60 mmHg.
Some people have low blood pressure all the time. They have no signs or symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of some event or medical condition.
In a healthy person, low blood pressure without signs or symptoms is usually not a problem and requires no treatment.
The three main forms of hypotension with signs and symptoms are orthostatic hypotension, neurally mediated hypotension (NMH), and severe hypotension associated with shock.
Orthostatic hypotension is low blood pressure that occurs upon standing up from a sitting or lying down position. NMH is low blood pressure that results from standing for too long or in reaction to severe emotional stress. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work properly. Shock can result from a major trauma to the body, such as serious bleeding, severe burns, heart attack, severe allergic reaction, or an infection in the blood.
People of all ages can have hypotension. Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have NMH.
Signs and symptoms of orthostatic hypotension and NMH include dizziness, blurry vision, weakness, nausea, and fainting. Both of these types of hypotension can be dangerous if a person falls because of the dizziness or fainting.
Signs and symptoms of shock include confusion, sweating, weak and rapid pulse, and warm and flushed skin that becomes cold and clammy. If shock progresses, the person can lose consciousness. Shock can be fatal if not treated immediately.
Treatments for orthostatic hypotension and NMH are intended to relieve symptoms and manage underlying conditions. They include medicines and use of compression socks or inflatable pants to improve circulation. Lifestyle changes also are important, such as standing up slowly, drinking lots of fluids, and learning to recognize symptoms to prevent fainting.
Treatment for shock includes restoring blood flow to the organs through special fluids or blood injected directly into the bloodstream through a needle. Medicines can be given to raise the blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments such as antibiotics or surgery may be required.
Resources :
www.nhlbi.nih.gov
Hypotension is abnormally low blood pressure. Normal blood pressure is a reading of less than 120/80 mmHg (mmHg = millimeters of mercury, a unit for measuring pressure). Hypotension is blood pressure that is lower than 90/60 mmHg.
Some people have low blood pressure all the time. They have no signs or symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of some event or medical condition. Hypotension is a medical concern only if it causes signs and/or symptoms such as dizziness, fainting, or, in extreme cases, shock.
What Is Blood Pressure?
Blood is carried from the heart to all parts of your body in vessels called arteries. Blood pressure is the force of the blood pushing against the walls of the arteries. Each time the heart beats (about 60–70 times a minute in adults at rest), it pumps blood out into the arteries. Your blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic (sis-TOL-ik) pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic (di-a-STOL-ik) pressure.
Blood pressure is always given as these two numbers, the systolic and diastolic pressures. Both are important. Usually they are written one above or before the other, such as 120/80 mmHg. When the two measurements are written down, the systolic pressure is the first or top number, and the diastolic pressure is the second or bottom number (for example, 120/80). If your blood pressure is 120/80, you say that it is “120 over 80.”
Blood pressure changes during the day. It lowers as you sleep and rises when you wake up. It also can rise when you are excited, nervous, or active.
The body is very sensitive to changes in blood pressure. Special cells in the arteries, called baroreceptors (BAR-o-re-SEP-ters), can sense if blood pressure begins to rise or drop. When the baroreceptors sense a rise or drop in blood pressure, they cause certain responses to occur throughout the body in an attempt to bring the blood pressure back to normal.
For example, if you stand up quickly, the baroreceptors will sense a drop in your blood pressure. They quickly take action to make sure that blood continues to flow to the brain, kidneys, and other important organs. The baroreceptors cause the heart to beat faster and harder. They also cause the small arteries (arterioles) and veins (the vessels that carry blood back to the heart) to narrow.
Most forms of hypotension happen when the body can’t bring blood pressure back to normal or can’t do it fast enough.
Outlook
In a healthy person, hypotension without signs or symptoms is usually not a problem and requires no treatment. Doctors will want to identify and treat any underlying condition that is causing the hypotension, if one can be found. Hypotension can be dangerous if a person falls because of dizziness or fainting.
Shock, a severe form of hypotension, is a life-threatening condition that is often fatal if not treated immediately. Shock can be successfully treated if the cause can be found and the right treatment provided in time.
Types of Hypotension
There are several types of hypotension. One type, chronic asymptomatic hypotension, happens in people who always have low blood pressure. They have no symptoms and need no treatment. Their low blood pressure is normal for them.
Other types of hypotension happen only sometimes, when blood pressure suddenly drops too low. The symptoms and effects on the body can be mild or severe. The three main types of this kind of hypotension are orthostatic hypotension, neurally mediated hypotension (NMH), and severe hypotension associated with shock.
Orthostatic Hypotension
Orthostatic hypotension is low blood pressure that occurs upon standing up from a sitting or lying down position. It can cause a person to feel dizzy, lightheaded or even to faint. It occurs when the body is not able to adjust blood pressure and blood flow fast enough for the change in position. Usually orthostatic hypotension lasts for only a few seconds or minutes after a person stands up. Sometimes a person will need to sit or lie down for a short time while the blood pressure returns to normal.
Orthostatic hypotension can occur in all age groups, but it is more common in older adults, especially those who are frail or in poor health. Orthostatic hypotension can be a symptom of other medical conditions, and treatment generally focuses on treating the underlying condition(s). Some people can have orthostatic hypotension but also have high blood pressure when lying down.
A form of orthostatic hypotension called postprandial hypotension is a sudden drop in blood pressure after a meal. Postprandial hypotension most commonly affects older adults. It also is more likely to affect those with high blood pressure or diseases such as Parkinson disease.
Neurally Mediated Hypotension
In this form of hypotension, blood pressure drops after a person has been standing for a long time. A person may feel dizzy, faint, or sick to the stomach as a result. NMH also can happen when a person faces an unpleasant, upsetting, or frightening situation.
NMH affects children and young adults more often than other age groups. Children often outgrow this form of hypotension.
Severe Hypotension Associated With Shock
Many times people will say a person has "gone into shock" as a result of an emotionally upsetting experience. But to doctors, the word "shock" has a different meaning. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work properly. It is different from the other forms of hypotension because blood pressure drops much lower, and it is life threatening if not treated immediately. There are many causes of shock, including major loss of blood, certain severe types of infection, severe burns, severe allergic reactions, and poisoning.
Other Names for Hypotension
Low blood pressure
Orthostatic hypotension
Postprandial hypotension
Postural hypotension
Neurally mediated hypotension
Neurogenic orthostatic hypotension
Shock
What Causes Hypotension?
Hypotension is caused by conditions or events that interfere with the body's ability to control blood pressure.
Orthostatic Hypotension
Orthostatic hypotension has many causes. Sometimes, two or more causes combined will result in hypotension.
Dehydration is the most common cause of orthostatic hypotension. Dehydration occurs when the body loses more water than it takes in. People can become dehydrated because of:
Not drinking enough fluids
Fever
Vomiting
Severe diarrhea
Excessive sweating from strenuous exercise
Some medicines used to treat high blood pressure and heart disease can make it more likely that a person will develop orthostatic hypotension. These medicines include:
Diuretics
Calcium channel blockers
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers
Nitrates
Beta blockers
Also, medicines used to treat certain other medical conditions, such as anxiety, depression, erectile dysfunction, and Parkinson disease, can make it more likely that a person will develop orthostatic hypotension.
Other substances that can contribute to orthostatic hypotension include alcohol, barbiturates, and some prescription and over-the-counter medicines, when taken in combination with high blood pressure medicines.
Certain medical conditions can increase a person's chances of having orthostatic hypotension. Some of these conditions are:
Anemia (low red blood cell count).
Heart conditions leading to heart failure, such as a heart attack or viral infection of the heart. These conditions reduce the heart's ability to pump enough blood around the body.
Heart valve disorders.
Severe infections.
Endocrine conditions, such as hypothyroidism (underactive thyroid), hyperthyroidism (overactive thyroid), Addison's disease (adrenal insufficiency), low blood sugar, and diabetes.
Disorders of the central nervous system, such as Parkinson disease, multiple systems atrophy (Shy-Drager syndrome), and amyloidosis.
Pulmonary embolism (a sudden blockage in a lung artery).
Finally, other events or conditions that can contribute to orthostatic hypotension include:
Being out in the heat for a long time
Having to stay in bed for a long time because of a medical condition
Being pregnant
Getting older (the body doesn't manage changes in blood pressure as well as it gets older)
Neurally Mediated Hypotension
Neurally mediated hypotension (NMH) occurs when the brain and heart don't communicate with each other properly. For example, when a person stands for a long time, blood begins to pool in the legs. This causes the person's blood pressure to drop. Instead of telling the brain that blood pressure is low, the body mistakenly tells the brain that blood pressure is high. In response, the brain slows the person's heart rate, which makes the blood pressure drop even further, causing dizziness and other symptoms.
Severe Hypotension Associated With Shock
Severe hypotension associated with shock can be caused by many conditions or events. Some of these conditions and events also are causes of orthostatic hypotension. The difference in shock is that the blood pressure doesn't return to normal by itself, and it is at dangerously low levels. Shock is a medical emergency that must be treated immediately.
Certain severe infections can cause shock. This is known as septic shock. This type of shock can occur when bacteria enter the bloodstream. The bacteria release a toxin (a poison) that leads to a dangerous drop in blood pressure.
Shock can be caused by a severe decrease in the amount of blood or fluids in the body. This is known as hypovolemic shock. Hypovolemic shock can happen as a result of:
Major bleeding on the outside of the body (for example, from an injury)
Major bleeding inside the body (for example, from a ruptured blood vessel)
Significant loss of body fluids from severe burns
Severe inflammation of the pancreas
Severe diarrhea
Severe kidney disease
Excessive use of diuretics
A major decrease in the heart's ability to pump blood can cause shock. This is known as cardiogenic shock. It can be caused by a heart attack, pulmonary embolism, or arrhythmia.
A sudden and extreme relaxation of the muscles of arteries, which leads to dilation (widening) of the arteries and a drop in blood pressure, can cause shock. This is known as vasodilatory shock. It can happen because of:
Severe head injury
Reaction to some medicines
Liver failure
Poisoning
Severe allergic reaction (anaphylactic shock)
Who Is At Risk for Hypotension?
People of all ages can have hypotension, though people of certain ages are more likely to have certain kinds:
Older adults are more likely to have orthostatic and postprandial hypotension.
Children and young adults are more likely to have neurally mediated hypotension.
People who take certain medicines, such as high blood pressure medicines, have a higher risk of hypotension.
People with Parkinson disease and some heart conditions also have a higher risk of hypotension.
What Are the Signs and Symptoms of Hypotension?
Orthostatic Hypotension
The symptoms of orthostatic hypotension happen within a few seconds or minutes of a person standing up after sitting or lying down. They go away if the person sits or lies down again. The signs and symptoms include:
Dizziness or feeling lightheaded
Blurry vision
Confusion
Feeling faint or weak
Fainting
Neurally Mediated Hypotension
The symptoms of neurally mediated hypotension (NMH) happen after a person has been standing for a long time or in response to an unpleasant, upsetting, or frightening situation. Like orthostatic hypotension, the drop in blood pressure with NMH is temporary and usually goes away after the person sits down. The signs and symptoms of NMH are similar to those of orthostatic hypotension.
Severe Hypotension Associated With Shock
In shock, not enough blood flows to the major organs, including the brain.
The early signs and symptoms of reduced blood flow to the brain include lightheadedness, sleepiness, and confusion. In the earliest stages of shock, it may be hard to detect any signs and symptoms. In older people, the first symptom may only be confusion.
As shock worsens, eventually, the person cannot sit up without passing out. If it continues, the person will lose consciousness. Shock is often fatal if not treated.
Some of the other signs and symptoms of shock vary, depending on the cause. When shock is caused by low blood volume (such as from massive bleeding) or poor pumping action by the heart (as in heart failure):
The skin becomes cold and sweaty. It often looks blue or pale. If pressed, the color returns more slowly than normal. A bluish network of lines can be seen under the skin.
The pulse becomes weak and rapid.
The person begins to breathe very quickly.
When shock is caused by extreme widening or stretching of blood vessels (such as in septic shock), a person feels warm and flushed at first. Later, the skin becomes cold and clammy, and the person feels very sleepy.
How Is Hypotension Diagnosed?
Hypotension is diagnosed using a medical history and physical exam to find out:
The type of low blood pressure and how severe it is
Whether an underlying condition is causing the low blood pressure
Specialists Involved
Depending on the type of hypotension, it might be diagnosed and treated by a primary care doctor, or specialists may be involved, especially for the treatment of shock. The type of specialist most commonly involved is a cardiologist. A cardiologist is a doctor who diagnoses and treats heart diseases. Other specialists, including surgeons, nephrologists (kidney specialists), neurologists (brain and nerve specialists), and others may be involved.
Diagnostic Tests and Procedures
If a person is in shock, emergency action is required to find the cause and treat the shock. For other types of hypotension, the doctor may order the following tests:
Tilt table test. This test is used if you have fainting spells for no known reason. You lie on a table that moves from a lying down to an upright position. The doctor checks your reactions to the change in position. The test can be used to diagnose orthostatic hypotension and neurally mediated hypotension (NMH). People who have NMH usually faint during this test. The test can help the doctor identify any underlying neurological condition.
Blood tests. These tests can show whether anemia (low red blood cell count) or low blood sugar is causing the hypotension.
EKG (electrocardiogram). This test measures the rate and regularity of the heartbeat.
Portable EKG monitoring. Wires are attached to your chest with sticky patches and connected to a small battery-operated recorder.
A Holter monitor records all the heart's electrical activity for 24 hours.
An event monitor records selected periods of the heart's electrical activity. You may use this monitor for 1-2 months. When you feel symptoms, you press a button and the device records the heart's electrical activity. The information can be sent over the telephone to the doctor.
Echocardiogram. This test uses sound waves to create a moving picture of your heart. Echocardiogram provides information about the size and shape of your heart and how well your heart chambers and valves are functioning. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow.
There are several different types of echocardiograms, including a stress echocardiogram. During this test, an echocardiogram is done both before and after your heart is stressed either by having you exercise or by injecting a medicine into your bloodstream that makes your heart beat faster and work harder. A stress echocardiogram is usually done to find out if you have decreased blood flow to your heart (coronary artery disease).
Stress Test. Some heart problems are easier to diagnose when your heart is working harder and beating faster than when it's at rest. During stress testing, you exercise (or are given medicine if you are unable to exercise) to make your heart work harder and beat faster while heart tests are performed.
During exercise stress testing, your blood pressure and EKG readings are monitored while you walk or run on a treadmill or pedal a bicycle. Other heart tests, such as nuclear heart scanning or echocardiography, also can be done at the same time. These would be ordered if your doctor needs more information than the exercise stress test can provide about how well your heart is working.
If you are unable to exercise, a medicine can be injected through an intravenous line (IV) into your bloodstream to make your heart work harder and beat faster, as if you are exercising on a treadmill or bicycle. Nuclear heart scanning or echocardiography is then usually done.
During nuclear heart scanning, radioactive tracer is injected into your bloodstream, and a special camera shows the flow of blood through your heart and arteries. Echocardiography uses sound waves to show blood flow through the chambers and valves of your heart and to show the strength of your heart muscle.
Your doctor also may order two newer tests along with stress testing if more information is needed about how well your heart works. These new tests are magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning of the heart. MRI shows detailed images of the structures and beating of your heart, which may help your doctor better assess if parts of your heart are weak or damaged. PET scanning shows the level of chemical activity in different areas of your heart. This can help your doctor determine if enough blood is flowing to the areas of your heart. A PET scan can show decreased blood flow caused by disease or damaged muscles that may not be detected by other scanning methods.
How Is Hypotension Treated?
Treatment depends on the cause of the hypotension and how severe the signs and symptoms are.
Hypotension in a healthy person that does not cause signs or symptoms usually does not need to be treated. Hypotension that causes signs or symptoms often needs to be treated. Severe hypotension associated with shock is a medical emergency. It can cause death if it is not treated immediately.
A person's response to treatment depends on his or her age and overall health and strength. It also depends on how easily the person can stop, start, or change medicines.
Any person with blood pressure low enough to cause symptoms should immediately sit or lie down, with the feet up above the level of the heart. Low blood pressure symptoms that do not go away very quickly upon sitting or lying down can be a medical emergency, and immediate medical attention is needed.
Treating Orthostatic Hypotension
The goals of treatment are to relieve or improve signs and symptoms and to manage any underlying medical condition causing the hypotension.
Treatment can include:
Making lifestyle changes, such as:
Drinking plenty of fluids, like water
Drinking little or no alcohol
Standing up slowly
Gradually sitting up for longer periods of time if you've had to stay in bed for a long time
Using compression stockings that apply pressure to the lower body. These garments drive blood from the legs to the heart and brain and help blood circulate through the body.
Stopping a medicine or changing the dose if the medicine is causing the hypotension.
Taking medicine to raise blood pressure, reduce signs and symptoms, and treat related conditions. Medicines include ephedrine, phenylephrine, fludrocortisone, beta blockers, and nonsteroidal anti-inflammatory medicines.
Treating Neurally Mediated Hypotension
Treatment for neurally mediated hypotension (NMH) can include:
Making lifestyle changes, such as:
Avoiding situations that trigger symptoms. For example, don't stand for long periods of time, and avoid frightening or upsetting situations.
Drinking plenty of fluids, like water.
Increasing salt intake.
Learning to recognize symptoms that occur before fainting, and taking action to raise blood pressure (crossing the legs and squeezing them together or lying down).
Stopping a medicine or changing the dose if the medicine is causing the hypotension.
Taking medicines, such as fludrocortisone, to treat the hypotension if symptoms are very bad.
Children with NHM often outgrow it.
Treating Severe Hypotension Associated With Shock
Shock is a life-threatening emergency that usually requires treatment in a hospital or by emergency medical personnel. The goals of treating shock are to restore blood flow to the organs as quickly as possible, to prevent organ damage, and to find and reverse the cause of the shock.
Restoring blood flow to the organs often requires that special fluids or blood be given directly into the bloodstream through a needle. Medicines can be given to raise the blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments such as antibiotics or surgery may be required.
Living With Hypotension
Hypotension can often be successfully treated, and many people with hypotension live normal, healthy lives.
If you have hypotension, it's important to try and prevent or minimize symptoms, such as dizzy spells and fainting. Steps to take may include the following:
Get up slowly after sitting or lying down if you have orthostatic hypotension.
Don't stand for long periods of time if you have neurally mediated hypotension.
Eat small, low-carbohydrate meals if you have postprandial hypotension.
Drink plenty of fluids, like water.
Drink little or no alcohol.
Increase salt intake, if appropriate.
Use compression stockings.
Get regular exercise, as appropriate for your state of health.
Learn to take your own blood pressure to find out what's normal for you.
Keep a record of blood pressure readings done by health professionals.
Key Points
Hypotension is abnormally low blood pressure. Normal blood pressure is a reading of less than120/80 mmHg. Hypotension is blood pressure that is lower than 90/60 mmHg.
Some people have low blood pressure all the time. They have no signs or symptoms and their low readings are normal for them. In other people, blood pressure drops below normal because of some event or medical condition.
In a healthy person, low blood pressure without signs or symptoms is usually not a problem and requires no treatment.
The three main forms of hypotension with signs and symptoms are orthostatic hypotension, neurally mediated hypotension (NMH), and severe hypotension associated with shock.
Orthostatic hypotension is low blood pressure that occurs upon standing up from a sitting or lying down position. NMH is low blood pressure that results from standing for too long or in reaction to severe emotional stress. Shock is a life-threatening condition in which blood pressure drops so low that the brain, kidneys, and other vital organs can't get enough blood to work properly. Shock can result from a major trauma to the body, such as serious bleeding, severe burns, heart attack, severe allergic reaction, or an infection in the blood.
People of all ages can have hypotension. Older adults are more likely to have orthostatic and postprandial hypotension. Children and young adults are more likely to have NMH.
Signs and symptoms of orthostatic hypotension and NMH include dizziness, blurry vision, weakness, nausea, and fainting. Both of these types of hypotension can be dangerous if a person falls because of the dizziness or fainting.
Signs and symptoms of shock include confusion, sweating, weak and rapid pulse, and warm and flushed skin that becomes cold and clammy. If shock progresses, the person can lose consciousness. Shock can be fatal if not treated immediately.
Treatments for orthostatic hypotension and NMH are intended to relieve symptoms and manage underlying conditions. They include medicines and use of compression socks or inflatable pants to improve circulation. Lifestyle changes also are important, such as standing up slowly, drinking lots of fluids, and learning to recognize symptoms to prevent fainting.
Treatment for shock includes restoring blood flow to the organs through special fluids or blood injected directly into the bloodstream through a needle. Medicines can be given to raise the blood pressure or make the heartbeat stronger. Depending on the cause of the shock, other treatments such as antibiotics or surgery may be required.
Resources :
www.nhlbi.nih.gov
Dengue High Fever (DHF)
Dengue [DEN-ghee] is a flu-like viral disease spread by the bite of infected mosquitoes. Dengue hemorrhagic fever is a severe, often fatal, complication of dengue.
Dengue occurs in most tropical areas of the world. Most U.S. cases occur in travelers returning from abroad, but the dengue risk is increasing for persons living along the Texas-Mexico border and in other parts of the southern United States.
There is no specific treatment for dengue.
Prevention centers on avoiding mosquito bites in areas where dengue occurs or might occur and eliminating breeding sites.
What is dengue fever? What is dengue hemorrhagic fever?
Dengue fever is a flu-like illness spread by the bite of an infected mosquito.
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.
What is the infectious agent that causes dengue?
Dengue and dengue hemorrhagic fever are caused by any of the dengue family of viruses. Infection with one virus does not protect a person against infection with another.
How is dengue spread?
Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting an infected person and then biting someone else.
Where is dengue found?
Dengue viruses occur in most tropical areas of the world. Dengue is common in Africa, Asia, the Pacific, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most common in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet.
The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower pots, old oil drums, and water storage containers close to human dwellings. Unlike the mosquitoes that cause malaria, dengue mosquitoes bite during the day.
What are the signs and symptoms of dengue fever and dengue hemorrhagic fever?
Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older children and adults are usually sicker than young children.
Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults.
How soon after exposure do symptoms appear?
The time between the bite of a mosquito carrying dengue virus and the start of symptoms averages 4 to 6 days, with a range of 3 to 14 days. An infected person cannot spread the infection to other persons but can be a source of dengue virus for mosquitoes for about 6 days.
How is dengue diagnosed?
Dengue is diagnosed by a blood test.
Who is at risk for dengue?
Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue hemorrhagic fever include a person's age and immune status, as well as the type of infecting virus. Persons who were previously infected with one or more types of dengue virus are thought to be at greater risk for developing dengue hemorrhagic fever if infected again.
What is the treatment for dengue and dengue hemorrhagic fever?
There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty of fluids. They should be kept away from mosquitoes for the protection of others. Dengue hemorrhagic fever is treated by replacing lost fluids. Some patients need transfusions to control bleeding.
How common is dengue?
In tropical countries around the world, dengue is one of the most common viral diseases spread to humans by mosquitoes. Tens of millions of cases of dengue fever and up to hundreds of thousands of cases of dengue hemorrhagic fever occur each year.
In the United States, approximately 100 cases of dengue are reported each year in travelers returning from tropical areas. Many more cases probably go unreported. A few persons have become infected with dengue while living in the United States. Aedes mosquitoes are found in Texas, Florida, and other southern states, and locally acquired dengue has been reported three times since 1980 in southern Texas.
Is dengue an emerging infectious disease?
Yes. All types of dengue virus are re-emerging worldwide and causing larger and more frequent epidemics, especially in cities in the tropics. The emergence of dengue as a major public health problem has been most dramatic in the western hemisphere. Dengue fever has reached epidemic levels in Central America and is threatening the United States.
Several factors are contributing to the resurgence of dengue fever:
No effective mosquito control efforts are underway in most countries with dengue.
Public health systems to detect and control epidemics are deteriorating around the world.
Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and substandard sanitation, allowing more mosquitoes to live closer to more people.
The increase in non-biodegradable plastic packaging and discarded tires is creating new breeding sites for mosquitoes.
Increased jet air travel is helping people infected with dengue viruses to move easily from city to city.
Dengue hemorrhagic fever is also on the rise. Persons who have been infected with one or more forms of dengue virus are at greater risk for the more severe disease. With the increase in all types of virus, the occurrence of dengue hemorrhagic fever becomes more likely.
How can dengue be prevented?
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention measure.
Avoid mosquito bites when traveling in tropical areas:
Use mosquito repellents on skin and clothing.
When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked into socks.
Avoid heavily populated residential areas.
When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are not screened or air-conditioned.
If you have symptoms of dengue, report your travel history to your doctor.
Eliminate mosquito breeding sites in areas where dengue might occur:
Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially old tires.
Regularly change the water in outdoor bird baths and pet and animal water containers.
Resources :
www.dhpe.org
Dengue occurs in most tropical areas of the world. Most U.S. cases occur in travelers returning from abroad, but the dengue risk is increasing for persons living along the Texas-Mexico border and in other parts of the southern United States.
There is no specific treatment for dengue.
Prevention centers on avoiding mosquito bites in areas where dengue occurs or might occur and eliminating breeding sites.
What is dengue fever? What is dengue hemorrhagic fever?
Dengue fever is a flu-like illness spread by the bite of an infected mosquito.
Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.
What is the infectious agent that causes dengue?
Dengue and dengue hemorrhagic fever are caused by any of the dengue family of viruses. Infection with one virus does not protect a person against infection with another.
How is dengue spread?
Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting an infected person and then biting someone else.
Where is dengue found?
Dengue viruses occur in most tropical areas of the world. Dengue is common in Africa, Asia, the Pacific, Australia, and the Americas. It is widespread in the Caribbean basin. Dengue is most common in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet.
The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower pots, old oil drums, and water storage containers close to human dwellings. Unlike the mosquitoes that cause malaria, dengue mosquitoes bite during the day.
What are the signs and symptoms of dengue fever and dengue hemorrhagic fever?
Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name "breakbone fever." Nausea, vomiting, and loss of appetite are common. A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older children and adults are usually sicker than young children.
Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults.
How soon after exposure do symptoms appear?
The time between the bite of a mosquito carrying dengue virus and the start of symptoms averages 4 to 6 days, with a range of 3 to 14 days. An infected person cannot spread the infection to other persons but can be a source of dengue virus for mosquitoes for about 6 days.
How is dengue diagnosed?
Dengue is diagnosed by a blood test.
Who is at risk for dengue?
Anyone who is bitten by an infected mosquito can get dengue fever. Risk factors for dengue hemorrhagic fever include a person's age and immune status, as well as the type of infecting virus. Persons who were previously infected with one or more types of dengue virus are thought to be at greater risk for developing dengue hemorrhagic fever if infected again.
What is the treatment for dengue and dengue hemorrhagic fever?
There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty of fluids. They should be kept away from mosquitoes for the protection of others. Dengue hemorrhagic fever is treated by replacing lost fluids. Some patients need transfusions to control bleeding.
How common is dengue?
In tropical countries around the world, dengue is one of the most common viral diseases spread to humans by mosquitoes. Tens of millions of cases of dengue fever and up to hundreds of thousands of cases of dengue hemorrhagic fever occur each year.
In the United States, approximately 100 cases of dengue are reported each year in travelers returning from tropical areas. Many more cases probably go unreported. A few persons have become infected with dengue while living in the United States. Aedes mosquitoes are found in Texas, Florida, and other southern states, and locally acquired dengue has been reported three times since 1980 in southern Texas.
Is dengue an emerging infectious disease?
Yes. All types of dengue virus are re-emerging worldwide and causing larger and more frequent epidemics, especially in cities in the tropics. The emergence of dengue as a major public health problem has been most dramatic in the western hemisphere. Dengue fever has reached epidemic levels in Central America and is threatening the United States.
Several factors are contributing to the resurgence of dengue fever:
No effective mosquito control efforts are underway in most countries with dengue.
Public health systems to detect and control epidemics are deteriorating around the world.
Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and substandard sanitation, allowing more mosquitoes to live closer to more people.
The increase in non-biodegradable plastic packaging and discarded tires is creating new breeding sites for mosquitoes.
Increased jet air travel is helping people infected with dengue viruses to move easily from city to city.
Dengue hemorrhagic fever is also on the rise. Persons who have been infected with one or more forms of dengue virus are at greater risk for the more severe disease. With the increase in all types of virus, the occurrence of dengue hemorrhagic fever becomes more likely.
How can dengue be prevented?
There is no vaccine to prevent dengue. Prevention centers on avoiding mosquito bites when traveling to areas where dengue occurs and when in U.S. areas, especially along the Texas-Mexico border, where dengue might occur. Eliminating mosquito breeding sites in these areas is another key prevention measure.
Avoid mosquito bites when traveling in tropical areas:
Use mosquito repellents on skin and clothing.
When outdoors during times that mosquitoes are biting, wear long-sleeved shirts and long pants tucked into socks.
Avoid heavily populated residential areas.
When indoors, stay in air-conditioned or screened areas. Use bednets if sleeping areas are not screened or air-conditioned.
If you have symptoms of dengue, report your travel history to your doctor.
Eliminate mosquito breeding sites in areas where dengue might occur:
Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially old tires.
Regularly change the water in outdoor bird baths and pet and animal water containers.
Resources :
www.dhpe.org
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