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8/19/2019 Isi Sindrom Rubella Kongenital
1/21
Minireferat Fetomaternal
SINDROM RUBELLA KONGENITAL
OLEHD. Irsat Syafardi
PEMBIMBING
dr. Risman F. Kaban M. K!d"OG# S$OG
DEPARTEMEN OBSTETRI DAN GINEKOLOGI
FAKULTAS KEDOKTERAN UNI%ERSITAS SUMATERA
UTARA
M E D A N & ' ( )
1
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DAFTAR ISI
DAFTAR ISI....................................................................................................
i
DAFTAR GAMBAR........................................................................................
ii
DAFTAR TABEL.............................................................................................
iii
BAB I PENDAHULUAN..................................................................................
1
1.1. Latar Belakang....................................................................................
11.2. Tujuan..................................................................................................
2
1.2.1. Tujuan Uu......................................................................................
21.2.2. Tujuan !"u#u#....................................................................................
21.$. Man%aat...............................................................................................
2
BAB II TIN&AUAN PUSTA!A.........................................................................
$
2.1. De%ini#i.................................................................................................
$2.2. E'i(ei)l)gi........................................................................................
$2.$. Pen*e+a+............................................................................................
,
2
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2.,. Pat)gene#i#.........................................................................................
-2.. Mani%e#ta#i !lini#.................................................................................
/2.-. Diagn)#i#.............................................................................................
112.0. Penatalak#anaan................................................................................
1$2./. Penega"an........................................................................................
1,
BAB $ PENUTUP...........................................................................................
1,
$.1. !e#i'ulan..........................................................................................
1-
DAFTAR PUSTA!A........................................................................................
10
DAFTAR GAMBAR
Ga+ar 1.......................................................................................................
3
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DAFTAR TABEL
Ta+el 1.........................................................................................
1
Ta+el 2.........................................................................................
1,
4
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BAB IPENDAHULUAN
(.(. Latar B!*a+an,
Ber(a#arkan (ata (ari 3H45 'aling ti(ak 2$-. ka#u# Sin(r)
Ru+ella !)ngenital 6SR!7 terja(i #etia' ta"un (i negara8negara
+erke+ang (an (a'at eningkat 1 kali li'at 'a(a #aat terja(i
e'i(ei. Se+elu 9ak#in Ru+ella (iteukan5 e'i(eik Ru+ella (i
negara aju unul 'a(a inter9al $81 ta"un. Setela" 'eneuan
9ak#in 'a(a ta"un 1:-:5 in#i(en#i Ru+ella enurun (ra#ti# enja(i
"an*a , 'en(erita 'er 1. ')'ula#i 'er ta"un (i (unia (engan
2$082, ka#u# 'er ta"un.152
Sin(r) Ru+ella !)ngenital 6SR!7 a(ala" in%ek#i tran#'la#enta
'a(a janin (engan Ru+ella5 +ia#an*a 'a(a ke"ailan trie#ter
'ertaa5 *ang (i#e+a+kan )le" in%ek#i aternal. Ma#ala" utaa
a(ala" ri#ik) keaatan 'a(a +a*i (ala in#i(en#i *ang #angat
tinggi. In%ek#i aternal 'a(a trie#ter 'ertaa /; akan
5
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en*e+a+kan in%ek#i %etu#5 +ila terja(i 'a(a trie#ter ke(ua5 "an*a
2; %etu# *ang akan terin%ek#i5 (an +ila terja(i 'a(a trie#ter $5
$81;.$
Diagn)#i# SR! #ulit (ik)n%ira#i aki+at gejalan*a *ang
a#i't)atik atau #u+klini# 'a(a aternal #e"ingga ti(ak a(a
alar untuk e'er"atikan k"u#u# janin *ang (ikan(ung. Di
#a'ing itu5 tera'i SR! juga "an*a +er#i%at #u')rti%. 4+at8)+atan
*ang (ike+angkan a#i" (i'ertan*akan keaanann*a 'a(a
8/19/2019 Isi Sindrom Rubella Kongenital
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BAB IITIN1AUAN PUSTAKA
&.(. D!finisi
Sin(r) Ru+ella !)ngenital 6SR!7 a(ala" in%ek#i tran#'la#enta
'a(a janin (engan Ru+ella5 +ia#an*a 'a(a ke"ailan trie#ter
'ertaa5 *ang (i#e+a+kan )le" in%ek#i aternal. SR! ketika +a*i
+era(a (ala kan(ungan *ang (a'at en*e+a+kan in%ek#i kr)nik
intrauterin (an engganggu 'ertu+u"an (an 'erke+angan janin
#a'ai e*i#akan aat +a
8/19/2019 Isi Sindrom Rubella Kongenital
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In%ek#i aternal 'a(a trie#ter 'ertaa /; akan en*e+a+kan
in%ek#i %etu#5 +ila terja(i 'a(a trie#ter ke(ua5 "an*a 2; %etu#
*ang akan terin%ek#i5 (an +ila terja(i 'a(a trie#ter $5 $81;.152
&anin *ang tertular +eri#ik) engalai SR!5 terutaa +ila in%ek#i
terja(i 'a(a u#ia janin ?, +ulan. SR! +ia#an*a terja(i "an*a +ila
i+u terin%ek#i 'a(a #aat uur ke"ailan a#i" kurang (ari , +ulan.
Bila #u(a" le
8/19/2019 Isi Sindrom Rubella Kongenital
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#er)l)gi# *ang e'at (an 'rakti#. Ber+agai jeni# jaringan5
k"u#u#n*a ginjal kera 'aling +aik (igunakan untuk enga#ingkan
9iru#5 karena (a'at eng"a#ilkan 'ara# 6le9el7 9iru# *ang le+i"
tinggi (an #eara uu le+i" +aik untuk eng"a#ilkan antigen.
Pertu+u"an 9iru# ti(ak (a'at (ilakukan 'a(a telur5 tiku# (an
kelini (e
8/19/2019 Isi Sindrom Rubella Kongenital
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+i)#inte#i#5 atura#i5 (an 'ele'a#an. Setela" a("e#i (an 'enetra#i5
a#a nukleat 9iru# "aru# #u(a" uncoating (i 'erukaan #el (ala
9iru# )le" enCi li#)#). !eu(ian5 akan terja(i re'lika#i (an
atura#i (an 9iru# +aru #ia' (ile'a#kan.1
@iru# Ru+ella (itran#i#ikan elalui 'erna'a#an (an engalai
re'lika#i (i na#)%aring (an kelenjar geta" +ening. @ireia terja(i
antara "ari ke8 #a'ai "ari ke80 #etela" ter'ajan 9iru# Ru+ella.
Ma#a inku+a#i 9iru# Ru+ella +erki#ar antara 1,821 "ari. Ma#a
'enularan 1 inggu #e+elu , "ari unuln*a rua./81
&.). Pat2,!n!sis
Su+er in%ek#i Ru+ella janin a(ala" (ari 'la#enta
8/19/2019 Isi Sindrom Rubella Kongenital
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in%ek#i kr)ni# *ang eru'akan k"a# Ru+ella intrauterin (ala
inggu8inggu a
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Pa(a (aera" *ang +aru akan terja(i 'ele'a#an (an 'erang#ang
ke)kin IL82 (an IFN8gaa. Sel T"e akan e'r)(uk#i IL8, (an
IL81 untuk akti9a#i re#')n iun "u)ral #el B. IFN (iteukan
+er'eran (ala akti9a#i #el N!5 eningkatkan )lekul MH15 (an
IFN8al%a elalui kina#e (an 'r)tein STAT.1
&.3. Manif!stasi K*inis
SR! (a'at en*e+a+kan gangguan 'a(a aternal (an %etal. Ma#a
inku+a#i Ru+ella a(ala" 1282$ "ari. Peri)(e in%ek#iu# a(ala" 80
"ari #e+elu )n#et unuln*a rua. Pa(a
8/19/2019 Isi Sindrom Rubella Kongenital
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Gejala 'r)(r)al ini akan +erlang#ung 18 "ari #e+elu )n#et
rua #karletini%)r *ang gatal. Li%a(en)'ati *ang unul terja(i
n)(u# li%atiku# +elakang telinga. Li%a(en)'ati eru'akan #uatu
gejala klini# *ang 'enting 'a(a Ru+ella. Pe+e#aran kelenjar li%e
+i#a ti+ul 80 "ari #e+elu ti+ul ek#antea. Bia#an*a
'e+engkakan kelenjar geta" +ening itu +erlang#ung #elaa 8/
"ari.$
Pa(a "ari ke(ua atua ketiga5 unul ')la rua Ru+ella
kale(i()#k)'i. Mula8ula akula era" u(a *ang irreguler
6+ia#an*a (ala 2, ja7 ti+ul (i le"er5 +a(an5 lengan (an
ak"irn*a (i kaki. Pa(a "ari +erikutn*a le#i ini en*atu5 e+entuk
k)')nen akul)'a'ular (an enja(i #kar atini%)ri#. Muka
#ering +e+a# rua 'a(a #aat rua 'enu" #a'ai tungkai +a
8/19/2019 Isi Sindrom Rubella Kongenital
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:; in%ek#i aternal unul #e+elu u#ia ge#ta#i 11 inggu5 $$;
'a(a u#ia ge#ta#i 11812 inggu5 11; 'a(a u#ia ge#ta#i 1$81,
inggu5 2,; 'a(a u#ia ge#ta#i 181- inggu5 (an ; 'a(a u#ia
ge#ta#i le+i" (ari 1- inggu.1
Tab!* (. 42n,!nita* d!f!5ts and *at! manif!stati2ns 2f r-b!**a
inf!5ti2n
Pr!s!nt at birt/
Au(i)l)gi an)alie# 6-0;7
• Sen#)rineural (ea%ne##
ar(ia (e%et# 612;7• Pul)nar* #ten)#i#
• Patent (utu# arteri)#u#
• @entriular #e'tal (e%et
4'"t"ali (e%et# 612;7
• Retin)'at"*
• atarat#
• Mir)'"t"alia
• Pigentar* an( )ngenital
glau)a
entral ner9)u# #*#te 612;7
• Mental retar(ati)n
• Mir)e'"al*
• Mening)ene'"aliti#
4t"er#
• T"r)+)*t)'enia
• He'at)#'len)egal*
• Ra(i)luent +)ne (i#ea#e
• "arateri#ti 'ur'ura
6Blue+err* u%%in a''earane7
Lat! manif!stati2ns
Dia+ete# ellitu#
T"*r)i(iti#
Gr)
8/19/2019 Isi Sindrom Rubella Kongenital
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'neu)nia inter#titial5 kelainan jantung k)ngenital 6'atent (utu#
ateri)#u# a(ala" kelainan *ang 'aling #ering (iteukan75 glauk)a
atau katarak k)ngenital5 (an ikr)#e%ali.0
Pa(a gejala extended (a'at unul Cerebral Palsy 5 retar(a#i
ental5 keterla+atan 'ertu+u"an (an +er+iara5 kejang5 ikteru#
(an gangguan iun)l)gi. Pa(a delayed symptoms (a'at terja(i
'anen#e%aliti#5 DM ti'e 15 atau ganguan ata'en(engaran *ang
+aru unul laa #etela" in%ek#i 'rier.10
&.6. Dia,n2sis
!)n%ira#i (iagn)#i# in%ek#i Ru+ella akut 'a(a
8/19/2019 Isi Sindrom Rubella Kongenital
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1. P)l*era#e "ain Reati)n 6PR7Ba"an 'eerik#aan (ia+il (ari air ketu+an 6airan ani)n7
atau (ara" janin. Penga+ilan #a'el air ketu+an atau 'un
(ara" janin "aru# (ilakukan )le" ()kter a"li kan(ungan (an
ke+i(anan5 (an "an*a (a'at (ilakukan #etela" u#ia ke"ailan (i
ata# 22 inggu.2. ELISA
IgM #en#iti% unutuk in%ek#i akut 'rier (an rein%ek#i. IgM
Ter(etek#i 'a(a 18 "ari #etela" unul rua5 ena'ai
'unak 'a(a "ari ke8-812 (an +erta"an "ingga 18, inggu. Titer
turun5 ti(ak ter(etek#i #etela" -812 inggu. IgG (a'at (i (etek#i
'a(a 18$ "ari #etela" unul gejala5 +erta"an #euur "i(u'.$. La+)rat)riu Heaglutina#i Pa#i%
Bila ter(a'at aglutina#i aka te(a'at anti+)(i #'e#i%ik ter"a(a'
Ru+ella.,. Uji He)li#i# Ra(ial
J)na 'a(a le'engan te# enunjukkan a(an*a iunita#
anti+)(i ter"a(a' 9iru# Ru+ella 6J)na "e)li#i# 'a(a le'engan
k)ntr)l terentang antara $58 7.
Diagn)#i# 'renatal (ilakukan (engan eerik#a a(an*a IgM (ari
(ara" janin elalui @S atau k)r()#ente#i#. !)n%ira#i in%ek#i
%etu# 'a(a trie#ter I (ilakukan (engan eneukan a(an*a
antigen #'e#i%ik Ru+ella (an RNA 'a(a @S.
Ber(a#arkan gejala klinik (an teuan #er)l)gi5 SR! (a'at
(ikla#i%ika#ikan #e+agai +erikut
1051/
1. !)n%ira#i SR! +ila te# PR atau IgM ')#iti%.2. SR! k)'ati+el +ila a(a (e%ek k)ngenital teta'i #er)l)gi#
negati%.$. SRI +ila ti(ak a(a (e%ek k)ngenital teta'i #er)l)gi# ')#iti%.,. Stillbirth +ila (i#e+a+kan Ru+ella aternal.. Bukan SR!.
Alg)rita 'enanganan i+u "ail *ang ter'ajan1
16
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&.7. P!nata*a+sanaan
Tera'i (ari SR! +ia#an*a #u')rti%5 self limited (i#ea#e5 ti(ak (a'at
(i)+ati "an*a +i#a (iega" (engan 9ak#ina#i. Baru8+aru ini5
a(aantanain "i(r)kl)ri(a 6aanta(in7 tela" (ila')rkan e%ekti% invitro (ala eng"a+at #ta(iu a
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"aru# (i#i'an (ala leari e# 'a(a #u"u , (an (igunakan
#e#egera 9ak#in ini (ilarutkan ke+ali. @ak#in (i+erikan #e+agai
#atu injek#i #u+kutan.1:
Ta+el 2. ara 'en*i'anan 9ak#in MMR (an MMR@
Pa(a )rang *ang rentan5 'r)tek#i 'a#i% (ari atau 'elea"an
'en*akit (a'at (i+erikan #eara +er9aria#i (engan injek#i
intrau#kuler Gl)+ulin Iun Seru 6GIS7 *ang (i+erikan (engan
()#i# +e#ar 65285 Lkg atau 512852 Ll+7 (ala 08/ "ari
'a#a 'eajanan. E%ekti9ita# gl)+ulin iun ti(ak (a'at (iraalkan.
Ta'akn*a tergantung 'a(a ka(ar anti+)(i 'r)(uk *ang (igunakan
(an 'a(a %akt)r *ang +elu (iketa"ui. Man%aat GIS tela"
(i'ertan*akan karena 'a(a +e+era'a kea(aan rua (iega" (an
ani%e#ta#i klini# ti(ak a(a atau inial
8/19/2019 Isi Sindrom Rubella Kongenital
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Se+elu "ail #e+aikn*a eerik#a keke+alan tu+u" ter"a(a'
Ru+ella5 #e'erti juga ter"a(a' in%ek#i T4RH lainn*a. &ika anti8
Ru+ella IgG #aja *ang ')#iti%5 +erarti 'erna" terin%ek#i atau #u(a"
(i9ak#ina#i ter"a(a' Ru+ella5 ti(ak ungkin terkena Ru+ella lagi5
(an janin 1; aan. &ika anti8Ru+ella IgM #aja *ang ')#iti% atau
anti8Ru+ella IgM (an anti8Ru+ella IgG ')#iti%5 +erarti +aru terin%ek#i
Ru+ella atau +aru (i9ak#ina#i ter"a(a' Ru+ella. Pa#ien (i#arankan
untuk enun(a ke"ailan #a'ai IgM enja(i negati%5 *aitu
#elaa $8- +ulan. &ika anti8Ru+ella IgG (an anti8Ru+ella IgM
negati% +erarti ti(ak e'un*ai keke+alan ter"a(a' Ru+ella.Pa#ien +ila +elu "ail akan (i+erikan 9ak#in Ru+ella (an
enun(a ke"ailan #elaa $8- +ulan. Bila #u(a" terlanjur "ail5
"an*a (a'at eng"in(ari %akt)r ri#ik).22
BAB IIIPENUTUP
0.(. K!sim$-*an1. Sin(r)a Ru+ella !)ngenital 6SR!7 a(ala" in%ek#i
tran#'la#enta 'a(a janin (engan Ru+ella5 +ia#an*a 'a(a
ke"ailan trie#ter 'ertaa5 *ang (i#e+a+kan )le" in%ek#iaternal.
2. Ber(a#arkan (ata (ari 3H45 'aling ti(ak 2$-. ka#u# SR!
terja(i #etia' ta"un (i negara8negara +erke+ang (an (a'at
eningkat 1 kali li'at 'a(a #aat terja(i e'i(ei.$. Pen*e+a+ Ru+ella a(ala" 9iru# Ru+ella (ari genu# t)ga9iri(ae.,. Diagn)#i# SR! #ulit (ik)n%ira#i aki+at gejalan*a *ang
a#i't)atik atau #u+klini# 'a(a aternal #e"ingga ti(ak a(a
alar untuk e'er"atikan k"u#u# janin *ang (ikan(ung.
. Tera'i (ari SR! +iaan*a #u')rti% (an self limited disease.
19
8/19/2019 Isi Sindrom Rubella Kongenital
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-. SR! "an*a (a'at (iega" (engan iuni#a#i #e+elu
ke"ailan.
DAFTAR PUSTAKA
1. D)ntign* L5 Ar#enault MK Martel M&. Rubella in pregnancy . SOGC
Clinical Practice Guidelines 2/ 2$ 18.2. ED. Survey on rubella, rubella in pregnancy and congenital rubella
sureillance systems in !"# contries. C$C 21$ 18$:.$. D. T"e Pink B))k )ur#e tet+))k 12 t" E(iti)n Se)n(
Printing. C$C 212 1 182.,. Dee'ika D5 Ra"na R5 Saran S5 R)* !! Neena M. $iagnosis of
acute rubella infection during pregnancy . % Obstet Gynecol &ndia 2-
-617 ,,8,-.. 3H4. liminating measles and rubella and preventing congenital
rubella infection. '(O 21$ 18$.-. MM3R. Prevention of measles, rubella, congenital rubella syndorme,
and mumps. C$C 21$ 18,.0. Ga++e SG5 Nie+*l &R5 Si'#)n &L5 e(#. Obstetrics)normal and
problem pregnancies. ,t" e(. Ne< K)rk "ur"ill Li9ing#t)ne5
In.221$2/$./. Batti#ti A5 K)#er &D5 Ple9ka P5 3inkler D5 Pra#a( @M5 !u"n R&5 et al.
Cryo)electron tomography of rubella virus. % *irol+ 212 2 0/8/.:. !ujala. T"e t)ga9iru# RNA Re'liati)n )'le. !niversity of (elsini
2 182.
1. Gre+er. Mechanisms of virus uncoating .
20
8/19/2019 Isi Sindrom Rubella Kongenital
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11. Na#iriR5 K)#e%%i &5 !"aje(al)e M5 Ka(i MS Delg)#"aei F. Congenital
rubella syndrome after rubella vaccination in -). /ees
periconceptiona period . &ndian % Ped 2: 0- 20:82/2.
12. En(er# G5 Nikerl8Pa"er U5 Miller E5 ra()k83at#)n &E. Outcome
of confirmed periconceptional maternal rubella. Lanet 1://11,,
0.1$. D"ian N5 Harala+ie9a I5 @ierkant RA5 PankratC @S5 R*an &E5
&a)+#)n RM5 et al. Predominant &nflammatory Cytoine Secretion
Pattern &n Response 0o 0/o $ose Of 1ive Rubella *accine &n (ealthy
*accinees. Cytoine 21 617 2,82:.1,. enter# %)r Di#ea#e )ntr)l. Control and prevention of rubella2
evaluation and management of suspected outbreas, rubella in
pregnant /omen, and surveillance for congenital rubella syndrome.
MM3R Re) Re' &ul* 1$5 216RR12712$.1. Ree% SE5 Pl)tkin S5 )r(er) &F5 !atC M5 ))'er L5 S"