Epiglottitis

Supraglottitis
Last reviewed: April 18, 2011.
Epiglottitis is inflammation of the tissue that covers the trachea (windpipe). It is a life-threatening
disease.
See also: Croup
Causes, incidence, and risk factors
The epiglottis is a piece of stiff, yet flexible tissue (called cartilage) at the back of the tongue. It closes
your windpipe (trachea) when you swallow so food does not enter your airways. This helps prevent
coughing or choking after swallowing.
Swelling of the epiglottis is usually caused by the bacteria Haemophilus influenzae (H. influenzae). It
may also be caused by other bacteria or viruses related to upper respiratory infections.
Epiglottitis is now very uncommon, because the H. influenzae type B (Hib) vaccine is a routine
childhood immunization. The disease was once most often seen in children ages 2 - 6. Rarely,
epiglottitis can occur in adults.
Symptoms
Epiglottitis begins with a high fever and sore throat. Other symptoms may include:
Abnormal breathing sounds (stridor)
Chills, shaking
Cyanosis (blue skin coloring)
Drooling
Difficulty breathing (patient may need to sit upright and lean slightly forward to breathe)
Difficulty swallowing
Voice changes (hoarseness)
Signs and tests
Epiglottitis is a medical emergency. Seek immediate medical help. Do not use a tongue depressor
(tongue blade) to try to examine the throat at home, as this may make the condition worse.
The health care provider may examine the voice box (larynx) using either a small mirror held against
the back of the throat or a viewing tube called a laryngoscope. This exam may be done in the operating
room if the windpipe is blocked.
Tests that may be done include:
Blood culture or throat culture
Complete blood count (CBC)
Neck x-ray
Treatment
A hospital stay is needed, usually in the intensive care unit (ICU).
Treatment involves methods to help the person breathe, including:
Breathing tube (intubation)
Moistened (humidified) oxygen
Other treatments may include:
Antibiotics to treat the infection
Anti-inflammatory medicines called corticosteroids to decrease throat swelling
Fluids given through a vein (by IV)
Expectations (prognosis)
Epiglottitis can be a life-threatening emergency. However, with proper treatment, the outcome is
usually good.
Complications
Spasm may cause the airways to close abruptly. In this case, death follows within minutes.
The airways may become totally blocked, which could result in death.
Calling your health care provider
Call the local emergency number (such as 911) if your child has symptoms of epiglottitis, including
sudden breathing difficulties, excessive drooling, and irritability.
Prevention
Immunization with the Hib vaccine protects most children from epiglottitis.
The bacteria that causes epiglottitis is contagious. If someone in your family is sick from this bacteria,
you need to be tested and treated appropriately.

Laryngitis
Last reviewed: December 16, 2010.
Laryngitis is swelling and irritation (inflammation) of the voice box (larynx) that is usually associated
with hoarseness or loss of voice.
Causes, incidence, and risk factors
The voice box (larynx) is located at the top of the airway to the lungs (trachea). The larynx contains the
vocal cords. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness,
and may sometimes block the airway.
The most common form of laryngitis is an infection caused by a virus, such as cold or flu viruses. It
may also be caused by:
Allergies
Bacterial infection
Bronchitis
Gastroesophageal reflux disease (GERD)
Injury
Irritants and chemicals
Pneumonia
Laryngitis often occurs with an upper respiratory infection.
Several forms of laryngitis occur in children that can lead to dangerous or fatal respiratory blockage.
These forms include:
Croup
Epiglottitis
Symptoms
Fever
Hoarseness
Swollen lymph nodes or glands in the neck
Signs and tests
A physical examination can determine whether hoarseness is caused by a respiratory tract infection.
Patients with hoarseness that lasts for more than a month (especially smokers) will need to see an ear,
nose, and throat doctor (otolaryngologist) for tests of the throat and upper airway.
Treatment
Because most common laryngitis is caused by a virus, antibiotics may not help. Your health care
provider will make this decision.
Resting your voice helps by reducing inflammation of the vocal cords. A humidifier may soothe the
scratchy feeling that comes with laryngitis. Decongestants and painkillers may relieve the symptoms of
an upper respiratory infection, if you have one.
Expectations (prognosis)
Laryngitis that is not caused by a serious condition should get better.
Complications
Rarely, severe respiratory distress may develop. This will require medical attention.
Calling your health care provider
Call your health care provider if:
A small child who is not teething has difficulty breathing, swallowing, or is drooling
A child less than 3 months old has hoarseness
Hoarseness has lasted for more than 1 week in a child, or 2 weeks in an adult
Prevention
Try to avoid people who have upper respiratory infections during cold and flu season.
Wash your hands regularly.
Avoid crowded places.
Stopping smoking may help prevent tumors of the head and neck or lungs, which may lead to
hoarseness.

Pharyngitis
Pharyngitis - bacterial; Sore throat
Last reviewed: February 22, 2011.
Pharyngitis, or sore throat, is discomfort, pain, or scratchiness in the throat. It often makes it painful to
swallow.
See also:
Infectious mononucleosis
Strep throat
Causes, incidence, and risk factors
Pharyngitis is caused by swelling (inflammation) of the pharynx, which is in the back of the throat,
between the tonsils and the voicebox (larynx).
Most sore throats are cauesd by a viral infection, such as the cold or flu. Some viruses can cause
specific types of sore throat, such as coxsackie infection or mononucleosis.
Bacteria that can cause pharyngitis include Group A streptococcus, which leads to strep throat in some
cases.
Other, less-common bacteria that cause sore throats include corynebacterium, gonorrhea, and
chlamydia.
Most cases of pharyngitis occur during the colder months. The illness often spreads among family
members.
Symptoms
The main symptom is a sore throat.
Other symptoms may include:
Fever
Headache
Joint pain and muscle aches
Skin rashes
Swollen lymph nodes in the neck
Signs and tests
Your health care provider will perform a physical exam and look at your throat.
A rapid test or throat culture to rule out strep throat may be done. Additional laboratory tests may be
done depending on the suspected cause.
Treatment
Most sore throats are caused by viruses. Antibiotics do not help. Using them to treat viral infections
helps strengthen bacteria and make them resistant to antibiotics.
Sore throats should only be treated with antibiotics if a strep test is positive. Strep cannot be accurately
diagnosed by symptoms or a physical exam alone. For more information, see: Strep throat
The following tips may help your sore throat feel better:
Drink warm liquids such as lemon tea or tea with honey.
Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
Drink cold liquids or suck on popsicles.
Suck on hard candies or throat lozenges. Young children should not be given such products
because they can choke on them.
A cool-mist vaporizer or humidifier can moisten and soothe a dry and painful throat.
Try over-the-counter pain medications, such as acetaminophen.
Complications
Complications may include:
Blockage of the airway (in severe cases)
Sore (abscess) around the tonsils or behind the throat
Calling your health care provider
Call your health care provider if:
You develop a sore throat that does not go away after several days
You have a high fever, swollen lymph nodes in your neck, or a rash
Seek immediate medical care if you have a sore throat and trouble breathing.

Bacterial vaginosis ( BV ) adalah suatu kondisi patologis dimana terjadi perubahan

ekologi vagina oleh karena pertumbuhan Lactobacillus yang merupakan flora normal
dominan pada vagina digantikan oleh bakteri lain seperti Gardnerella vaginalis dan
bakteri-bakteri anaerob lainnya.1-3 Penyebab BV pada umumnya belum diketahui
secara jelas, namun BV dapat dihubungkan dengan adanya peningkatan pH vagina
dan perubahan sekret vagina.2,4 Pada penderita BV sekret vagina menjadi berlebih
dengan konsistensi cair, homogen, berwarna putih keabuan, dan berbau amis.1,5,6
Perubahan ini merupakan keluhan yang sangat mengganggu wanita sehingga
membutuhkan pelayanan medis.
Penelitian-penelitian sebelumnya telah melaporkan angka kejadian BV di beberapa
negara, diantaranya Thailand 33 %, Afrika-Amerika 22,7 %, London 21 %, Indonesia
17 %, Jepang 14 %, Swedia 14 %, dan Helsinki 12 % .1 Beberapa penelitian juga
menunjukkan banyaknya penderita BV yang tidak menunjukkan gejala ( asimtomatis
).1,4,5 Pada tahun 2005 di India terdapat 31,2 % wanita dengan BV asimtomatis.5 Di
Italia 5 % asimtomatis, di Peru 23 % asimtomatis dan 37 % simtomatis.1 Penelitian di
Amerika Serikat melaporkan 11 % asimtomatis dan 19 % simtomatis.4
Pada umumnya BV ditemukan pada wanita usia reproduktif dengan aktifitas seksual
yang tinggi dan promiskuitas. Penggunaan alat kontrasepsi dalam rahim,usia
menopause,vaginal douching, sosial ekonomi rendah, dan wanita hamil juga
merupakan faktor resiko terjadinya BV.6-8 Hasil penelitian diThailand menunjukkan
16 % kasus BV ditemukan pada ibu hamil dan di USA terdapat 16,3% BV pada ibu
hamil.1
BV merupakan penyakit yang hingga saat ini diagnosis dan penanganannya masih
problematik. Kepentingan diagnosis didasarkan pada pendapat umum bahwa BV
merupakan salah satu penyakit menular seksual ( PMS ).9,10 Selain itu, terbukti
pula bahwa BV dapat menimbulkan masalah infeksi traktus genitalis,misalnya infeksi
intra amnion yang akan menyebabkan gangguan atau penyulit selama
kehamilan,antara lain kelahiran prematur, berat bayi lahir rendah ( BBLR ), infeksi
panggul (Pelvic Inflammatory Dissease/PID) setelah persalinan, bahkan dapat terjadi
abortus.1,2,6-8
Dengan memperhatikan prevalensi dan komplikasi BV terutama pada ibu hamil dan
mengingat banyaknya penderita yang asimtomatis, maka perlu dilakukan skrining (tes
penapisan) BV pada ibu hamil dan melakukan tes konfirmasi terhadap hasil skrining
yang positif dengan pemeriksaan yang lebih akurat. Diagnosa BV dapat ditegakkan
melalui kriteria klinik dari Amsel.1,2,11,12 Menurut kriteria ini, seorang wanita
terdiagnosis BV apabila memenuhi tiga atau lebih dari empat kriteria, yaitu adanya
sekret vagina yang homogen; peningkatan pH vagina 4,5; tes amin positif; dan
ditemukannya clue cell melalui pemeriksaan mikroskopis.1,2,13,14 Selain kriteria Amsel,
diagnosa BV dapat pula ditegakkan melalui pengecatan Gram.2,9,15,16 Metode
pengecatan ini dinilai objektif dan tidak dipengaruhi oleh banyak faktor seperti
menstruasi dan hubungan seks.4,14,17 Namun demikian, kedua metode pemeriksaan
tersebut membutuhkan peralatan berupa mikroskop, sedangkan diketahui bahwa di
tempat-tempat pemeriksaan kehamilan alat tersebut sangat terbatas. Oleh karena
itu,dibutuhkan suatu metode yang praktis dalam melakukan skrining BV, salah
satunya dengan metode pengukuran pH vagina. Pada pengukuran pH vagina hasil
skrining dikatakan positif apabila pH vagina 4,5. Metode ini mudah dilakukan, tidak
membutuhkan keahlian khusus, tidak membutuhkan biaya mahal,dan tidak
membutuhkan peralatan seperti mikroskop. Oleh karena itu, diharapkan pengukuran
pH vagina dapat menjadi alat skrining BV yang baik sehingga dapat digunakan di
tempat-tempat antenatal care ( ANC ). Tujuan dari penelitian ini adalah untuk
mengetahui sensitivitas,spesifisitas, PPV (Positive Predictive value), NPV (Negative
Predictive value) dan reliabilitas eksterna tes pH vagina dalam menapis kejadian BV
pada ibu hamil.