Leptospirosis pada Anak

Leptospirosis pada Anak
Leptospirosis merupakan infeksi yang disebabkan oleh bakteri gram negatif dari golongan Spirochaeta, yaitu Leptospira sp.

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Definisi

Leptospirosis merupakan infeksi yang disebabkan oleh bakteri gram negatif dari golongan Spirochaeta, yaitu Leptospira sp. Leptospira sendiri digolongkan menjadi 2 kelompok, yaitu kelompok patogen dan non patogen. Infeksi Leptospira masuk melalui luka atau goresan di kulit atau melalui mata, hidung, atau mulut.

Tikus merupakan pembawa utama dan bakteri ini dipelihara secara alami di dalam tubuh tikus dan dikeluarkan melalui urin. Sebagian besar kasus leptospira memiliki gejala yang membuat tubuh tidak nyaman tetapi tidak membahayakan jiwa. Gejala seperti kasus flu dan berlangsung kurang dari 1 minggu.

Pada umumnya, gejala leptospirosis muncul dalam rentang waktu kurang dari 2 minggu walau beberapa kasus, gejala tidak muncul dalam waktu 1 bulan atau tidak sama sekali. Saat tubuh terinfeksi, gejala akan muncul dengan cepat seperti demam. Beberapa gejala lain seperti sakit kepala, nyeri otot, kulit dan mata kekuningan (Jaundice), muntah, diare, dan kulit kemerahan.

Leptospirosis umumnya ditemukan di lingkungan dengan cuaca lembap. Namun bakteri tersebut dapat hidup di semua daerah di bumi dan terutama ditemukan secara umum di Australia, Afrika, Asia Tenggara, Amerika Selatan dan Karibia.  

Anak - anak dapat terpapar dengan bakteri leptospira akibat aktivitas bermain dan olah raga, bermain di sungai atau danau, dan memelihara hewan peliharaan. Dalam perkembangan infeksi penyakit ini, anak - anak lebih rentan terhadap infeksi leptospira dibandingkan orang dewasa.

Penyebab

Leptospirosis disebabkan oleh bakteri leptospira. Bakteri tersebut masuk ke dalam tubuh anak melalui mulut, hidung, atau mata atau melalui kulit. Bakteri akan masuk dan menyebar di dalam tubuh melalui darah, sehingga bakteri akan menuju organ tubuh dan terkumpul di ginjal.

Bakteri dari dalam ginjal akan dikeluarkan sebagai produk samping sehingga leptospirosis dapat menyebar atau menular ke orang lain atau hewan. Leptospirosis merupakan menyakit zoonotik sehingga dapat disebarkan antara hewan dan manusia. Jalur infeksi dari penyakit ini melalui:

  • Kontak langsung dengan air kencing (urine) atau cairan reproduksi dari hewan yang terinfeksi
  • Kontak dengan air atau tanah yang terkontaminasi
  • Mengkonsumsi makanan atau air yang terkontaminasi.

Faktor Risiko

Leptospirosis dapat dimiliki oleh individu di semua jenis lingkungan namun secara umum leptospirosis lebih sering ditemukan di daerah tropis dan negara dengan iklim yang hangat dengan curah hujan yang tinggi. Risiko leptospirosis menjadi lebih tinggi apabila tinggal atau berpergian ke daerah dengan iklim tersebut yang mencakup Oseania (Australia, Selandia baru, dan kepulauan Pasifik), Karibia, bagian dari Afrika sub Sahara, bagian dari Amerika Latin, Asia selatan, dan Asia tenggara.

Gejala

Leptospirosis memiliki gejala seperti flu dan dapat muncul tanpa gejala. Leptospirosis dalam kasus yang parah dapat menyebabkan gejala pendarahan internal dan kerusakan organ. Dalam kondisi leptospirosis akut, gejala dapat muncul tiba - tiba. Gejala tersebut mencakup demam yang tinggi, mata kemerahan (injeksi konjungtival), sakit kepala, mengigil, nyeri otot, nyeri perut, mual dan muntah, diare, kulit dan mata kekuningan (jaundice), dan kulit kemerahan (rash).

Beberapa kondisi leptospirosis yang parah dapat muncul setelah tiga hingga sepuluh hari kemudian, seperti batuk berdarah (hemoptysis), nyeri dada, kesulitan bernapas, kulit dan mata yang kekuningan dengan parah, buang air besar yang kehitaman, terdapat darah di dalam air seni, dan munculnya bintik datar kemerahan pada kulit seperti rash (petechiae).

Diagnosa

Dokter akan mendiagnosa leptospirosis dengan melakukan pemeriksaan fisik, pemeriksaan darah dan pemeriksaan urin. Dokter akan menanyakan mengenai gejala, riwayat perjalanan dan apakah mengalami kontak dengan hal yang telah terkontaminasi. Bila memiliki gejala yang parah, pasien akan disarankan melakukan pemeriksaan Xray dada atau CT scan.

Beberapa pemeriksaan yang dilakukan untuk mendiagnosa leptospirosis, antara lain :

  • Pemeriksaan urin atau darah

Dokter akan menyarankan untuk melakukan pemeriksaan darah atau pada pemeriksaan urin  di laboratorium. Laboratorium akan melakukan pemeriksaan untuk mencari tanda dari leptospira.

  • Pemeriksaan radiologi

Apabila memiliki gejala leptospirosis, dokter akan menyarankan melakukan pemeriksaan X-ray dada, CT  scan, dan pemeriksaan radiologi lainnya. Dokter akan menggunakan alat untuk mengambil gambar dari organ anda dan melihat apakah terdapat kerusakan organ.

Tata laksana

Pengabatan leptospirosis tergantung dengan tingkat keparahan dan gejala yang dialami penderita. Secara umum, Tata laksana yang dilakukan adalah penanganan gejala dan pemberian antibiotik. Dalam kasus dengan gejala yang sedang, dokter akan mengobati sesuai gejala tanpa diperlukan perawatan. Dalam kasus leptospirosis dengan gejala yang parah, pasien dapat dirawatdi rumah sakit. Selain antibiotik, tata laksana juga dilakukan sesuai dengan organ yang terpengaruh dengan penyakit.

Secara umum, tata laksana dari leptospirosis mencakup:

  • Tata laksana cairan dan demam

Dalam beberapa kasus leptospirosis dengan gejala sedang dapat diobati dengan pengobatan sederhana seperti meminum cairan dengan jumlah yang banyak, beristirahat, dan mengkonsumsi obat demam atau nyeri.

  • Antibiotik

Antibiotik yang digunakan untuk pengobatan leptospirosis meliputi amoksisilin, ampicilin, penicilin G dan ceftriaxone. Dokter akan menentukan jenis obat yang akan digunakan berdasarkan gejala yang dialami. Untuk anak - anak di bawah 8 tahun tidak disarankan mengkonsumsi doksisiklin disebabkan adanya potensi efek samping seperti adanya bercak permanen pada gigi.

  • Alat ventilasi

Apabila paru - paru terinfeksi dengan bakteri dan memiliki penderita menunjukkan gejala yang berat, penderita dapat memiliki kesulitan untuk berapas dan membutuhkan bantuan mesin untuk bernapas. 

  • Plasmapheresis

Plasmapheresis atau pertukaran plasma dapat dilakukan apabila penderita memiliki risiko kerusakan organ akibat leptospirosis. Selama prosedur tersebut, dokter akan mengambil darah dengan menggunakan selang yang terpasang pada pembuluh darah. Mesin khusus akan memisahkan plasma dari darah yang diambil dan mengganti dengan plasma pengganti. Darah dengan plasma yang telah diganti akan dikembalikan ke tubuh melalui selang lain.

Komplikasi

Pengobatan dapat mengurangi beratnya tingkat leptospirosis. Tanpa adanya pengobatan lebih lanjut dapat menyebabkan komplikasi seperti meningitis, gagal hati, kerusakan ginjal yang dapat menyebabkan gagal ginjal, gangguan pernapasan, kolaps hemodinamik (syok), kematian fetus (di ibu hamil). Beberapa kasus dapat menyebabkan kematian.

Pencegahan

Pencegahan terbaik dari leptospirosis adalah menghindari hal yang terkontaminasi dengan bakteri. Salah satunya adalah dengan tidak berenang atau bermain di dalam air yang terdapat air sei hewan, meliputi saat banjir.

Beberapa cara untuk mengurangi risiko, antara lain:

  • Mengkonsumsi obat pencegahan

Bila sering berpergian dan memiliki risiko tinggi leptospirosis, tanyakan pada dokter anda terkait obat yang perlu dikonsumsi untuk mencegah sakit (profilaksis)

  • Menghindari hewan yang mungkin memiliki leptospirosis
  • Mengenakan pakaian dan sepatu pelindung apabila bekerja disekitar hewan
  • Hindari olahraga air dan berenang di sungai dan danau setelah banjir
  • Minum hanya air yang telah diolah.

Tidak meminum air dari sungai, danau dan kanal tanpa merebus terlebih dahulu

  • Mengenakan sarung tangan bila anda menyentuh hewan yang sudah mati.
  • Menutup luka terbuka atau goresan dengan pelindung air.

Kapan Harus ke Dokter

Hubungi dokter apabila merasa ada gejala leptospirosis. Hubungi dokter apabila berkontak dengan air atau tanah yang terkontaminasi dengan bakteria.

Segera hubungi unit gawat darurat bila menunjukkan gejala seperti batuk berdarah, nyeri dada, kesulitan bernapas, kulit dan mata kemerahan, darah di air kencing, berkurangnya frekuensi berkemih, dan bintik merah seperti ruam di kulit.

Mau tahu informasi seputar penyakit lainnya? Cek di sini, ya!

Writer : dr Kevin Luke
Editor :
  • dr. Pandu Lesmana
Last Updated : Kamis, 6 Juni 2024 | 04:14

Overview of Leptospirosis in Humans. (2022). Retrieved 06 March 2023, from https://www.healthline.com/health/leptospirosis

Leptospirosis. (2021). Retrieved 06 March 2023, from https://emedicine.medscape.com/article/220563-overview

Leptospirosis. (2022). Retrieved 06 March 2023, from https://www.ncbi.nlm.nih.gov/books/NBK441858/

Leptospirosis. (2022). Retrieved 06 March 2023, from https://my.clevelandclinic.org/health/diseases/24021-leptospirosis

Leptospirosis. (2019). Retrieved 06 March 2023, from https://www.cdc.gov/leptospirosis/index.html

Leptospirosis. (2020). Retrieved 06 March 2023, from https://medlineplus.gov/ency/article/001376.htm 

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      • 3: 0
      Hints
      • Use SELECT * only if you need all columns from table
      • The != operator is not standard. Use the <> operator to test for inequality instead.
      Backtrace
      • app/Repositories/Categories/CategoryHealtTopics.php:11
      • app/Http/Controllers/WebController.php:376
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • WebController.php#377aicare_prod_new145msselect * from `posts` where `status` = 1 and `publish_date` <= '2025-05-15 08:02:09' and `content_type` = 'article' and `posts`.`deleted_at` is null order by RAND() limit 7
      Bindings
      • 0: 1
      • 1: 2025-05-15 08:02:09
      • 2: article
      Hints
      • Use SELECT * only if you need all columns from table
      • ORDER BY RAND() is slow, try to avoid if you can. You can read this or this
      Backtrace
      • app/Http/Controllers/WebController.php:377
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • WebController.php#391aicare_prod_new8.55msupdate `posts` set `views_count` = 812 where `id` = 6651
      Bindings
      • 0: 812
      • 1: 6651
      Backtrace
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
      • vendor/laravel/framework/src/Illuminate/Routing/Route.php:205
    • ActivityLogger.php#174aicare_prod_new4.72msinsert into `activity_log` (`log_name`, `properties`, `batch_uuid`, `event`, `subject_id`, `subject_type`, `description`, `updated_at`, `created_at`) values ('default', '[]', null, 'updated', 6651, 'App\\Models\\Admin\\Post', 'updated', '2025-05-15 08:02:09', '2025-05-15 08:02:09')
      Bindings
      • 0: default
      • 1: []
      • 2: 
      • 3: updated
      • 4: 6651
      • 5: App\Models\Admin\Post
      • 6: updated
      • 7: 2025-05-15 08:02:09
      • 8: 2025-05-15 08:02:09
      Backtrace
      • vendor/spatie/laravel-activitylog/src/ActivityLogger.php:174
      • vendor/spatie/laravel-activitylog/src/Traits/LogsActivity.php:88
      • app/Http/Controllers/WebController.php:391
      • vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
    • single-post-healthpedia.blade.php#37aicare_prod_new900μsselect * from `users` where `users`.`id` = 43 limit 1
      Bindings
      • 0: 43
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::web.v2.single-post-healthpedia:37
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.4msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6925 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6925
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.32msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2893 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2893
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.21msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 5584 and `categories`.`deleted_at` is null
      Bindings
      • 0: 5584
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.15msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 524 and `categories`.`deleted_at` is null
      Bindings
      • 0: 524
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.34msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8210 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8210
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.18msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 8111 and `categories`.`deleted_at` is null
      Bindings
      • 0: 8111
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • article-popular.blade.php#8aicare_prod_new7.31msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6775 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6775
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.article-popular:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new7.31msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2838 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2838
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new7.33msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 2988 and `categories`.`deleted_at` is null
      Bindings
      • 0: 2988
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new7.31msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3027 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3027
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new7.31msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 6702 and `categories`.`deleted_at` is null
      Bindings
      • 0: 6702
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • related-article.blade.php#8aicare_prod_new7.34msselect `categories`.*, `category_post`.`post_id` as `pivot_post_id`, `category_post`.`category_id` as `pivot_category_id`, `category_post`.`created_at` as `pivot_created_at`, `category_post`.`updated_at` as `pivot_updated_at` from `categories` inner join `category_post` on `categories`.`id` = `category_post`.`category_id` where `category_post`.`post_id` = 3953 and `categories`.`deleted_at` is null
      Bindings
      • 0: 3953
      Hints
      • Use SELECT * only if you need all columns from table
      Backtrace
      • view::web.v2.partials.related-article:8
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#122aicare_prod_new1.31msselect * from `pages` where `slug` = 'about-us' limit 1
      Bindings
      • 0: about-us
      Hints
      • Use SELECT * only if you need all columns from table
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:122
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#547aicare_prod_new880μsselect * from `faqs` limit 1
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      • LIMIT without ORDER BY causes non-deterministic results, depending on the query execution plan
      Backtrace
      • view::layouts.v2.web_layout:547
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    • web_layout.blade.php#551aicare_prod_new1.2msselect * from `term_policies`
      Hints
      • Use SELECT * only if you need all columns from table
      • The SELECT statement has no WHERE clause and could examine many more rows than intended
      Backtrace
      • view::layouts.v2.web_layout:551
      • vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • vendor/livewire/livewire/src/Mechanisms/ExtendBlade/ExtendedCompilerEngine.php:22
      • vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:72
    App\Models\Admin\Post
    192Post.php#?
    App\Models\Admin\Category
    25Category.php#?
    App\User
    4User.php#?
    App\Models\Admin\Tag
    3Tag.php#?
    App\Models\TermPolicy
    3TermPolicy.php#?
    App\Models\Admin\Healthpedia
    1Healthpedia.php#?
    App\Models\Admin\Page
    1Page.php#?
    App\Models\Admin\Faq
    1Faq.php#?
        locale
        id
        _token
        hQGJzrrXofgEyxVgiXR1JB33TH0qBy6aQN5dEZoY
        _previous
        array:1 [ "url" => "https://ai-care.atmatech.id/healthpedia-obat/leptospirosis-pada-anak" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        path_info
        /healthpedia-obat/leptospirosis-pada-anak
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:19 [ "accept-encoding" => array:1 [ 0 => "gzip, deflate, br, zstd" ] "sec-fetch-dest" => array:1 [ 0 => "document" ] "sec-fetch-user" => array:1 [ 0 => "?1" ] "sec-fetch-mode" => array:1 [ 0 => "navigate" ] "sec-fetch-site" => array:1 [ 0 => "none" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "sec-ch-ua-platform" => array:1 [ 0 => ""Windows"" ] "sec-ch-ua-mobile" => array:1 [ 0 => "?0" ] "sec-ch-ua" => array:1 [ 0 => ""Chromium";v="130", "HeadlessChrome";v="130", "Not?A_Brand";v="99"" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] "x-real-ip" => array:1 [ 0 => "3.141.196.30" ] "x-forwarded-for" => array:1 [ 0 => "3.141.196.30" ] "x-forwarded-proto" => array:1 [ 0 => "https" ] "x-forwarded-scheme" => array:1 [ 0 => "https" ] "host" => array:1 [ 0 => "ai-care.atmatech.id" ] "connection" => array:1 [ 0 => "keep-alive" ] ]
        request_cookies
        []
        
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