Infeksi Gigi Sebagai Faktor Pencetus Terbanyak Henoch-Schonlein Purpura dengan Keterlibatan Ginjal

Abstract

Latar belakang.Henoch Schonlein purpura (HSP) dengan keterlibatan ginjal memiliki prognosis yang lebih buruk, dan infeksi gigi merupakan faktor risiko terbanyak terjadinya HSP dengan keterlibatan ginjal. Tujuan.Menganalisis hubungan antara riwayat infeksi gigi dan terjadinya HSP dengan keterlibatan ginjal pada anak.Metode.Penelitian retrospektif dengan rancangan potong lintang terhadap 146 anak yang didiagnosis HSP berdasarkan kriteria American College of Rheumatology(ACR) sertaEuropean League Against Rheumatism(EULAR), Pediatric Rheumatology International Trials Organization(PRINTO), dan Pediatric Rheumatology European Society(PRESS). Penelitian dilakukan di Divisi Alergi-imunologi Departemen Ilmu Kesehatan Anak Rumah Sakit Hasan Sadikin Bandung, periode Januari 2006− Desember 2012. Data pasien diambil dari rekam medis dan dianalisis menggunakan uji Chi square.Hasil.Didapatkan 146 anak dengan HSP, 93(63,7%) laki-laki dan 53(36,3%) perempuan dengan rasio 1,8:1. Rerata usia pasien 8,05±2,9 tahun. Sembilan puluh dua pasien (63%) diduga mengalami infeksi sebagai pencetus terjadinya HSP. Didapatkan 41 pasien HSP dengan keterlibatan ginjal (28%), yaitu proteinuria 6 (14,6%), hematuria 9 (22,0%), serta proteinuria dan hematuria 26 (63,4%) Infeksi gigi merupakan faktor pencetus terbanyak dibandingkan dengan faktor pencetus lainnya pada HSP dengan keterlibatan ginjal, yaitu 25 pasien (61%) dengan p=0,025; Odd ratio(OR) 2,7 (1,1–6,4) dengan interval kepercayaan 95%.Kesimpulan. Anak dengan riwayat infeksi gigi memiliki risiko tinggi untuk terjadi HSP dengan keterlibatan ginjal.

Comprehensive Dental Management of Children with Henoch-Schonlein Purpura: A Literature Review

“…Research conducted at Hasan Sadikin Hospital (RSHS) Bandung stated that there was an increase in the incidence of HSP from 2008 to 2010, and most patients had odontogenic infections. 11,27 In line with research conducted by Igawa et al26 who reported that focal oral infections may be a precipitating factor for HSP. Research conducted by Abe et al 7 in their case report concluded that periodontal infection and apical periodontitis are the main candidate factors causing HSP in these patients, 7 therefore, it is very important to maintain comprehensive oral health in HSP patients.…”

“…7 Ghrahani et al 11 in their research conducted at the Department of Pediatrics at Hasan Sadikin Hospital (RSHS) Bandung from 2006 to 2011 found that 13.3% of HSP cases were probably caused by odontogenic infections. Another study also conducted at RSHS Bandung in 2013 found that in 41 patients with HSP with kidney involvement, odontogenic infection was the most precipitating factor compared Advances in Health Sciences Research, volume 48 to other precipitating factors, as many as 25 patients, 27 this requires special attention because it can become a focus of infection. 11 All these data indicate that chronic infection that occurs in the oral cavity plays a role in the occurrence of the pathogenic process in HSP.…”

“…Bacterial pathogens on the other hand can enter the blood vessels during transient bacteremia and damage the inner lining of the blood vessel walls, therefore odontogenic infections, especially chronic apical periodontitis, are potential triggers for HSP. 27,28 The results of a study conducted by Abe et al7 showed that proper treatment of focal odontogenic infections can help heal HSP. Nakaseko et al 29 also stated that comprehensive management of dental infections would reduce the incidence of HSP with renal involvement.…”

“…Patients with HSP need to be consulted to the Dental and Oral Department to find a focus of infection and comprehensive management to prevent the occurrence of HSP with renal involvement. 27 Children with HSP, as well as patients with certain medical conditions (such as cardiovascular disease) also need to be carefully considered as candidates for patients requiring prophylactic antibiotic therapy prior to dental procedures. This condition is due to various studies showing that odontogenic infections and dental procedures have the potential to trigger HSP with renal involvement in pediatric patients.…”