Tuberculosis

.
Definition Mycobacterium Canetti

Mycobacterium bovis

Mycobacterium tuberculosis ( other

Mycobacterium africanism
L, penyakitmenular lang sung yang disebabkan Oleh Kumari members include
mycobacterium micron
. )
( OMPI @X Mycobacterium pinniped ii

transmission ( l 5 Mm)
Mode of respiratory droplets airborne aerosol Mycobacterium caprae
-

↳ :
,

l
Gd shaped

!
- → rod -
→ nonmotile
n -

- -

→ obligate aerob → cell wall :

my colic ,
acid rich , long chain glycolipids , Phospho lip 0919 can
-
- -

-
s
-
→ Non -
spore forming → facultative
- -
,

→ catalase negative → intracellular

virulence factors :

-
high my colic acid content of bacteria outer capsule → difficult to phagocytize

-
lipids and fatty acid metabolism

.
synthesis of complex lipids : cord factor ( Trehalose 6 -
G dimycolate) → directly damage alveolar macrophages

-
Ph ago,ome arresting and inhibition of apoptosis

4 Incubation period : within 4 -

8 weeks with a range of 2 -
12 weeks

ix. pathophysiology

Primary infection

m.tv?fcuFsis →
§ , ,
! ''
→
•
bacteremia ,
spread via lymphatic

to other part of lungs

or blood vessels

( particularly lung
"
alveolar macrophage
endosomal manipulation

Maturation arrest apices

hypersensitivity
.

- type Iv

controlled by : cell -
mediated immunity .
Lack of acid pH
heterosis kaseosa :
resp on intlamati temples gnon primer

.
Ineffective Phagolycososome formation

Post primary tuberculosis

-

Gohn focus
1L 12 -

O
e-

④ :÷÷÷÷÷÷÷÷÷÷
→

•t
necrosis

.ua#...:.i:::i.mreinriittemen
-0 -
caseous

"
""
' .
.
.se . . . . . ."
T -
cell "
a "

epithelial granuloma hypersensitivity

Alveolar macrophage / L
z
-

I cells depend IL is produced by antigen presenting cells that have encountered bacilli
l Differentiation of Th on 12 , which
- -
-
.

z . Th -
I mediated macrophage activation and killing of bacteria by producing IFN -
8

3 .
Activated macrophages
differentiate into epithelial histiocytes that aggregate to form granuloma

karakteristik : limfadenopatiintratorakal dan infiltrate di lap ang par u

ix. .
classifications

paru : parents in parv dan trakeobrehkidl

Tuber KU IOS is f r
meningitis TB
: cell CSF ,
Kaku kuduk

ekstra paru : pleura meninges pericardium , lymph nodes bone joint Skin , intestine
, , , , .
, kidney , urinary tract ,
( FNAB
lymphadenitis TB :

sexual organs , etc .

Tuberculosis Paro aktif

i :) Berdasarkan tes BTA : .

BTA ( t) SPS = Sewaktv -
pagi -
sewaktu
( Batang Tahan Asam )

↳ 7 2 13 Spesimen dandle SPS BTA ( t )

L, I spesimendahak SPS BTA (t ) & foto torak, men uniukkan infeksi TB

↳ I spesimendahak SPS BTA (t ) & Kultur TB positif

↳ 7
, I spesimcn dandle SPS BTA (t) Setelah 3 Spe Simen da hak SPS Pada

Pemeriksaan sebelumnya has it BTA C ) dan -

tidal add perbaikan setelah

konsvmsi OAT

-
BTA C ) -

↳ 3 Spe Simen dah AK SPS BTA C ) -

y Foto taraki abnormal men vnjukkan gamba ran tuberculosis

4 Tidal add perbaikkan Sete Iah Pem berian antibiotic non OAT

ii. ) Berdasarkan riwayat pasien :

-
Kas vs baru

↳ bewm per nah diobati OAT

↳ Sudan per nah mene Ian OAT L l bulan

-
Kas vs Kam buh l re laps

L, perndhsembuhtetapikambvh lagi

kasvsputvsberob.at/ loss to follow UP

↳ putusberobat 2 bulan berturut -

turret setelahminvm OAT 1 bulan .

-
Kas vs gag at l failure

↳ Pemeriksaan dahdk tetap BTA (t) at au Kemba Ii Ct) pada bulan Keli ma atavlebih

-
ka sus Kronik

↳ BTA Ct) setelah Peng Obata n ul ang ,

Kate gori 2 dan pengawasan Yang baik

- KASVS bekas TB

L, BTA C ),
-
radiologic ) -

,
riwayat Peng Obata n OAT adekuat

↳ Gamba ran radiology meragukan ,

OAT 2 bulan

latent pulmonary tuberculosis infection

c, primary infection without any pathological findings on radiological imaging ,

however screening tests indicate previous

infection with M tuberculosis is

. positive .
 Patient B terkonfirmasibakteriologis :

. Patients Paro BTA Ct )

i Clinical features pasien to parubiakan Ct)

- . .
.

o Pasion TB pan hasn't tescepat M TB . (t)

-
B -
symptoms : BB d ,
night sweats , fever
productive .
Pasi en TB ekttraparuterkonfirmaribakteriolog.si BTA ( t ) .
,
Uji

.
pulmonary symptoms : cough , sputum ,
hemoptysis
> 2 weeks tescepat Lt )

. abnormal chest radiographic findings . Ta anak ter diagnosis secara bacteriologist

Other symptoms : anorexia , malaise chest pain secara Minis :

patients ter diagnosis
.
.
,

. TD Paro BTA L ) deng an radiologic)

-

.
To pan BTA C-) ,
Perbaikan Kunis dgn obdt non DAT t )
,
f- akter risi Kotb ( t)

klinis.lt) histopatologislt) laboratories Ct)

Diagnosis TB Ekstra part
-

X
.
. , ,
-

. TB Anak ter diagnosis dari sisters steering

A Pemeriksaan Dahak Mikroskopis

.

2 hari Kunjungan se Cara SPS ( Sewa Ktv sewaktu )

HOW ? mengvmpulkan Spesimen da hak Yang dikvmpulkan dalam Pag ;
-

3
-

interpret asi Has it pemeriksaan

3X ( t ) at au 2x ( t) ,
IX C )
- BTA ( t)

Ix ( t) ,
2x C )
-
Wangi BTA 3X

↳ Bila IX (t) 2x C -
) BTA (t ) mikroskopikbiasa : pewarnaan Ziehi - Nielsen
,

↳ Bila 3X C ) -
BTA L ) -

pewarnaan kinyovn Gabbett

Mikroskopikfluoresens : Pew armaan aura min -

rhodamin

Interpret Asi Mikroskopis Skala IVATLD & ATS

Pem @ Katan Dahak

1 .
Ma sukkah dahak 2 -
4mL ketabung centrifuge t NaOH 41
.

2. Kook tabling 5 - lo men it atavsampaidahak men Cair

Posing tabling Selam a 15 -

30 men it pad a 3000 rpm
3 .

4 . Buangcairanatas → tambah 1 fetes indicator fenol Merah

-

Meng Adi Merah

-

Warner akan

warn a pink Kun ing

Netralkandengantetesan HCl 2n → -

5 .

G .
Sediaansiapdijadikansediaan pulas an

Hasilujiresistensiobat

BTA : -
Mono resister

↳ 9 OAT lini Pertama

. Poli resisters

↳ 77 OAT lini per tain a Sela in isoniazid & rifampicin se Cara bersamaan
B . Pemeriksaan Bactec
-
Multidrug resistant ( TB -
MDR )

M tuberculosis y resister isoniazid & rifampicin siecarabersamaan

LE MAK coz
.
Annika ""
ASAM -
, Extensive drug resistant Lto -
XDR )
Kapreomisin
-

lini tedua Jenissuntikan

( OAT 901 Fworokuinolont OAT kanamisin
TB Mar t
did @teksi growth index NYU
is - .

.
Rifampicin resistant ITB RR )

↳ Cuman Sama RIFAMPICIN

9 old standard
C .
Pemeriksaan Kultur
54.000 Kotani 28 - 42 hari

.
Egg base media ( Lowenstein - Jensen ,
Ogawa , Kud 0h ) .
Agar base media : Middle Brook .
( air
↳ Mycobacterium
Growth Indicator

Ogawa Tube CMG IT)

↳ 2 Ming gu

Lowenstein - Jensen
 cause impairment in glucose tolerance T Blood glucose level
Gene Xpert ? TB can →
, why
(
Pemeriksaan Tes Cep at Molekuler ( TCM ) t test HIV t test 9W Kosa darah !

↳ Mendeteksi Mtb dan resist en si rifampicin

425am !

PNPK TB 2019

-
IG RA test
D ,
pemeriksaan Radio logi

4 Foto toraks PA !

c, pemeriksa an Iain : lateral , top lordotik , oblik ,

CT - scan

TB Paw aktif bera Wan l nodular di seq men dpikal dan posterior lob US at as dan legmen superior
↳ curiosa le si : .
Bayan gan

10 bus bawah pan

-
Kawiti 7, I dikelilingi bayan gan opak berawan at au nodular
,

bercak Miller
.
bayan gan

'
Efusi pleura unilateral lumumnya )

10 bus
4 curiosa le si par v TB indktif : .
Fibrotic ( seamen apical dan 1 at au posterior lob us at as dan latausegmen superior

bawah

-
Kalsifikasi

. penebalan pleura

↳ was lesi : .
Cesi minimal

4 Sebag ; an dari Satu at au dva Parti de ngan was tidaklebih dari volume pan yang terletak di at as

chondrostemal junction dari iga Kedva de Pandan prosesus spinosus dari vertebra Ty atav korpus I-5

dan tiaak dijvmpai kaviti

.
lesi was

lebih was dari lesi minimal

y Bila p roses

cavity

fibrotic

Tuberculosis aktif foto PA thoraks milliary tuberculosis

pleura

/
Penebalan
/
calcified
Alur Diagnose TB parv

E . Pemeriksaan PCR

4
'
Mend eteksi DNA M ,
tuberculosis

E
pemeriksaan serologi : I . ELISA
.

2 .
My CO dot

s .
Uji Peroksidase Anti Peroksidase

y . Immuno chromatographic tuberculosis ( ICT)

G .
Pemeriksaancairan pleura

↳ Uji Rivalta → Cai ran eksudat ,

set limfositdominan , glvkosarendah

H . pemeriksaanhistopatelogi.io ring an

melaivi ITBLB ) dan Trans Thora Cal Biopsy ( TTB)

↳ Trans Bronchial lung Biopsy

↳ Untuk TB Ekstra paru

I .
Pemeriksaan daran

L, T LED ,
T limfosit

J . Uji tuber Kulin

interpret Asi halil : .

W/ HIV → > 512 mm

W/o HIV → 715 MM

 treatment Short ) course ( PMO )
obdt
X
-

.
.
Management pots ( Direct observed , pengawas Mene Ian

D Ob at Anti tuberculosis COAT)

tivmlah Kumari dalam tubuh pas ien -
e meminimalisirpengaruhdarisebagian Kecil
(
Kumari yang Sudan resister sebelum pengobatan
intens if bulan
First line : .
Rifampisin ; R Ease : 2- 3

Ease lanjvtan : 417 but an

-
Isoniazid ( Intl ) i H
( membunuh Koman lanjvtan

. piratinamid ; z

.
Etambvtel I E

.
Streptomisin ; s Rifampisin 150mg

Isoniazid 75mg
4 OAT dalam 1 tablet
Kombi nasi dos is tetap i -

pirazinamid yoo mg

Etambutol 275mg

Rifampisin 150mg

dalam t tablet
.
3 OAT isoniazid 75mg

pirating mid 400mg

Second -
line : . Konami sin

. Kvinolon

- Mak raid t Asam klavvvlanat ( Masih dalam penelitian )

. Deriv at rifampisin dan INH

Obat Anti tuberculosis DOS is

10 Mg 1kg BB ,
Maki .
600mg 2-3×1 Ming gu

at au

BB 760 KG i 600 Mg

Ri fam Pisin BB 40 -
60kg : 450mg

( 40 kg i 300 Mg
↳ RNA polymerase inhibitors BB
-

Dos is intermit en Goo mas l Kali

1kg BB males 300 Mg 10 mg 1kg BB 3X Se Ming gu 15mg 1kg BB 2x semingguatav 300mg Chari
5 mg ,
. , ,

isoniazid ( INH )
600 mg l Kali
↳ inhibit cell wall synthesis basis intermit en :

Ease intens if 25mg 1kg BB ,

35 Mg 1kg BB 34 Semin 990 ,
50 Mgl KGB B 2x semi nggu

at au

BB 760 KG i 1500mg
Pirating mid
BB 40 -
60 Kg i 1000 Mg
liinhibit cell wall synthesis

BB ( 40 kg i 750mg

Ease intens if 20mg 1kg BB , false lanjvtan 15 M9lk9BB , 30 Mg 1kg BB 34 Semin 990 ,
45 m9/k9BB

2x semi nggu at AU

Etambvtll BB 760 kg i 1500 Mg

BB 40 -
60 Kg i 1000 Mg
4 inhibit cell wall synthesis

BB ( 40 kg i 750mg
I
 15 MGIKGBB atau

BB 760 k9 i tooo mg
Streptomisin
BB 40 -
60 Kg i 750 Mg
↳ Affect ribosomal activity

BB ( 40kg i Ses Vai BB

faseintensif :
3 - 4 tablet Inari
kombinasidosistetap
Kombi nasi 2 diesis OAT
faselaniutan :

MA
50 -
75

Pandian pemberian

Ka sus Pandu an

BTA ( t ) desi was 14 RH

TB Kasus baru ,
Wtvh Paw
,
2. RHEE
at au
(program PZTB )

2RH.IE/6HEPen90batanfaselanjutan
TB Ivar Paro KASUS berat 2. RHEE 141231-13

at au 2. RHEE 171231-13
: 2 RHZE I > pH

-
TB lesi was

. penyakit Komorbid ( DM , imvnosvpresif )

- TB kasvs berat ( milier )

KASVS baru BTA l ) lesi minimal atau 2kHz I 4R3H3 at au GRHE

par v 2kHz l HRH
-

+B . , ,

TB war pan ring an

TB pdrv KAI US kambvh 312 Htt IGRH at AU ZRHZES I 7. RHEE 15 R3H3E3 ( program PZTB )

2 RATES ketika menvnggu has it Uji resist ensi

TB par v ka sus 99gal pengobatan
11 RHZE I 51231-13 E3 ( program PZTB )
tidal add Uji resist en si : 212 Htt's

Hentiobat L2 Ming gu : dilanjutkansesuaijadwal

1. hero bat 34 but an t BTA C ) -

t Klinik l ) trad C-)
-
: stop OAT

2. hero bat 74 bulan t BTA ( t ) : dimvlai dari awal

TB Paw kasvs lalai be robot

hero bat C 4 but an t BTA ( t )

3.
: dimulai dari awal

4. hero bat a 4 bulan t berhentiberobat 71 bulan t BTA t ) t Klinik Lt ) trad ( t ) : dimulai dari Awal

5. hero bat a 4 bulan t berhentiberobat 2-4 min 990 t BTA t) : diteruskan Ses Vai jadwal
 Behm ada has it Uji resist en si : RHZES

OAT yang Masih sensitif deng an H t kuinolon /

ada has it Uji resist en si i 2 macam
TB par v ka sus kronik

betalaktam I makrolid

INTI sevmvr hid up

MDR TB sesuai vji resisters i t kvinolon at au H seumur hid up

(
! -
goat iini 1 ciprofloxacin 2×500 MG
iz bulan
min .
-
zy

> pengobatan Suportif Of 10Ksasin l X 400mg

- Rawat jalan

- Rawat inap

↳ Indi Kasi : TB parvdengan . batukberdarah

.
keadaan um um b. Uruk

-
pneumothorax

.
Empyema

. sesak natas berat

TB War pdru : .
Miller

Meningitis TB

- Pembedahan
TINH
oxidative stress on mitochondria Cho testas is and
OAT & hepatotoxicity :
,

* Evaluasi Pengobatan accum mutation of fat cells in liver

i .
Klinik

4 Seti AP 2 Ming gu Pada ? but an pertama law selanjutnya Setia p i

.
but an
,

Penge bat an dan efek Sam ping o bat Kennan BB PF

↳ Resp ons , , ,

ii. Bakteriologik dan radiologic

Sete 19h 2 but an
,
O -
2 - 6 / 9
I -

se bellum pengobatan Akhirpengobatan

iii. Evaluasi Efek Sampling

daran Ieng Kap

'
4 fungsi hati ,
ginjal ,

e, Asam ur at

4 Buta warn a

↳ Uji keseimbangan dan audiometric

iv. keteraturanobat

V .
Apabila Sudan sembuh

4 Mikroskopik BTA dahak 3, 6 ,

12 dan 24

l, Foto tora KS 6,12 , 24

Tuberculosis in Pediatric

Storing TB Anak IDAI

Tuberculosis apabila 76

t
Beri OAT
HIV and TB

4 Diagnosis

.
Gamba ran radiologist . -
Stadium awal :
fete toraks TB UMVM

- stadium lanjvt :
fate to milier

TD LAM lateral flow as say

-

deteksi LAM di Urim Pasion HIV salat berat ( Coy E too set 1µL)
- -
Ag :

↳ Penge batan

'
imvnosvpresi berat Cay C 50 sell mm → ARV dimvlai di 2 Ming gu pertain a pengobatan TB
.
pasien

HIV TB
'

.
semva past en
' → ARV dimuiai di ming gu ke -
s t kotriioktatel

ARV reverse transcriptase inhibitors

-

non - nucleoside analogue

(

( EFV ) go longan NNRTI

Lini 1 : Efavi rent I lamivvdine
efavirenstnevirapine
Lini lopinavirlritonauir ( LPV Ir)
2 :

Penge batan Pence gahan tuberculosis

1 Pp INH 6 bulan 300mg Inari t pyridoxine 25 mg / hari

.

r 900 MS r 15mg Ibb

2 . pp rifapentine t IN H IX / Ming gu Sela ma 12 mihggv