© Kucoba.com Webmaster Tools | Blogger Tool
Tuberculosis (TB)
Understanding Tuberculosis (TB)
• Tuberculosis (TB) is a disease caused by germs mycobakterium tuberkculosis systemic so it can be about all the body organs with the highest location in the lungs which is usually the primary site of infection (Arif Mansjoer, 2000).
• Pulmonary Tuberculosis is the infectious disease that primarily attacks the lung parenchyma. Tuberculosis can also spread to other body parts, especially the meninges, kidney, bone, and lymph nodes (Suzanne and Brenda, 2001).
• Pulmonary Tuberculosis is infectious disease, which primarily attacks the lung parenchyma (Smeltzer, 2001).
• Tuberculosis is a disease caused by Mycobacterium tuberculosis that almost all organs can be affected by it, but the most are the lungs (IPD, FK, UI).
Etiology of Tuberculosis (TB)
The main infectious agents, tuberculosis is a rod mycobakterium aerobic acid-resistant (Price, 1997) which grow slowly and are sensitive to heat and ultraviolet light, with a length of 1-4 / um thick and 0.3 to 0.6 / um.
Classification of Tuberculosis (TB)
a) The division of pathologically:
• Primary Tuberculosis (Child hood tuberculosis).
• post-primary tuberculosis (Adult tuberculosis).
b) Based on the examination of sputum, pulmonary tuberculosis were divided into 2, namely:
• Pulmonary Tuberculosis smear positive.
• Smear-negative Pulmonary Tuberculosis
c) The division of a radiologically activity:
• Pulmonary Tuberculosis (pulmonary Koch) is active.
• non active Tuberculosis.
• quiesent Tuberculosis (active cough that begins to heal).
d) The division of a radiologically (lesion area)
• Tuberculosis is minimal, the presence of a small portion of non kapitas infiltrates in one lung or both lungs, but the amount does not exceed one lobe of the lung.
• Moderateli advanced tuberculosis, namely the kapitas with a diameter of not more than 4 cm, the number of infiltrates subtle shadow no more than one part of the lung. When the rough shadow no more than one-thirds of one lung.
• For advanced tuberculosis, the presence of infiltrates and kapitas moderateli that exceeds the state in advanced tuberculosis.
e) Based on the aspects of public health at the 1974 American Society Thorasic provide a new classification:
• Karegori O, ie never exposed and not infected, never contact history, tuberculin test negative.
• Category I, which is exposed to tuberculosis but not TEBUKTI an infection, a positive contact history here, a negative tuberculin test.
• Category II, which is infected with tuberculosis but not sick.
• Category III, which is infected with tuberculosis and pain.
f) Based on the treatment of tuberculosis WHO divides into 4 categories:
• Category I: directed against new cases with positive sputum and a new case with severe TB coughs.
• Category II: directed against uh kamb cases and failure cases with sputum smear positf.
• Category III: intended to smear negative cases with pulmonary abnormalities that are not large and extra-pulmonary TB cases other than those referred to in category I.
• Category IV: directed against chronic TB.
Clinical manifestations of tuberculosis (TB)
Symptoms of TB disease can be divided into general symptoms and specific symptoms that arise according to the organ involved. Clinical picture is not very typical, especially in new cases, making it quite difficult to diagnose clinically.
Symptoms of systemic / general, are as follows:
• Common symptoms of pulmonary TB are cough for more than 4 weeks with or without sputum, malaise, flu-like symptoms, mild fever, chest pain, coughing up blood (Mansjoer, 1999).
• Other symptoms are fatigue, anorexia, decreased weight (Luckman et al, 93).
Specific symptoms, among others, as follows:
• Depending on which organs are affected, in case of partial bronchial obstruction (the channel leading to the lungs) due to pressure of enlarged lymph nodes, will lead to sound "wheezing" sound accompanied by shortness of breath weakened.
• If there dirongga pleural fluid (lung packing), may be accompanied by complaints of chest pain.
• If the bone, there will be symptoms such as bone infection at some point can form channels and lead to the overlying skin, in this estuary will discharge pus.
• In children can affect the brain (wrapping a layer of the brain) and is referred to as meningitis (inflammation of the lining of the brain), the symptoms are high fever, a decrease in consciousness and seizures.
Complications of Tuberculosis (TB)
According to the MOH (2002), a complication that can occur in patients with advanced stage of pulmonary tuberculosis:
• severe haemoptysis (bleeding from the lower respiratory tract), which can result in death due to hypovolemic shock or due to blockage of the airway.
• atelectasis (lung expands less than perfect) or the collapse of the lobe due to bronchial retraction.
• Bronchiectasis (dilation of the local broncus) and fibrosis (the formation of connective tissue in the process of recovery or reactive) in the lung.
• The spread of infection to other organs such as brain, bones, joints, and kidneys.
Diagnostic Examination of Tuberculosis (TB)
a. Laboratory examination
• Sputum culture: Positive for Mycobacterium tuberculosis at the active stage of disease.
• Ziehl-Neelsen (acid fast on the use of glass for liquid blood smears): Positive for acid-fast bacilli.
• The skin test (Mantoux, pieces Vollmer): a positive reaction (induration area of 10 mm or greater, occurring 48-72 hours after injection intradcrmal antigen) indicates past infection and the presence of antibodies but not the means indicate active disease. Significant reaction in patients who are clinically ill means that active TB can not be inherited or caused by different mycobacteria.
• if the disease runs a chronic anemia.
• Leukocytes lightly with lymphocyte predominance.
• LED increased especially in the acute phase is generally the value is returned to normal at this stage of healing.
• GDA: may be abnormal, depending on location, weight and residual lung damage.
• Needle biopsy of lung tissue: Positive for TB granulomas, the giant cells showed necrosis.
• Electrolytes: Can not normally depend on the location and severity of infection, eg hyponatremia caused by water retention normally not be found in the area of chronic pulmonary tuberculosis.
b. Radiology
• Photo of the thorax: Infiltration early lesions in the lung area of calcium deposits healed primary lesion or pleural fluid shows more extensive changes, including TB can be fibrous cavity. Changes indicate a more severe TB may include hollow and fibrous areas. In the thorax photograph appears on the affected side silhouette and diaphragm protruding upward.
• Bronchografi: a special inspection for damage bronchus or lung damage due to TB.
• Overview of other radiological TB is that often accompanies pleural thickening, pleural effusion or emphysema, penumothoraks (black shadows alongside a radio lusen lung or pleura).
c. Examination of lung function
Decrease in vital quality, increased dead space, increased residual air ratio: total lung capacity and decreased oxygen saturation secondary to parenchymal infiltration / fibrosis, loss of lung tissue and pleural disease.
Prevention of Tuberculosis (TB)
• BCG immunization among children under five, BCG vaccine should be given since the child was a child in order to avoid the disease.
• If there is a suspected TB patient then it must be treated immediately to the bottom so as not to become more severe disease and transmission.
• Do not drink raw cow's milk and should be cooked.
• For people to not throw spit carelessly.
• Prevention of TB disease can be done with no air in contact with patients, taking a high dose of preventative medicine and healthy living. Especially the home must be either air vents where the morning sun into the house.
• Cover your mouth with a handkerchief when coughing and not spit / phlegm in the indiscriminate issue and provide a place where a given lisol saliva or other material that encouraged physicians and to reduce work activities as well as calming the mind.
Management of Tuberculosis (TB)
A. Pharmacology
There are two kinds of properties / activity of drugs against tuberculosis, which is as follows:
• Activity bakterisid
Here are the drug kills the germs that are growing (metabolically active). Bakteriosid activity is usually measured by the drug kecepataan kill or eliminate bacteria so that the breeding will get negative results (2 months of beginning treatment).
• Activity sterilization
Here the drug kills the germs are slow-growing (metabolically less active). Sterilizing activity was measured from the recurrence rate after treatment was stopped.
Treatment of Tuberculosis disease once only used one drug alone. Reality with the use of single drug resistance is a lot happening. To prevent the occurrence of this resistance, tuberculosis treatment is performed using a combination of drugs, administered at least 2 kinds of drugs that are bakterisid. By using this drug combination, the possibility of initial resistance can be ignored because it is rarely found resistance to two or more kinds of drugs and patterns of resistance that is found most INH.
B. Medical
Types of drugs used
Primary Drug
1. Isoniazid (H)
2. Rifampicin (R)
3. Pyrazinamide (Z)
4. Streptomycin
5. Ethambutol (E)
- Drug Secondary
1. Ekonamid
2. PAS (The Saliciclyc Amino Acid)
3. Sikloserin
4. Kanamycin
5. Protionamid
There are two stages of TB treatment according to DEPKES.2000 namely:
• Phase INTENSIVE
Patients received daily medication and supervised to prevent the occurrence of resistance to rifampicin. When the time is given intensive tahab appropriately, the patient becomes infectious noninfectious within 2 weeks. Most people with TB smear positive to negative (conversion) at the end of intensive treatment. Strict supervision in an intensive tahab very important to prevent the occurrence of drug immunity.
• Phase CONTINUED
In the advanced stage patients received the drug over a long period of time and fewer types of drugs to prevent the occurrence of tenderness. Advanced Tahab important to kill the germs persistent (dormant) thus preventing recurrence.
Treatment failure of Tuberculosis (TB)
The causes of failure pengobataan:
a) Drugs:
• Combination drugs are not adequately
• dose of medication is not enough
• Take medications irregular / ill. In accordance with the instructions given.
• Term waktupengobatan less than it should be
• There is drug resistance.
b) Drop out:
• Lack of medical expenses
• Feeling is cured
• Lazy treatment
c) Disease:
• Lung Lesions are sick too broad / ill
• There lainyang disease accompanying example: fever, etc. Alcoholism
• There is an immunological disorder
Patient Specific Countermeasures Tuberculosis (TB)
a) To patients who are treated on a regular basis
• reassess whether the alloy has adequate medication regarding dose and mode of administration.
• Examination of the sensitivity test / test bacteria resistance to the drug
b) With respect to the treatment of patients with a history of irregular
• Continue treatment ± 3 months old with bacteriological evaluation of each month.
• The re-test resistance of germs to the drug
• Duration of drug resistance, replace with a blend of drugs that are still sensitive.
In patients with relapse (already undergoing regular and adequate treatment according to plan but in the control re-BTA (+) are microscopically or by culture).
1. Give the same treatment with the first treatment
2. Perform microscopic examination of smears 3 times, culture and resistance.
3. As a chest X-ray evaluation.
4. Identify the presence of accompanying diseases (fever, alcoholism / long-term steroids).
5. Something to test drug sensitivity / resistance.
6. Re-evaluation of each month: treatment, radiological, bacteriological.
Download this article here
Download this article in Indonesia here
