Etiologi Demam

Demam merupakan respon fisiologis dimana suhu tubuh meningkat akibat pengaturan tulang pada set point di hipotalamus. Suhu tubuh normal memiliki perbedaan yang cukup jauh pada setiap orang dan perbedaan diurnal (tertinggi – malam hari, terendah dini hari).

Suhu tubuh normal berkisar antara 36,50-37,20C. Suhu subnormal di bawah 360C. Demam diartikan suhu tubuh diatas 37,20C, hiperpireksia adalah suatu keadaan kenaikan suhu tubuh sampai setinggi 41,20C atau lebih, sedangkan hipotermia adalah keadaan suhu tubuh di bawah 350C. Biasanya terdapat perbedaan antara pengukuran suhu di aksila dan oral maupun rektal. Dalam keadaan biasa perbedaan ini berkisar sekitar 0,50C, suhu rektal lebih tinggi daripada suhu oral.

Etiologi

  1. Penyebab Infeksi
  • v      Parasit
  • v      Bakteri
  • v      Virus
  • v      Jamur
  • v      dll
  1. Penyebab Non Infeksi
  • v      Neoplasma
  • v      Nekrosis Jaringan
  • v      Kelainan Kolagen Vaskular
  • v      Emboli Paru / Trombosis vena dalam
  • v      Obat , metabolism, dll
  1. Demam tanpa penyebab yang jelas (Fever Of Unknown Origin)

Demam yang menetap dengan hasil pemeriksaan penunjang awal negatif disebut Demam Tanpa Penyebab Yang Jelas (Fever of Unknown Origin). Definisi klasik dari kelainan ini adalah Demam > 38,3°C yang menetap tanpa diagnosis selama 3 minggu termasuk pemeriksaan 1 minggu di rumah sakit

INFEKSI
Infeksi Piogenik Infeksi bakteri Sistemik Infeksi Riketsia, Chlamydia, dan Mikoplsama
Appendicitis

 

Cat-scratch disease

Cholangitis

Cholecystitis

Dental abscess

Diverticulitis/abscess

Lesser sac abscess

Liver abscess

Mesenteric lymphadenitis

Osteomyelitis

Pancreatic abscess

Pelvic inflammatory disease

Perinephric/intrarenal abscess

Prostatic abscess

Renal malacoplakia

Sinusitis

Subphrenic abscess

Suppurative thrombophlebitis

Tuboovarian abscess

Bartonellosis

 

Brucellosis

Campylobacter infection

Cat-scratch disease/bacillary

angiomatosis (B. henselae)

Gonococcemia

Legionnaires’ disease

Leptospirosis

Listeriosis

Lyme disease

Melioidosis

Meningococcemia

Rat-bite fever

Relapsing fever

Salmonellosis

Syphilis

Tularemia

Typhoid fever

Vibriosis

Yersinia infection

Rickettsial infections

 

Anaplasmosis

Ehrlichiosis

Murine typhus

Q fever

Rickettsialpox

Rocky Mountain spotted fever

Chlamydial infections

Lymphogranuloma venereum

Psittacosis

TWAR( C. pneumoniae) infection

Mycoplasmal infections

Infeksi Virus Infeksi Jamur Infeksi parasit
Colorado tick fever

 

Coxsackievirus group B infection

Cytomegalovirus infection

Dengue

Epstein-Barr virus infection

Hepatitis A, B, C, D, and E

Human herpesvirus 6 infection

Human immunodeficiency virus infection

Lymphocytic choriomeningitis

Parvovirus B19 infection

Aspergillosis

 

Blastomycosis

Candidiasis

Coccidioidomycosis

Cryptococcosis

Histoplasmosis

Mucormycosis

Paracoccidioidomycosis

Sporotrichosis

Parasitic infections

 

Amebiasis

Babesiosis

Chagas’ disease

Leishmaniasis

Malaria

Pneumocystis infection

Strongyloidiasis

Toxocariasis

Toxoplasmosis

Trichinosis

Infeksi Intravaskular Infeksi Micobacterium Lain-lain
Bacterial aortitis

 

Bacterial endocarditis

Vascular catheter infection

M. avium/M. intracellulare infections

 

Other atypical mycobacterial infections

Tuberculosis

Actinomycosis

 

Bacillary angiomatosis

Nocardiosis

Whipple’s disease

Kawasaki’s disease (mucocutaneous lymph

node syndrome)

Kikuchi’s necrotizing lymphadenitis

NON INFEKSI
Neoplasma Collagen Vascular/Hypersensitivity Diseases Penyakit Metabolik Dan Bawaan
Ganas

 

Colon cancer

Gall bladder carcinoma

Hepatoma

Hodgkin’s lymphoma

Imunoblastic T-cell lymphoma

Leukemia

Lymphomatoid granulomatosis

Malignant histiocytosis

Non-Hodgkin’s lymphoma

Pancreatic cancer

Renal cell carcinoma

Sarcoma

Jinak

Atrial myxoma

Castleman’s disease

Renal angiomyolipoma

Adult Still’s disease

 

Behcet’s disease

Erythema multiforme

Erythema nodosum

Giant cell arteritis/polymyalgia

rheumatica

Hypersensitivity pneumonitis

Hypersensitivity vasculitis

Mixed connective-tissue disease

Polyarteritis nodosa

Relapsing polychondritis

Rheumatic fever

Rheumatoid arthritis

Schnitzler’s syndrome

Systemic lupus erythematosus

Takayasu’s aortitis

Weber-Christian disease

Wegener’s granulomatosis

Adrenal insufficiency

 

Cyclic neutropenia

Deafness, urticaria, and amyloidosis

Fabry’s disease

Familial cold urticaria

Familial Mediterranean fever

Hyperimmunoglobulinemia D and

periodic fever

Muckle-Wells syndrome

Tumor necrosis factor receptor–

associated periodic syndrome

Type V hypertriglyceridemia

Granulomatous Diseases Gangguan Termoregulator Lain-Lain
Crohn’s disease

 

Granulomatous hepatitis

Midline granuloma

Sarcoidosis

Central

 

Brain tumor

Cerebrovascular accident

Encephalitis

Hypothalamic dysfunction

Peripheral

Hyperthyroidism

Pheochromocytoma

Aortic dissection

 

Drug fever

Gout

Hematomas

Hemoglobinopathies

Laennec’s cirrhosis

PFPA syndrome: periodic fever, adenitis,

pharyngitis, aphthae

Postmyocardial infarction syndrome

Recurrent pulmonary emboli

Subacute thyroiditis (de Quervain’s)

Tissue infarction/necrosis

Demam buatan

Referensi :

  1. Kasper, MD dkk, Harrison Principles of internal medicine 16th ed, McGraw-Hill
  2. Guyton & Hall. 1997. Demam, Fisiologi Kedokteran. EGC: Jakarta. hal 1152-1153.
  3. R.H.H. Nelwan, dkk. Demam; Tipe dan Pendekatan, Buku Ajar Ilmu Penyakit Dalam. Pusat Penerbitan Ilmu Penyakit Dalam FK UI, Jilid III. Jakarta. Hal 1697-1699 .
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