Imunopatofisiologi Kep

7/23/2019 Imunopatofisiologi Kep

1/96

IMUNOPATOFISIOLOGI

Aris Dwi Cahyono, S.Kep.Ns., M.Kes.


2/96

Pertahanan nonspesifi

! "arrier fisi

! "ahan anti#ateri

! Miroor$anis%e o%ensa&! Fa$osit

! Inf&a%asi

! De%a%


3/96

Ko%p&e%en

! Protein 'a&a% 'arah yan$ #erperan 'a&a%

pertahanan t(#(h

!Se#anya )* protein y$ terati+asi searaasa'e

! Terati+asi %e&a&(i - a&(r / a&(r &asi,

a&ternatif 'an Mannose0#in'in$ Letin


4/96

Ati+asi o%p&e%en


5/96

Pertahanan Spesifi

! Li%fosit T

! Li%fosit "

! Anti#o'i


6/96

Li%fosit T

! Mat(rasi 'i ti%(s

! Me%i&ii T Cell Receptor1TC23

! Men$ena& anti$en! Me%i&ii (taan tipe 1C&one3

! Me%i&ii #er#a$ai tipe se&


7/96

Tipe Li%fosit T

! T he&per 4 CD 5/ %e%#ant( 'an

%en$ati+asi sisti% i%(n

!T sitotosi 4 CD 6 / %e%#(n(h se& yan$terinfesi +ir(s

! T re$(&ator / %e%#ant( %ere$(&asi7

%en$at(r sisti% i%(n


8/96

Li%fosit "

! Pro'(si anti#o'i

! Mat(rasi 'i s(%s(% t(&an$

! Me%i&ii anti#o'i se#a$ai reseptornya


9/96

Anti#o'i

! Protein #er#ent( h(r(f 8

! Me%i&ii #a$ian/

! Fa#/ anti$en #in'in$ fra$%ent! Te%pat %e&eat anti$en

! F/ rista&&i9a#&e fra$%ent

! Te%pat %e&eat pa'a reseptor anti#o'i


10/96

Anti#o'i


11/96

Ke&as Anti#o'i

! I%(no$&o#(&in/

! I$ M / perta%a a&i ter#ent(

! I$ G / ter#ent( e'(a, ter#anya '&%'arah

! I$ : / %eran$san$ 7 %e%i( a&&er$i

! I$ D / s#$ reseptor (nt( anti$en! I$ A / 'iseresi &ewat ASI, Li(r, air %ata


12/96

2eseptor anti#o'i

! Te%pat %e&eatnya anti#o'i sete&ah

%en$iat anti$en

! Ter'apat pa'a se&/ Marofa$, Ne(trofi&,

:osinofi& 'an Se& Mast

! "erf(n$si 'a&a% %e%per%('ah

fa$ositosis 'an pe&epasan %e'iator

inf&a%asi


13/96

;arin$an Li%foi'

! Se& &i%fosit T 'an " yan$ #erasa& 'ari

Ti%(s 'an S(%s(% t(&an$ aan

%enye#ar e/

! Ke&enar $etah #enin$

! Tonsi& 1 %(&(t3

! Li%pa! Peyer p&a


14/96

2espon I%(n

! Anti$en yan$ %as( aan 'i tan$ap o&eh

Fa$osit

! Fa$osit %e%presentasian e Li%fosit T

! Li%fosit T aan %e%#eritah( Li%fosit ",

'an %eran$san$ (nt( %e%pro'(si

anti#o'i


15/96

2easi hipersensiti+itas


16/96

2easi hipersensiti+itas TIP: =

! Diperantarai I$ :

! I$ : %en$iat anti$en 1 A&&er$en 3

! I$ : %e&eat pa'a reeptornya pa'a#asofi&0 %ast e&& 'an %enye#a#an

&epasnya %e'iator inf&a%asi

! Me'iator inf&a%asi aan %enye#a#ant(#(h %en$a&a%i per(#ahan


17/96

Penyait pa'a >S tipe =

! Siste%i anafi&asis

! Asth%a

! :9e%a! A&&er$y %aanan

! Urtiaria


18/96

2easi hipersensiti+itas TIP: )

! Di perantarai o&eh I$ G 'an Ko%p&e%en

! Anti$en pa'a per%(aan se& aan

%eran$sa%$ %e&eatnya I$G

! "eri(tnya I$G aan %eran$san$

%e&eatnya o%p&e%en

! I$G 'an o%p&e%en aan %e&eat pa'aLi%fosit T sitotosi yan$ #erai#at

er(saan pa'a se& terse#(t


19/96

Penyait pa'a >S Tipe )

! 2easi Tranf(si

! :ritro#&astosis Foeta&is

! Ane%ia he%o&iti a(toi%(n


20/96

2easi hipersensiti+itas TIP: -

! Di perantarai Anti$en0anti#o'i o%p&es

! A$0A# Ko%p&es %eran$san$ ati+asi

o%p&e%en

! Ati+asi o%p&e%en %eran$san$

'atan$nya se& inf&a%asi ter(ta%a ne(trofi&

e te%pat terse#(t


21/96

Penyait pa'a >S tipe -

! 2easi Arth(s

! Ser(% siness

! G&o%er(&onephritis! 2he(%atoi' arthritis

! Siste%i L(p(s :rithro%atos(s


22/96

2easi hipersensiti+itas TIP: 5

! Diperantarai o&eh se&

! Anti$en aan %en$ati+asi se& T

%e&epasan %e'iator, Me'iator aan

%eran$san$ ati+asi Marofa$ ata(

Li%fosit T sitotosi

! Marofa$ ata( T sitotosi aan %er(sa

se& ata( arin$an


23/96

Penyait pa'a >S tipe 5

! Der%atitis onta

! Lesi Gran(&o%a

! Graft 2eetion


24/96

A&&er$i

! Meanis%e >S tipe =

! Atopi / >S pa'a in'i+i'( tertent(

! Men$enai sat( sa%pai #e#erapa or$anyan$ %e%#erian %anifestasi yan$

#er#e'a


25/96

Anafi&asis

! Meanis%e >S tipe =

! Mer(paan a&&er$i siste%i %en$enai

or$an +as(&er, pernafasan , (&it 'an

&ainnya.

! Tera'i %en'a'a sete&ah terena a&er$en

! Syo anfi&asis / anafi&asis 'isertaipen(r(nan teanan 'arah 1syo3.


26/96

Definisi Anafi&asis

! Anafi&asis a'a&ah sin'ro%a &ini yan$ #er(pa

reasi a&er$i siste%i yan$ #erat yan$ 'i sti%(&i

o&eh a&er$en, onset %en'a'a 'an ti'a

#erahir 'a&a% )5 a%, %en$enai sat( ata(&e#ih siste% or$an 'an %e%#erian sat( ata(

&e#ih $ea&a seperti (rtiaria, f&(shin$, $ata&,

an$ioe'e%a, stri'or, whee9in$, nafas pen'e,

+o%itin$, 'iare ata( syo.Canadian Pediatric surveillance program, 2002


27/96

Definisi Anafi&asis

! 2easi A&er$i siste%i a(t yan$

%en$enai #e#erapa siste% or$an

ter(ta%a Kar'io+as(&ar, 2espirasi, K(&it

'an Gastrointestina&, yan$ %er(paanreasi i%(no&o$is arena terpapar a&er$en

pa'a pen'erita yan$ tersensitisasi.

A##a I Terr, )**-


28/96

Syo Anafi&ati

'an 2easi Anafi&atoi'Syo Anafi&ati

! Anafi&asis 'isertai hipotensi 'en$an ata(tanpa pen(r(nan esa'aran

2easi Anfi&atoi'

! Kon'isi 'en$an tan'a 'an $ea&a

anafi&asis tanpa a'anya %eanis%ereasi anti$en0anti#o'i


29/96

:pi'e%io&o$i

! Ti'a 'ietah(i seara $eo$rafis, rasia&'an pre'i&esi ses

! *.5 as(s tiap se(ta pertah(n pa'a

pop(&asi (%(%! Di&aporan *.*-0*.*? per =*** pasien

M2S

! Men(n(an #ahwa pen$o#atan 'anpro'( #io&o$is yan$ a'i penye#a#nya

! Penye#a# @** e%atian pertah(n 'i AS


30/96

A&er$en Anafi&asis

! Maanan/ Ian, s(s(, te&(r, ('an$,

epitin$, eran$ serta aan$0aan$an

! O#at0o#atan/ Ana&$esi, opiat 'an ra'io

ontras

! Gi$itan ata( sen$atan seran$$a

! Lates


31/96

A&&er$en Mo'e of Ation


32/96

Foo' A&&er$en

! U'an$

! Kepitin$

! Te&(r

! Keran$

! S(s(

! Kaan$


33/96

Dr($s A&&er$en

! Protein 'an

Po&ipepti'a >etero&o$

! >or%on , :n9i%,

asin! >apten

! Anti#ioti, ita%in,

a$en Dia$nosti


34/96

Inset eno%

! Le#ah Ma'(

! Se%(t Merah ata(

Api

! Basp

! >ornet

! esp(&a


35/96

Lates


36/96

Patofisio&o$i Anafi&asis

! 2easi A&er$i

! Coo%# 'an Ge&& / >ypersensiti+ity Tipe =

! Se& Uta%a yan$ ter&i#at/ Mast Ce&& 'an"asophi&

! Prinsip / reasi A&er$en 4Anti#o'i

! Anti#o'i / I%(no$&o#(&in :


37/96

2easi A&er$i


38/96

Coo%# an' Ge&&

>ypersensiti+ity


39/96

Mast Ce&&


40/96


41/96


42/96


43/96

Anafi&asis

I+an M 2oitt 1)**-3 %e%#a$i proses Anafi&asis%ena'i - Fase/

! Fase Sensitisasi

%ast e&& #eriatan 'en$an a&&er$en perta%a a&i! Fase Ati+asi

Mast e&& terpapar a&&er$en e'(a a&i

De$ran(&asi Mast Ce&&

! Fase :fetor

:fe %e'iator pa'a or$an tar$et


44/96


45/96

De$ran(&asi Mast Ce&&


46/96


47/96


48/96


49/96

Tan'a 'an Gea&a Anafi&asis


50/96

Gea&a Awa& 'an K(&it

! Sait epa&a

! P(sin$

! Gata&

! 2asa Panas

Pa'a K(&it /

! :rite%a F&(shin$,%a(&opap(&ar rash

! Urtiaria

! An$ioe'e%a


51/96

An$ioe'e%a


52/96

Urtiaria


53/96

O(&ar

! Con(ti+itis

! Pr(rit(s

! inesi on(n$ti+a

! Lari%asi


54/96

Tan'a Kar'io+as(&ar

Kar'ioas(&ar! Tahyar'ia,

hypotension,

! syo, %yoar'ia&ishae%ia 7 infar,

! ar'ia arrest

! Diaphoresis! >iposia

! Arit%ia


55/96

2espirasi

! Sa&(ran Nafas Atas/Kon$esti nasa&, snee9in$,hoarseness, stri'or,orofarin$ 'an &arin$

e'e%a, #at( 'ano#str(si

! Sa&(ran Nafas "awah/Dyspnea, "ronhospas%,tahypnea, aesory

%(s&e (se, yanosis,respiratory arrest


56/96

Gastrointestina&

! M(a&

! M(ntah

! Cra%pPer(t

! Diare

! Uro$enita& / spas%e,

nyeri

! Sen'i/ arthra&$ia


57/96

Siste% Saraf P(sat

! Parestesi

! Kesa'aran %en(r(n

! Beaness

! Kon+(&si

! Ko%a

! Di99ines

! Synope


58/96

Dia$nosis

! Ana%nesa paparan A&er$en

! Gea&a K&inis

!Pe%erisaan Fisi! Pe%erisaan La#oratoris


59/96

Dia$nosa Diferensia&

! As%a Atta

! Syo #ent( &ain

! :'e%a par(

! Arit%ia ant(n$

! Kean$

! intosiasi o#at

! Urtiaria


60/96

Ko%p&iasi

! Ke%atian

! Ker(saan ota

per%anen

! Urtiaria an$ioe'e%a#er%in$$(

! Myoar' infar

! A#orsi! Ga$a& Gina&


61/96

Pre+ensi Anafi&asis

Ce$ah reasi (&an$

Ana%nesa penyait a&er$i

I'entifiasi 'an hin'ari a&er$en ata( penye#a# &ain.

Sin test (nt( o#at inesi

:neran o#at inesi

Catat ata( tanyaan P o#t y$ %enye#a#an a&er$i

"i&a %(n$in $(naan o#at seara perora& saa.

O#ser+asi pen'erita se&a%a -* %enit sete&ah pe%#erian

o#at yan$ #erisio tin$$i.


62/96

Pre+ensi Anafi&asis


63/96

Penyait A(toi%(n

! Anti#o'i ata( se& T %e&awan se&f anti$en

! Interasi anti#o'i ata(se& T terha'ap

arin$an #erpen$ar(h pa'a proses

penyait

! Tera'i 'isf(n$si i%(n

! Penyait #isa tertranfer %e&a&(i A" ata(

se& T


64/96

Penyait A(toi%(n

Or$an spesifi

! Gra+e 'isease

! DM tipe =

! Myasthenia $ra+is

Siste%i

! 2he(%atoi' arthritis

! S&ero'er%a siste%i

! SL:


65/96

I%(no'efisiensi

Pri%er

! Se& " 'efisiensi

! Se& T 'efisiensi

! Se& " T

Se(n'er

! O#at / ortiosteroi'7

sitostatia! Penyait %eta#o&i/

DM

! Infesi / AIDS! Kaner

! Diet0 Ma&n(trisi


66/96

AIDS

! Dise#a#an o&eh >(%an

I%%(no'efiieny ir(s 1>I3 yan$

%e%#erian $ea&a pen(r(nan ee#a&an

t(#(h! Perta%a a&i 'ietah(i tah(n =E6=

! >I 'ite%(an seara #ersa%aan o&eh 2.

Ga&&o 1AS3 'an L( Montainier 1Peranis3


67/96


68/96

Trans%isi >I

! Lewat sa&i+a, air %ata,(rine, CSF,ser(%,

se& 'arah, se%en, seresi +a$ina&

! Ati+itas ses(a&

! Ker(saan %e%#ran %(osa 1tra(%a,

infetion3

! Inesi 1I &ine3

! Transf(si


69/96

>I

! Mer(paan 2NA retro+ir(s 'apat

%e%#(at DNA 'ari 2NAnya arena

%e%i&ii RNA Reverse Trancriptase

! Me%i&i ) +arian/>I0= 'an >I0)

! >I0=, pre'o%inan, %en$infesi %an(sia

! >I0), 'ite%(an 'i Afria, trans%isi &ewat

heteroses(a&


70/96

>I


71/96

Geneti >I

Gen (ta%a! :n+0 en+e&op protein, $p=?*

$p=)* 'an $p5=

! Ga$0 ore protein, p)5,p=H, pE'an pH

! Po&0 en9y%e re+ersetranriptase, inte$rase 'anprotease

Gen re$(&ator

! tat0ati+asi tranripsi DNA

+ir(s! Nef0%e%#ant( rep&iasi +ir(s

! 2e+0 %e%#ant( re$(&asiati+itas %02NA


72/96

>I enter

! >I $p=)* #eriatan '$ CD5 'an CC2@

! >I f(si 'an entry '$ %e'ia $p5=


73/96

>I enter


74/96

Asse%#&y +irion


75/96

Co 2eeptor >I


76/96

2o&e of Co reeptor >I


77/96

Pato$enesis >I

! Tar$et (ta%a 'a&ah se& Th CD5, 'i &ysis

o&eh +ir(s

! "e#erapa se& yan$ %e%i&ii CD 5 'apat

terinfesi 1Marofa$, strosit, 'en'ritiCe&&3ti'a &ysisreser+oir +ir(s &aten


78/96

Infesi >I


79/96

>I ' T > &


80/96

>I pa'a T >e&per

! Ati+itas nor%a&%en$hi&an$

! Dep&esi %onosit7%arofa$, se& ",ne(trofi&, anti#o'i, NKe&&s

! Pen(r(nan f(n$siADCC, fisasio%p&e%en,Inf&a%asi, Opsonisasi'an fa$ositosis


81/96

>I i f i t i ti


82/96

>I 4infesi oport(nisti

! T he&per %aa tera'i pen(r(nan sitoin

'an e%e%p(an %e&awan infesi

! Tera'i infesi a$en en'o$en 'an

nosoo%ia& antara &ain/ Pne(%oystis,CM, Toop&as%a, Can'i'a,

Myo#ateri(%, >erpes +ir(s 'an

Cryptoo(s! Tera'i KaposiJs saro%a,'an &y%pho%a

S t I f i >I


83/96

Spetr(% Infesi >I

! Infesi a(t

! Infesi asi%pto%ati

! Li%fa'enopati $enera&isata persisten

1PGL3

! AIDS0re&ate' Co%p&e 1A2C3

!AIDS


84/96

I f i A t >I


85/96

Infesi A(t >I

! Seroon+ersi ne$atif e Positif

! Gea&a %a&aise, 'e%a%, r(a%

%a(&opap(&ar, 'iare 'an &i%fo'enopati

! "e&&s pa&sy

! Monon(&eosis #e#erapa %in$$(

!Menin$itis0&ie

I f i i t ti >I


86/96

Infesi asi%pto%atis >I

! Seroon+ersi positif

! P ta%pa sehat se&a%a #ertah(n0tah(n

! D '$ #iaan ser(% 'an anti#o'i

! Para%eter i%(no&o$is Nor%a&

Li%fa'enopati Genera&isata


87/96

Li%fa'enopati Genera&isata

Persisten 1PGL3

! Li%fa'enopati &e#ih'ari = % pa'a &e#ih

'ari = e&enar,

se&a%a = #(&an

! Ter'apat 'e%a% 'an

%a&aise

AIDS & t ' C & 1A2C3


88/96

AIDS re&ate' Co%p&e 1A2C3

! Di tan'ai 'e%a%, %a&aise, e&e%ahan(%(%, erin$at %a&a%, 'iare 'an

pen(r(nan ""

! Para%eter i%(no&o$is ti'a #(r(

AIDS


89/96

AIDS

! A2C 'isertai pen(r(nan para%eteri%(no&o$is yan$ #(r(

! Ter'apat infesi oport(nisti 'an

e$anasan seperti Pne(%oystis,KaposiJsSaro%a,Toop&as%osis, Cyto%e$a&o+ir(s

! De%entia, '&&

C 'i' i


90/96

Can'i'osis

K iJ S


91/96

KaposiJs Saro%a

Pne %o stis arinii


92/96

Pne(%oystis arinii

Dia$nosa AIDS


93/96

Dia$nosa AIDS

! K&inis 1si$n 'ansi%pto%s3

! :LISA

! Bestern "&ot! PC2

Therapy


94/96

Therapy

Tar$et O#at

Pen$iatan reeptor Anti$en CD5, 2ANT:S,

Anti#o'i CD5

Transripsi 2NA e DNA AT, DDC, DDI, DDA,Fosarnet

Inhi#isi +irion0%2NA Interferon , Anti#o'i

Tar$et Teraphy


95/96

Tar$et Teraphy


96/96

Terima KasihAtas Perhatiannya

Semoga Bermanfaat

Wassalamualaikum wr wb

Imunopatofisiologi Kep

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