•Tablets Rifampicin 150mg, Isoniazid 75mg,

•2 additional antibiotics (pyrazinamide and Pyrazinamide 400mg, Ethambutol 275mg.

ethambutol) for the first 2 months of the 6-month
treatment period
Regime of Directly Observed Therapy:
•Tablets Rifampicin 120mg, Isoniazid 50mg,
•Directly Observed Therapy (DOT). Pyrazinamide 300mg.

•Tablets Rifampicin 300mg, Isoniazid 150mg

MANAGEMENT
•2 antibiotics (isoniazid and rifampicin) for 6 months
•Treatment for tuberculosis (TB) usually involves
taking antibiotics for several months. •Tablets Rifampicin 150mg, Isoniazid 100mg

•After taking antibiotics for 2 weeks, most people are

no longer infectious and feel better.
•Taking medication for 6 months is the best way to
ensure the TB bacteria are killed.
-Lung Abscess

-Bronchiectasis

• Mantoux test, also called the tuberculin skin test (TST)

-Asthma

• Result active PPD - Chest X-ray (to confirm).

-Cystic Fibrosis

• SPUTUM AFB -3X Early morning.

-Empysema

INVESTIGATIONS
• Skin staning.
-Bronchiolitis

Pneumonia DDX • Blood – for ELISA test. (trace of turbeculosis Antigen,

Stay home. Don't go to work or to school until your healthcare antibody IgE,IgM).
provider says you can go back.
-COPD

-COAD
Avoid public areas until you have been told that you cannot Bakteria yang dipanggil Mycobacterium tuberculosis.
spread TB.
-Kanser paru²

Cover your mouth when you sneeze or cough. After you

cough, throw the tissue away in a covered container.
Jangkitan HIV

HEALTH EDUCATIONS TUBERCULOSIS (TB) ETIOLOGY

Keep your hands clean. Wash them if you use them to cover
your mouth when you cough Tibi tahan dadah

Take your antibiotics as directed. Do not stop taking them just

because you feel better. You need to take the full course of
antibiotics. Faktor risiko:

Sistem imun yang lemah (HIV/ DM)

Wear a mask when you are around other people.

Melancong atau tinggal di kawasan tertentu (Afrika,

Asia, Eropah Timur, Rusia & Amerika Latin)

Menggunakan tembakau
PATHOPHYSIOLOGY

Bekerja dalam penjagaan kesihatan

Tinggal atau bekerja di kemudahan penjagaan

kediaman
Seven Steps in the Pathophysiology of Active
Tuberculosis.These steps are aerosolization, macrophage • A high temperature
phagocytosis, phagolysosome blockage and replication, TH1
response, granuloma formation, clinical manifestations, and
transmission.
• Extreme tiredness or fatigue
CLINICAL MANIFESTATIONS
• Lack of appetite and weight loss

A) Aerosolization is the beginning and the end of the cycle of • Night sweats
tuberculosis pathophysiology. Aerosolization occurs when a
person with active tuberculosis forcefully expires through
actions such as coughing.
• Breathlessness that gradually gets worse • persistently swollen glands

• cough that lasts more than 3 weeks and usually

• abdominal pain
brings up phlegm, which may be bloody
B) A susceptible person who breathes in the aerosolized
Mycobacterium tuberculosis and droplets small enough to
reach the alveolar sacs will encounter macrophages, TB outside the lungs, symptoms can include: • confusion
dendritic cells, and monocytes. The macrophages will
phagocytose the bacteria and attempt to destroy the invader.
Dendritic cells will migrate to lymph nodes to activate T-
helper cells.
• fits (seizures)

• pain and loss of movement in an affected bone or

joint

C) M. tuberculosis prevents the phagolysosome fusion,

avoids destruction, begins replicating, and releases DNA,
RNA, proteases, and lipids. Additionally, the macrophages • a persistent headache
will release cytokines and vascular endothelial growth factor
(VEGF). The VEGF will trigger angiogenesis and increase
vascularization to the lesion. The cytokines will initiate the
innate response and recruit natural killer (NK) cells, dendritic
cells (DC), neutrophils, and macrophages in different forms.

D) The T-helper cell response will involve the migration of

TH1, Tregs, and B cells primed in the germinal center. These
cells will combine to form the granuloma.

E)The granuloma is a prison to wall off the bacteria from

spreading systemically.

F) Later, or present, immunocompromisation prevents the

granuloma from containing the bacteria. The bacteria will
spread and multiply in multiple clinical manifestations.

G) During this phase, the bacteria can be aerosolized by the

original susceptible, now infected, host, and begin the cycle
anew