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  uberculosis

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tuberculosis

- KUMAN PENYEBAB : MYCOBACTERIUM TB

- SUMBER PENULARAN : BTA (+)

- CARA PENULARAN : INHALASI

  HEMATOGEN, LIMFOGEN,  LANGSUNG

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Indonesia 10%Indonesia 10%Bangladesh 4%

China

15%

India

30%

Other 28%

Philippines 3%

Pakistan 4%

Nigeria 3%

South Africa 2%

Russia 1%

KONTRIBUSI TB INDONESIA DI DUNIA

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Definisi

• Tuberkulosis adalah penakit !

disebabkan "#Tuberkulosa

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$ioolekuler 

• "#Tb#

• $entuk lurus&elen!kun!'pan(an!&lebar 1)*u&0'3)0'+u#

• ,truktur dd ! kople-'enebabkantahan asa'apabila di .arnai'akan tetaptahan thd upaa pen!hilan!an /at .arnatsb d! larutan asa)basa

• oponen anti!en di dindin! sel dansitoplasa'aitu koponenlipid'polisakharid dan protein

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Tuberculosis

natural histor clinical features

• riar infection

• asptoatic or non)

specific sptos

fe4er' alaise' .ei!ht

loss' ni!ht s.eats

• Inhalation of tubercle

bacilli• leads to lun! infection

• In!estion of tubercle

bacilli

• tonsils cer4ical nodes

• sall bo.el .ithesenteric nodes Direct

iplantation into skin

Ghon complex:infection spreads

to involvemediastinal

nodes

Ghon focus:initial subpleuralfocus of infection

Ghon complex:infection spreads

to involvemediastinal

nodes

Ghon focus:initial subpleuralfocus of infection

Atelectase

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ost)riar Infection15)*0 ears old&chronic tb

• as a result of reacti4ation

of latent infection

• latent period bet.een

priar infection and

reacti4ation can be se4eral

decades

•

certain factors predispose

to reacti4ation

• iunosuppression' e#!#

ID,' ctoto-ics

• alnutrition

• alcoholis

• diabetes

• old a!e

 Typicallyapicallesions, often

cavitating, with orwithout pleural

eusion

 Typicallyapicallesions, often

cavitating, with orwithout pleural

eusion

 Tubercoloma/caverne

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atho!enesis of tuberculosis

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er(alanan la%iah Infeksi

uberculosis

• %cobacteriu%tuberculosis droplet 657  al4eoli paru  akrofa!  bertahan hidup berkeban! biak  enebar heato!en#

• I9:,I infeksi T$ laten

atau penakit T$ aktif ;CDC'2005*? ,all et al#'1>>*? @oo/A dan Dale' 2003

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DISSEMIATI! !" T#$E%'!SIS

%elated to immunolo(ic process

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lasifikasi

TB$:B=O,I,• Tuberkulosis paru'adalah ! eneran!

 (arin!an paru'tdk terasuk pleura#

•

1#$rdasar hasil pe%eriksaan

dahak;$ 5

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•

2#$erdasar t ipe asien;berda sar r i. aat

pen!obatan sebelu%na<

•

 a#kasus barubelu pernah ndapat OT&pernah'tapi 61 bln

•  b#asus kabuh;relaps

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•  f #asus bekas T$

•   $T ;)

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T$ :kstra paru

• "eneran! or!an tubuh selain

paru'is#kelen(ar !etah

benin!'selaputotak'tulan!'!in(al'dll#

• D- berdasar atau kultur

tepat lesi'atau bukti kliniskuat&konsisten d! T$ :kstra

paru aktif#

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.i//us

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 DI@O,I, T$

1. ANAMNESA

2. PEMERIKSAAN FISIK 

3. MATERIAL PEMERIKSAAN SPUTUM MIKROSKOPIK 

4. FOTO RONTGEN TORAKS

. PEMERIKSAAN PENUN!ANG LAIN :

  KULTUR TBC "ARI BERBAGAI,BIOBSI#SITOLOGI "ARI PLEURA#CAIRAN PLEURA#YG LAIN,

PCR, MICO"OTS "AN PEMERIKSAAN SEROLOGI YANG LAIN

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:":I0,8 DG0

"I0O,0OI,

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TU!UAN PEMERIKSAAN

MIKROSKOPIS TBC

- UNTUK MENEGAKKAN "IAGNOSIS

- MENGE$ALUASI HASIL PENGOBATAN

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PENTINGNYA PEMERIKSAAN

MIKROSKOPIS TBC

- KOMPONEN KUNCI "% TBC

- "IAGNOSA PASTI KULTUR

- KULTUR 2 BULAN "AN LEBIH MAHAL

- PEMERIKSAAN BTA 3 KALI I"ENTIK

"ENGAN KULTUR 

- PEMERIKSAAN RA"IOLOGI TERUTAMA

PA"A KASUS LAMA BANYAK TER!A"I BIAS

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Differential dia!nosis of soe coon chest H)

ra findin!s

Chest X-ray fnding Dierential

diagnosisCavitation Somebacterial pneumonias

Lung abcessesSome ungal inection

 Non-infectious causes :

Bronchialcarcinomaccupational lung disease

!nilateral infltrat "neumonia

Bronchogenic carcinoma 

Bilateral infltrat "neumonia

Connective tissue disease

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(Sumining, !! ""N#$ B%&%n, 'ei

"engo)%&%n TB sel%m% s%&u )ul%n (*p%sien +%l%upun eng%n gi-i %nis&i.%h%& cu/up )elum %p%& men%i//%n.espon imun"ene.i&% (.is/%n melu%s (S&%&us imun TB

s%ng%& i&en&u/%n sel T, m%/.of%g, limfosi&B0Digun%/%n Th1miine(23 %n "2A$"se)%g%i pem%cu

'ENGAN4A' 5I6A'ENGAN4A' 5I6A

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:8@O$ 8

B$:0B=O,I, D:,

,:,BI

:0O":8D,I GO D8

IB =D G 1>>J

0 :@OI 1' ; 2 GK: * 3G3

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0 :@OI 2' ;2 GK:,# 1GK: #

53G3:3

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 anduan Obat ntituberculosis

  abel 3# e!i%en erapi ntituberculosis 

Regimen Pilihan IndikasiKategori I   2HRZE/4H3R3a

2HRZE/4HR2HRZE/6HE

Penderita baru TB paru dengan BTA (+)Penderita TB paru BTA(-), Rontgen (+) yang a!itberat b

Penderita TB e!tra paru berat "#

Kategori II   2HRZES/HRZE/5H3R3E3a

2HRZE$/HRZE/%HRE&a'bu (reap),*aga (aiure),aai (eaut) dan !e'bai dengan BTA (+)

oi trepto'iin.-BB 00 !g. 1,%1 gr-BB 00-%1 !g. 1,% gr-BB 3 %1 !g. gr5angan diberi!an pada uia 34% tn atau anitaa'i

Kategori III   2HRZ/4H3R3a

2HRZ/4HR

2HRZ/6HE

Penderita baru BTA negati dengan rontgen poitiringan

TB e!tra paru ringand

&eterangan.a . Paduan obat yang dipa!ai di 7ndoneiab . &erua!an ua 8aringan paru dan !ondii u'u' buru!  

" . 9eningiti TB, peri!arditi, peuriti, peuriti e!udatia biatera, peritoniti, 'iier TB,oteo'ieiti, oteo'ieiti, penya!it pada 'edua pinai dengan !o'pi!ai yara, TB uu, TBauran !e'i#d . i'adeniti, peuriti e!udati:a uniatera, TB !uit, TB tuang, !e"uai tuang bea!ang, endi,

dan !een8ar adrena#WHO dan IUATLD (International Union Against Tuberculosis and Lung Disease); DEPKES RI

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:8@O$ 8 $ D

0:D8 0GB,B,

• 1

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2

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5

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,BG

::T T$B

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32

B,I@ C: =

• ,,:,,":T

• DI@O,:,

• IT:N:TIO

• I"=:":TTIO

• :N=BTIO

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33

C,: ,TBDL• Tn "arto' +> th' sudah 5 hari dira.at di

,BD ropinsi den!an keluhan utaabatuk' sesak nafas' dahak putih kental'nafsu akan berkuran! dan erasa leas#

• ,

  ,e(ak 2 bln ,", klien en!eluh erasaleas' nafsu akan enurun dan $$enurun drastis# ,erin! berkerin!at diala hari# ,erin! sesak nafas' batukberdahak putih kental# eriksa ke

uskesas' tidak ada perubahan# 2 hari,", keluhan bertabah berat sehin!!ake ,BD ropinsi

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3*

C,: ,TBDL• D$elu pernah dira.at sebeluna

D- edik saat asuk Obser4asi febris

- penun(an!

) $T sputu ;))<) $C 12&3

) Gb >'+ !&dl

) =ain)lain dbn

) o tapak !abaran berkabut dilapan! paru kanan

) T$&$$ 1+8&5* k!

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35

C,: ,TBDL

Terapi an! diberikan

) OT

) Diit TT

) Infus = 20 tts&

) =a-adine srup 3-1 sdtTTN TD 100&>0 G!'

2+-&' 100-&' , 3J'5C

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3+

,,:,,":T

• Chief Coplaint

:arl detection depends on sub(ecti4e

findin!s rather than presence of spto

,uspect T$ if • cou!h for 2 .eeks or lon!er 

• unintentional .ei!ht loss

• loss of appetite

• ni!ht s.eats and fe4er • blood)stained sputu

• kno.n GIN)positi4e or ID, patient

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3J

,,:,,":T

 ast edical histor

) ast e-posure of T$

) The clients countr of ori!in andtra4el to forei!n countries in .hichthere is endeic area of T$

) rior test of T$ and .hat the result

.ere) Iuni/ation

) "edication

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38

,,:,,":T

• schosocial Gistor and

=ifestle

) Gistor of sokin!' alcohol use'dru! abuse' GIN

) .ork en4ironent

) clients li4in! conditions

) "alnourishent

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3>

,,:,,":T

• hsical ssesent

Clinical anifestation

9ati!ue' lethar!' nausea' anore-ia'

.ei!ht loss' lo.)!rade fe4ers .hicha ha4e occurred for .eeks toonths' ni!ht s.eat' cou!h and theproduction of sputu' heoptsis'

chest ti!htness and a dull' achin!chest pain a accopan the cou!h'dullness .ith percussion' bronchialbreath sounds' rales

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*0

,,:,,":T

=aborator findin!s

• cid 9ast ,tain of ,putu ,ear • sputu)positi4e pulonar T$ dia!nosed if 

• 2 positi4e sputu speciens for 9$

• 1 positi4e sputu specien' proptin! chest -)ra .hichsu!!ests T$

• 1 positi4e sputu specien but ne!ati4e chest -)ra' proptin!repeat sputu for 9$ .hich is positi4e

• if T$ not dia!nosed' ao-icillin 250 ! O 3 ties dail for Jdas !i4en and sputu sear for 9$ done if little ipro4eent?positi4e sputu 9$ considered dia!nostic in this scenario

 Chest -)raDetectin! old or ne. lesion# Caseation and

inflaation a be 4isuali/ed if the disease isacti4e

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*1

,,:,,":T

Culture

9ro sputu' C,9

D skin test ;u(i tuberkulin<

n area of induration easurin! 10 or ore indiaeter than *8)J2 hour after in(ection indicatee-posure of T$# positi4e reaction does notean that acti4e disease is present but indicatese-posure to T$ or the presence of inacti4e;dorant< T$

B(i tuberkulin positif bila indurasi P 10 #,edan!kan diaeter 5)> asih era!ukandan harus dinilai la!i dan indurasi kuran! dari 5 dinatakan ne!atif#

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*2

DI@O,:,

a

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*3

IT:N:TIO

• OC

) espirator status ir.a patenc

) espirator status @as e-chan!e) espirator status Nentilation

• IC

) Cou!h enhanceent

) Chest phsiotherapi) O-!en therap

) espirator onitorin!

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**

DI@O,:,

b< Ibalanced nutrition less than bodreQuireents r&t deficit intake

D,

lien en!atakan tidak nafsu akan dan

uallien en!atakan akan hana habis R

porsi

DO

on(un!ti4a aneis' leahT$&$$ 1+8&5* k!

Gb >'+ !&dl

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*5

IT:N:TIO

• OC

) utritional status utrient

intake

• IC

) utritional onitorin!

) utrition Therap

) utritional counselin!

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*+

DI@O,:,

c< cti4it intolerance r&t

D,

klien en!atakan leas serta

udah lelah saat akti4itas

DO

2+-&' 100-& saat

akti4itas

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*J

IT:N:TIO

• OC

) :ner! conser4ation

) cti4it tolerance

• IC

) :ner! ana!eent

) :-ercise prootion

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*8

:N=BTIO

• The nurse e4aluates the care

for a client .ith T$ on the basis

of the identified nursin!dia!noses

• :4aluasi respon pen!obatan

• :4aluasi efek sapin! obat• :4aluasi keteraturan berobat

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*>

DI,CG@: =I@

• Goe care preparation

• Client&9ail education

• schosocial preparation

• Gealth care resources

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50

DI,CG@: =I@• ethods to increase adherence to anti)

tuberculosis therap•

can be i%pro4ed .ith certain strate!ies

;re%inder cards sent to defaulters'

co%bination of %onetar incenti4es and health

education' increased super4ision of $ clinic

staff<

•

%ulti)co%ponent inter4ention %a i%pro4e

adherence and treat%ent success rate

inter4ention includin! trainin! to ipro4ecounselin! and counication bet.een healthpersonnel and patients' decentrali/ation of

treatent' !i4in! patients opportunit to choosetreatent supporter for directl obser4ed therap'and reinforcin! super4ision of health posts

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51

:N:TIO• .hen pro4idin! care for patients .ith

tuberculosis' health care .orkers ust userespirator protecti4e de4ices

•

natural 4entilation ;openin! .indo.s and

doors< %a reduce infection rate

 

• prophla-is indicated for • household ebers and other close contacts of

potentiall infectious persons

• ne.l infected persons ;positi4e D .ithin 2 ears<

• positi4e D and a!e 6 35 ears

• positi4e D .ith diabetes ellitus' lon!)ter steroids'iunosuppression' ID,' GIN' end)sta!e renaldisease' rapid .ei!ht loss or chronic undernutrition

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52

:N:TIO 

$C@ 4accination reported to be hi!hl cost)

effecti4e in pre4entin! se4ere childhood

tuberculosis in hi!h)incidence countries  ;=ancet 200+ pr 8?3+J;>51J

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53

:"$:T,

• ,upaa tercapai kesebuhan danence!ah resistensi' pelaksanaanDOT, perlu dukun!an

) eerintah

) Institusi pelaanan kesehatan'asarakat secara luas

) esepakatan ana(een kasus T$di , ;peerintah' s.asta

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THANK YOU

FOR 

YOUR TIME