REINITA ARLIN S.

KED
030.08.202

FAKULTAS KEDOKTERAN UNIVERSITAS TRISAKTI

Kepaniteraan Klinik Departemen Ilmu Kesehatan Anak
RSUD Kota Bekasi
Etiologi
Coxsackievirus A5, A7, A9,
A10, A16, B1, B2, B3, B5,
echovirus, enterovirus 71,
etc.
Un-enveloped, 7400
nukleotida.
11,12


Coxsackievirus
Group Group IV (+)ssRNA
Famili Pikornaviridae
Genus Enterovirus (non polio)
Species Human enterovirus A, B
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed. New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Morag A, Pearay LO. Enterovirus. In : Behrman RE, Kliegman, Arvin, editors. Nelson Textbook of Pediatrics. Vol.2. Terjemahan Oleh : Wahab AS. Jakarta: EGC;
2000. p. 1077-78
Mancini AJ, Ayelet SA. Other Viral Diseases. In: Bolognia JL et al, editors. Dermatology. 3
rd
Ed. Edinburgh: Elsevier Saunders; 2012. p. 1345-48
http://en.wikipedia.org/wiki/Coxsackievirus

Patogenesis
Thomas J. Hand-foot-and-mouth disease An Overview. e-Journal of the Indian Society of Teledermatolog. 2009; 3 (4) : p. 1-4
Manifestasi Klinis
Prodormal symptoms 12 24
hours
Demam yang tidak terlalu tinggi
Malaise
Nyeri abdominal
Gejala respiratorik lainnya.
25% limfadenopati submandibular &/
servikal.
Oral cavity lession (*90%)
Makula, vesikel, ulserasi, >10 Aphtae-like
erosion
Pedih anak tidak mau makan
Palatum, lidah, serta mukosa pipi (buccal)
paling sering.
Mucocutaneous lession
Makula eritematosa/pucat (3-7 mm)
papula vesikel dikelilingi dasar eritem
erosi dgn halo kemerahan (7-5 hari)
sembuh tanpa meninggalkan jaringan
parut.
Telapak tangan, kaki, bagian dorsal jari dan
ibu kaki, dan dapat menyebar ke wajah,
pantat, genitalia eksterna dan tungkai
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed. New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Habif TP. Clinical Dermatology 5th Ed. Edinburg: Mosby; 2009
Manifestasi Klinis
Vesikel football-shaped pada telapak kaki
penderita HFMD
5
Vesikel pada telapak tangan pasien HFMD
13

Ulserasi pada lidah yang merupakan salah
satu lesi oral HFMD
5

Vesikel dan eritem pada lidah pasien HFMD
5

Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed. New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Starling JC. Virus Infection. In: Burn T et al, editors. Rooks Textbook of Dermatology. 8
th
Ed. Massachusetts: Blackwell Publishing; 2010. p. 25.72-3

Pemeriksaan Penunjang
Darah Lengkap
Leukosit 4000-16000/L
Limfositosis
Histopatologi
Degenerasi retikular vesikel
intraepidermal berisi netrofil,
sel mononuklear, dan
eosinofilik.
Serologi Biomolekuler
PCR (etiologi spesifik)
Neutralizing antibodies
(akut)
Titer complement antibodies
(konvalesen)
Tzank
Tidak ditemukan
multinucleated giant cell dan
inclusion bodies.
Biakan Virus
Spesimen : feses, dahak,
apusan cairan vesikel
Identifikasi spesifikasi virus
melalui obs efek cytopathic
dlm sel/ pembentuk plak pada
sel monolayer (plaque assay)
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed. New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Thomas J. Hand-foot-and-mouth disease An Overview. e-Journal of the Indian Society of Teledermatolog. 2009; 3 (4) : p. 1-4
Wolff K, Richard AJ. Fitzpatricks Color Atlas and Synopsis of Clinical Dermatology. 6
th
Ed. New York: The McGraw Hills, Inc.; 2009. p. 803-4
Sarma N. Hand, foot, and mouth disease: Current scenario and Indian Perspective. Indian J Dermatol Venereol Leprol 2013; 79: 165-75
Pemeriksaan Penunjang
A). Positive immunostaining of EV71 antigens in neuron and neuronal
process. Original magnification, X158. B). Positive immunostaining of EV71
antigens in necrotic area. Original magnification, X158. C). An array of
picornavirus particles in a neuron (electron micrograph).
Diagnosis Banding
Herpangina Varicella Stomatitis
Aphthous
Erupsi Obat Eritema
Multiforme
Herpes
Gingivostomatitis
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed.
New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Komplikasi
Jarang
Eczema coxsackium
Dehidrasi
Meningitis aseptik
Enterovirus 71
Ensefalitis
Ensefalomielitis
Polio-like syndrome
Miokarditis
Edema paru
Perdarahan paru
Kematian
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed.
New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Tatalaksana
U
m
u
m

Edukasi
Penyakit
Virus di tubuh 1
bulan
Self limiting
Pencegahan
Penularan
Bintil jgn
pecahkan
Keparahan
Istirahat
Minum
Diet lunak

K
h
u
s
u
s

Topikal
Larutan dyclonine
hydrochlorida 0,5%
atau gel lidokain
(AC)
Sistemik
Simtomatik
Antipiretik
Analgesik
IVFD
Milrinone (cyclic
phosphodiesterase-
inhibitor)
IgG iv
Pencegahan
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed. New York: The McGraw Hills, Inc.; 2012. p. 2360-62
Centers for Disease Control and Prevention. Hand, Foot, and Mouth Disease : Prevention and Treatment. Available from: http://www.cdc.gov

Prognosis
Self-limiting disease, sembuh dalam kisaran 7-10 hari,
prognosisnya baik
Pengguna imunosupresan atau neonatus : berkembang
menjadi komplikasi yang mengancam jiwa.
17
Beberapa kasus : demam yang lama, keluhan sistemik,
diare, dan nyeri sendi.
5

Ooi, MH et al. Clinical Features, Diagnosis, and Management of Enterovirus 71. Lancet Neurology 2010; 9: 1097-1105
Ahmed AM et al. Viral Disease. In: Wolff K, et al. Fitzpatricks Dermatology in General Medicine. 8
th
Ed. New York: The
McGraw Hills, Inc.; 2012. p. 2360-62