The document describes a case of a patient presenting with cough and bloody sputum. It then provides details on tuberculosis, including that it is caused by Mycobacterium tuberculosis, usually affects the lungs but can spread to other organs, and if untreated has a 50-65% fatality rate within 5 years. It also summarizes transmission occurs via droplet nuclei and risk factors include HIV, diabetes, and immunosuppression.
The document describes a case of a patient presenting with cough and bloody sputum. It then provides details on tuberculosis, including that it is caused by Mycobacterium tuberculosis, usually affects the lungs but can spread to other organs, and if untreated has a 50-65% fatality rate within 5 years. It also summarizes transmission occurs via droplet nuclei and risk factors include HIV, diabetes, and immunosuppression.
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The document describes a case of a patient presenting with cough and bloody sputum. It then provides details on tuberculosis, including that it is caused by Mycobacterium tuberculosis, usually affects the lungs but can spread to other organs, and if untreated has a 50-65% fatality rate within 5 years. It also summarizes transmission occurs via droplet nuclei and risk factors include HIV, diabetes, and immunosuppression.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPTX, PDF, TXT or read online from Scribd
BLOK 405090223 SISTEM RESPIRASI FK UNTAR 2009 TUBERCULOSIS TUBERCULOSIS • Caused by Mycobacterium Tuberculosis complex • Usually affects lung, but in 1/3 case, can affect other organs • Transmissions via droplet nuclei • If untreated, maybe fatal in 5 years in 50-65% cases
Harrison’s Principle of Medicine
17th ed Volume 1 ETIOLOGIC AGENT • Caused by Mycobacterium Tuberculosis, the complex includes – M. Bovis (unpasteurized milk) – M. Caprae (related to M. Bovis) – M. Africanum (in West, East and Central Africa) – M. Microti – M. Pinnipedii – M. Canetii • Rod shaped, non-spore, thin aerobic bacterium measured 0,5um – 3um. Often neutral in gram staining.
17th ed Volume 1 EPIDEMIOLOGY • Mostly in developing country • In US, TB usually associated with elderly, HIV- infected, immigrants, and poor people • TB usually associated with poor hygiene and ventilation
Harrison’s Principle of Medicine
17th ed Volume 1 EPIDEMIOLOGY
Harrison’s Principle of Medicine
17th ed Volume 1 RISK FACTORS • HIV disease • Diabetes • Silicosis • Immunosupression • Gastrectomy • Malnutrition • Presence of fibrotic lesion
Harrison’s Principle of Medicine
17th ed Volume 1 PATHOGENESIS • Droplet masuk ke saluran napas (10% ke paru, sisanya disaring) netrofil makrofag kebanyakan mati dan dikeluarkan • Bila menetap berkembang biak dalam sitoplasma makrofag membentuk fokus gohn limfangitis lokal + limfadenitis regional = kompleks primer (Ranke), setelah itu dapat: – Sembuh total tanpa bekas (kebanyakan) – Sembuh dengan meimbulkan bekas – Berkomplikasi dan menyebar melalui • Per kontinuitatum • Bronkogen • Limfogen • hematogen Buku Ajar Ilmu Penyakit Dalam Edisi V Jilid III CLINICAL MANIFESTATIONS • Pulmonary – Primary disease – Post–Primary Disease • Extra Pulmonary – Tuberculous Lymphadenitis (>40%) – Pleural Tuberculosis (20%) – Tuberculosis of Upper Airways – Genitourinary Tuberculosis (15%) – Skeletal Tuberculosis (10%) – Tuberculous Meningitis and Tuberculoma (5%) – Percardial Tuberculosis – Miliary or Disseminated Tuberculosis Harrison’s Principle of Medicine 17th ed Volume 1 PULMONARY CLINICAL MANIFESTATIONS • Primary Disease – Occurs soon after initial infection, often in children – Affects middle and lower lobes lung zones – May cause lesion that can heal spontaneously and later seen as small calcified nodule (Gohn lesion) – In immunosupressed patients and children, disease may progress with cavitation, pleural efusion, hematogenous dissemination – Enlarged lymph nodes compress bronchi lobar collapse – May develop miliary tuberculosis and/or tuberculosis meningitis Harrison’s Principle of Medicine 17th ed Volume 1 PULMONARY CLINICAL MANIFESTATIONS • Post-Primary Disease – Also called adult-type, reactivation, secondary – Localized to the posterior segment of upper lobes and superior segements of lower lobes – Early symptoms : fever, night sweats, weight loss, anorexia, malaise – In majority cases : Cough and purulent sputum, often with blood streaks – Pleuritic chest pain, rochi, pallor and clubbing finger may occur in some cases – Hematologic findings : Mild Anemia and leukocytosis Harrison’s Principle of Medicine 17th ed Volume 1 EXTRAPULMONARY CLINICAL MANIFESTATIONS • Lymphadenitis – Painless swelling of cervical and supraclavicular nodes (scrofula) – Fine needle aspiration or surgical biopsy for diagnosis (AFB smear 50%, culture 70-80%) – DD : infectious conditions, neoplastic diseases (lymphomas and metastatic carcinomas), disorders (Kikuchi disease, Kimura disease, Castleman disease) • Pleural Tuberculosis – Fluid is straw-colored and exudative, protein level >50%, Glucose Level : Normal or Low, pH 7.3, MN cells common, PMN in early stages, Biopsy for diagnosis – Empyema results from rupture of a cavity Harrison’s Principle of Medicine 17th ed Volume 1 EXTRAPULMONARY CLINICAL MANIFESTATIONS • Genitourinary – Urinary frequency, dysuria, nocturia – Urinalysis : pyuria and hematuria – Genital TB more common among women, Fallopian Tube and uterine disease can cause infertility • Skeletal disease – Most common in spine, hips, and knees – May cause collapse of vertebral bodies and become kyphosis and gibbus • Meningitis – Cranial nerve involvement may cause coma, hydrocephalus, and intracranial hypertension – CSF may have High Lymphocyte, elevated protein level, low glucose. Culture (+) in 80% cases Harrison’s Principle of Medicine 17th ed Volume 1 EXTRAPULMONARY CLINICAL MANIFESTATIONS • Gastrointestinal disease – Affects terminal ileum and ceccum abdominal pain and diarrhea – Palpable mass on bowel may occur – TB peritonitis fever, abdominal pain, ascites exudative, need peritoneal biopsy • Pericarditis – Acute/subacute fever, dull retrosternal pain, friction rub, effusion is common, chronic fatal • Miliary / disseminated tuberculosis – Lesion are small granulomas, non spesific – Hepatomegaly, splenomegaly, lymphadenopaty, choroidal tubercles of the eye may occur Harrison’s Principle of Medicine 17th ed Volume 1 DIAGNOSIS • AFB Microscopy • Mycobacterial Culture • Nucleic Acid Amplification • Drug Suspectibility Testing • Radiographic Procedure • Additional Diagnostic Procedures • Serologic and other diagnostic test – Tuberculin Skin Test (TST) – IFN – Gamma Release Assays (IGRAs) Harrison’s Principle of Medicine 17th ed Volume 1 DIAGNOSIS • AFB Microscopy – Smear of expectorated sputum or tissue – Most modern : auramine-rhodamine staining and fluorescence microscopy – Traditional Method : Ziehl-neelsen staining – Three sputums preferaby in the morning • Mycobacterial Culture – Agar-based medium, incubated at 37o C, 4-8 weeks – Biochemical test to speciate mycobacterial isolates – New methods : molecular method or high-pressure liquid of chromatography of mycolic acid 2-3 weeks Harrison’s Principle of Medicine 17th ed Volume 1 DIAGNOSIS • Nucleic Acid Amplification – Amplification of mycobacterial nucleic acid – Ready in several hours – High specificity and sensitivity • Drug Suspectibility Testing – Tested for isoniazid, rifampin, and ethambutol • Radiographic Procedures – Classic X-ray : infiltrates and cavities – CT-Scan : diagnose extrapulmonary TB – MRI : Diagnose intracranial TB Harrison’s Principle of Medicine 17th ed Volume 1 DIAGNOSIS • Additional Diagnostic Procedures – Sputum induction by ultrasonic nebulization of hypertonic saline – Fiberoptic bronchoscopy – In children who cannot expectorate sputum, specimen from early morning gastric lavage for culture • Serologic test – Based on detection of antibodies – Marketed in developing countries, not in US • TST – Skin test with Tuberculin PPD – False negative in immunosupressed pts – False positive in BCG vaccinated pts Harrison’s Principle of Medicine 17th ed Volume 1 DIAGNOSIS • IGRAs – Measuring T cells release of IFN gamma in response to stimulation with highly tuberculosis spesific antigents ESAT-6 and CFP-10 – More spesific and less cross reaction to BCG vaccine and non-tuberculosis mycobacteria – Ex : QUANTIferon-TB Gold (ELISA) and T-SPOT.TB (ELISpot)
Harrison’s Principle of Medicine
17th ed Volume 1 Harrison’s Principle of Medicine 17th ed Volume 1 Harrison’s Principle of Medicine 17th ed Volume 1 Harrison’s Principle of Medicine 17th ed Volume 1 MANAGEMENT KATEGORI REGIMEN PENGOBATAN TB DIAGNOSTIK TB Fase Awal Fase Lanjutan
Kategori I Anjuran Utama Anjuran Utama
2 HRZE 4HR atau 4(HR)3 Opsional Opsional 2(HRZE)3 or 2HRZE 4(HR)3 or 6HE Kategori II Anjuran Utama Anjuran Utama 2HRZES / 1HRZE 5HRE Opsional Opsional 2(HRZE)3 / 1HRZE3 5(HRE)3 Kategori III Anjuran Utama Anjuran Utama 2HRZE 4HR or 4(HR)3 Opsional Opsional 2(HRZE)3 4(HR)3 OR 6HE Kategori IV Dirancang khusus
Farmakologi dan Terapi Edisi V
MANAGEMENT • Kategori I – Pasien baru sputum BTA (+) – Pasien baru TB-paru BTA (-) dg infeksi parenkim paru berat (ekstensif) – TB-Paru dg penyakit HIV atau TB ekstraPulmonal • Kategori II – Pasien TB-Paru BTA (+) yg pernah diobati • Kambuh • Pengobatan gagal – Pasien kategori I yg gagal diobati dg • Program pengobatan yg adekuat • Data yang representatif mengenai TB-MDR menunjukkan angka tinggi – Tersedia pengobatan IV
Farmakologi dan Terapi Edisi V
MANAGEMENT • Kategori III – Pasien baru TB paru dengan BTA (-), selain kategori I dan TB ektraparu ringan • Kategori IV – Kronik (Sputum BTA masih positif sesudah pengobatan ulang) – Terbukti atau suspek kasus TB-MDR