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Case Study TB
Case Study TB
JS, a 46 year old male patient, returned from India with cough, malaise,weight loss and
night sweats. Sputum culture showed acid fast bacilli and 3 days later Mycobacterium
tuberculosis was isolated.
Questions
This patient was commenced on triple therapy with rifampicin 600 mg daily, isoniazid 300
mg daily and streptomycin 750 mg daily. All three agents are bactericidal against fast
growing extracellular bacilli so they produce rapid sterilisation of sputum to decrease
spread. Rifampicin is also active against dormant intracellular organisms that undergo
phases of rapid growth. The patient was already taking carmazepine 200 mg b.d
throughout for epilepsy.
3. Are there any problems with this. And how might they be managed?
4. JS received only 750 mg daily streptomycin, why was this reduced and how should it
be monitored?
Three weeks later he was admitted to hospital complaining of increasing malaise, muscular
aches, nausea, decreased apptite, shortness of breath, cough and fever. He was jaundiced
with hepatomegaly, blood pressure 120/70 mmHg, pulse 76 beats perminute, regular.
Chest X-ray showed a right plural effusion and biochemistry showed increased bilirubin,
ALP, ALT and AST, albumin was low.
JS was diagnosed as having drug-induced hepatitis and all anti-TB medication was stopped.
A week after stopping the anti-TB drugs his liver function test had settled and isoniazid
was re-introdused at 150 mg dose, after 3 days increased to 300 mg daily. Rifampisin was
then started initially at 300 mg then increased to 600 mg daily. Three weeks into the
admission streptomycin was recommended and 4 days after commencing streptomycin
level were checked and found to be trough; ˂1mg/L, peak; 23mg/L (target peak;˂ 40mg/L,
trough; ˂mg/L). Note rifampicin can increase risk of streptomycin-induced renal
dysfunction.
A week later he went home on full anti-tuberculosis drugs with stable liver function
test and carbamazepine and the addition of pyridoxine. The white count does not suggest
resistance has emerged during this treatment gap but should be monitored over the full
treatment course. Any acute liver insult on top of this treatment would be very difficult to
resolve. Compliance with the pyridoxine is very important to prevent any toxicity.
KASUS TBC
IDENTITAS PASIEN
Nama : An. M A
Umur : 29 bulan
Jenis kelamin : Laki-laki
Tanggal MRS : 15 Agustus 2020
Tanggal Pemeriksaan : 18 Agustus 2020
1. Keluhan Utama
Batuk lama.
PEMERIKSAAN PENUNJANG
Pemeriksaan Laboratorium
Jenis Nilai Hasil Nilai Normal Satuan
Pemeriksaan Pemeriksaan
Hematologi Lengkap
Hemoglobin 7,8 11,5-15,5 gr/dl gr/dL
Leukosit 22 9 109/L
4,5 - 13 x 10 /L
Hematokrit 25,3 35-45 % %
Trombosit 987 9 109/L
150-450 x 10 /L
GDA 100 <200 mg/dL
Kesan :
terapi:
o OAT
INH 1X85mg
Rifampisin 1x120mg
Pirazinamid 1x250
Ethambutol 1x170mg
o Kortikosteroid 3x5mg
Mulai tanggal 16 Agustus 2020 – 30 Agustus 2020
Tappering off mulai tanggal 31 Agustus 2020 – 13 September 2020