Download - Referat Tb

7/21/2019 Referat Tb

http://slidepdf.com/reader/full/referat-tb-56d9e7ce40c85 1/21

DAFTAR ISI

KATA PENGANTAR…………………………………….………………………………………..i

DAFTAR ISI…………………………………………..……………………………………………1

BAB I PENDAHULUAN…………………………………………..……………………………...2

BAB II : PEMBAHASAN

2.1 Definisi……………………………………………………………………………….................3

2.2 Etioo!i…….……………………………………………………………………………………3

2.3 E"i#e$ioo!i…………………………………………………………………….........................3

2.% K&sifi'&si TB…………………………………………………………………………………..%

2.( P&to!enesis…………………………………………………………….......................................(

2.) M&nifest&si Kini'………………………………………………………………………………*

2.+ Di&!nosis…………………………………………………………………………………..…...1,

2.- Pen&t&&'s&n&&n………………………………………………………………………………...13

2.* Pene!&/&n…………………………………………………………………….……………….1*

2.1, Ko$"i'&si……………………………………………………………………………………2,

2.11 P0o!nosis………………………………………………………………………………………21

DAFTAR PUSTAKA………………………………………………………………………………22

1



BAB I

PENDAHULUAN

Te0'osis TB 4 &#&&/ s&t "en5&'it infe'si $en&0 5&n! #ise&'&n oe/

Mycobacterium tuberculosis (MTB). Di in#onesi&6 TB 7!& $&si/ $e0"&'&n $&s&&/

5&n! $enon7o. B&/'&n se&0& !o&6 In#onesi& $en##'i "e0in!'&t 'eti!& se&!&i

"en5$&n! '&ss te0&n5&' #i #ni& sete&/ in#i& #&n in&.163

Te0'osis &n&' $e$"n5&i "e0$&s&&/&n '/ss 5&n! e0e#& #en!&n o0&n!

#e8&s&. P&#& TB &n&'6 "e0$&s&&/&n 5&n! #i/&#&"i &#&&/ $&s&&/ #i&!nosis6

"en!o&t&n6 "ene!&/&n se0t& TB "&#& infe'si HI9.11

Be0e#& #en!&n TB #e8&s&6 !e7&& TB &n&' se0in!'&i ti#&' '/&s6 #i&!nosis "&sti

#ite!&''&n #en!&n $ene$'&n '$&n TB. P&#& &n&'6 sit #i#&"&t'&n s"esi$en

#i&!nosti' 5&n! #&"&t #i"e0&5&. Se'&i"n s"esi$en #&"&t #i"e0oe/6 "&#& "e$e0i's&&n

$i'0oioo!i'6 $i'0oo0!&nis$e "en5e& 7&0&n! #ite$'&n "&#& se#i&&n &n!sn! #&n

't0. Di ne!&0& e0'e$&n!6 #en!&n f&siit&s tes M&nto #&n foto 0ont!en "&0 5&n!

$&si/ '0&n!6 #i&!nosis TB &n&' $en7&#i ei/ sit. *611

Di&!nosis te0'osis TB4 "&#& &n&' s&n!&t sit. Kesit&n ini e0"&n!'& #&0i

"0oses 'e7&#i&n "en5&'it "&to!enesis4 TB "0i$e0 5&n! s&n!&t 'o$"e's6 isti$e8& #&n

e0i'. H&sin5& &#&&/ TB #&"&t $en!en&i e0&!&i o0!&n t/6 #&"&t $e$e0i

e0&!&i $&&$ !e7&& #&n t&n#& 'inis6 se0t& #&"&t $e$e0i'&n !&$&0&n Ront!en 5&n!

s&n!&t e0;&0i&si se/in!!& TB $en#&"&t !e&0 the great imitator . Ge7&& #&n t&n#& 'inis

5&n! $en!&0&/ 'e TB "&#& &n&' ti#&' '/&s '&0en& $i0i" &t& se0"& #en!&n !e7&& #&n

t&n#& 'inis e0&!&i "en5&'it &t& 'e&#&&n &in. 1,

2



BAB II

PEMBAHASAN

2.1 Definisi

Pen5&'it Te0'osis &#&&/ "en5&'it $en&0 &n!sn! 5&n! #ise&'&n oe/

'$&n TB Mycobacterium Tuberculosis4. Se&!i&n es&0 '$&n TB $en5e0&n! "&06

tet&"i #&"&t 7!& $en!en&i o0!&n t/ &inn5&.)

Te0'osis &#&&/ "en5&'it &'i&t infe'si '$&n TB Mycobacterium

Tuberculosis4 5&n! e0sif&t siste$i' se/in!!& #&"&t $en!en&i /&$"i0 se$& o0!&n t/

#en!&n o'&si te0&n5&' #i "&0 5&n! i&s&n5& $e0"&'&n o'&si infe'si "0i$e0.(6)

2.2 Etiologi

Pen5e& te0'osis &#&&/ Mycobacterium tuberculosis(MTB) 5&it s&t 7enis

'$&n 5&n! e0ent' &t&n! #en!&n '0&n "&n7&n! 1<%=$ #&n te& ,63<,6)=$6

$e$"n5&i sif&t '/ss 5&it t&/&n te0/&#&" &s&$ "&#& "e8&0n&&n. K$&n #&"&t /i#"

#&&$ #&0& 'e0in! $&"n #&&$ 'e&#&&n #in!in #&"&t t&/&n e0t&/n<t&/n #&&$

e$&0i es 4 #i$&n& '$&n #&&$ 'e&#&&n dormant . 162

K$&n /i#" se&!&i "&0&sit int0&se&0 5&'ni #&&$ sito"&s$& $&'0of&! #i

#&&$ 7&0in!&n. M&'0of&! 5&n! se$& $e$f&!ositosis 'e$#i&n #isen&n!in5& '&0en&

&n5&' $en!&n#n! i"i#. Sif&t &in '$&n ini &#&&/ &e0o se/in!!& '$&n ei/

$en5en&n!i 7&0in!&n 5&n! tin!!i '&n#n!&n o'si!enn5&. D&&$ /& ini te'&n&n o'si!en

"&#& &!i&n &"i'& "&0 ei/ tin!!i #&0i &!i&n &in6 se/in!!& &!i&n &"i'& ini $e0"&'&n

te$"&t "0e#ie'si "en5&'it te0'osis. B&'te0i TB &'&n e"&t $&ti i& te0'en& sin&0

t0&;ioet sin&0 $&t&/&0i4 &n!sn! #&n $#&/ $&ti "&#& &i0 $en#i#i/ ( $enit "&#&

s/ -,>? #&n 2, $enit "&#& s/ ),>?4. 162

2.3 Epideiologi

Dine!&0& e0'e$&n!6 TB "&#& &n&' @ 1( t&/n &#&&/ 1( #&0i se0/ '&ss

TB6 se#&n!'&n #ine!&0& $&76 &n!'&n5& ei/ 0en#&/6 5&it (<+. Te0'osis &n&'

$e0"&'&n f&'to0 "entin! #i ne!&0&<ne!&0& e0'e$&n! '&0en& 7$&/ &n&' e0si& @1(

t&/n &#&&/ %,<(, #&0i 7$&/ se0/ "o"&si.+

3



World Health Organization $e$"e0'i0&'&n &/8& TB $e0"&'&n "en5&'it infe'si

5&n! "&in! &n5&' $en5e&'&n 'e$&ti&n "&#& &n&' #&n o0&n! #e8&s&.(6* $&/ se0/

'&ss TB &n&' #&0i t7/ R$&/ S&'it RS4 Ps&t Pen#i#i'&n #i In#onesi& se&$& ( t&/n

1**-<2,,24 &#&&/ 1,-) "en5&n#&n! TB #en!&n &n!'& 'e$&ti&n 5&n! e0;&0i&si #&0i ,<

1%61. Keo$"o' si& te0&n5&' &#&&/ 12<), &n %26*46 se#&n!'&n nt' &5i @12

&n #i#&"&t'&n 1)6(.+

2.! "l#sifi$#si T%&e'$%losis

T%&e'$%losis p'ie'

Te0'osis "0i$e0 &#&&/ "e0&#&n!&n "&0 5&n! #ise&'&n oe/ &si

te0'osis "&#& t/ "en#e0it& 5&n! e$ "e0n&/ $e$"n5&i 'e'e&&n s"esifi'

te/&#&" &si te0set. Pe$&!i&n te0'osis "&0 "0i$e0:(

1. Te0'osis "0i$e0 5&n! "otensi& potential primary tuberculosis4 te07&#i 'ont&'

#en!&n '&ss te0'&6 tet&"i 7i te0in $&si/ ne!&ti;e.

2. Te0'osis "0i$e0 &ten latent primary tuberculosis4. T&n#& C t&n#& infe'si

s#&/ 'ei/&t&n6 tet&"i &s #&n &'ti;it&s "en5&'it ti#&' #i'et&/i. U7i te0in

$&si/ ne!&ti;e. R&#ioo!is ti#&' t&$"&' 'e&in&n.3. Te0'osis "0i$e0 5&n! $&nifest manifest primary tuberculosis46 7i te0in

"ositif #&n te0i/&t 'e&in&n 0&#ioo!is.

Pen5it te0'osis "&0 "0i$e0 16(

1. Pe$es&0&n 'een7&0 se0;i'& s"e0fii&6 Pen5e&0&n &n!sn! te0'osis 'e

'een7&0 i$fe $e#i&stin$ &!i&n &t&s #&n "&0&t0&'e& 5&n! e0&s& #&0i 'een7&0

/is6 se&in it 7!& $en5e0&n! 'een7&0 i$fe s"0&'&;i'& #&n se0;i'& &nte0io0.

Ke&in&n #i 'een7&0 te0set e0e&'si s&n!&t &$&t te0/&#&" o&t &nti

te0'osis. Bi& te07&#i &ses "&#& 'een7&0 #i&''&n "e$e#&/&n.

2. Pe0itis te0'osis $e0"&'&n "en5&'it #ini te0'osis "0i$e0 #&n te07&#i ) C -

&n sete&/ se0&n!&n &8& se0in! #ise0t&i 'e&in&n "&#& 'it 5&it e0ite$&

no#os$.

3. Efsi "e0& i&s&n5& 7e0ni/6 "0o!nos& $&si/ &i'6 0e&'si te/&#&" o&t &nti

te0'osis se0in! '&i #0&$&tis '&0en& #&"&t $e$e0i 0esosi se$"0n& #&&$ 1

C 2 $in!!. Ke$n!'in&n nt' $en#e0it& te0'osis "ost "0i$e0 #i 'e$#i&n

/&0i ei/ es&0.

4



%. Te0'osis $iie0 $e0"&'&n 'e&in&n "&in! #ini #i&n#in! #en!&n "en5&'it

te0'osis "0i$e0 5&n! &in. P0oses te0'osis $iie0 te07&#i - &n sete&/

ti$ te0'os& "0i$e0. G&$&0&n 0&#ioo!i t&$"&' 2 $in!! sete&/ !e7&&

'inis.

(. Menin!itis te0'osis #&"&t te07&#i se&!&i &'i&t "en5e&0&n /e$&to!en &t&

fo's "e0'e7&n 5&n! "e&/ #i 0on!!& s&0&/noi# "&#& t&/&" &'/i0 #&0i

te0'osis $iie0.

T%&e'$%losis p#'% post p'ie'

Te0'osis "&0 "ost "0i$e0 &#&&/ "e0&#&n!&n "&0 5&n! #ise&'&n oe/ &si

te0'osis "&#& t/ 5&n! te&/ "e'& te/&#&" te0'o"0otein.

• D&0i &0 e'so!en 4 infe'si &n! "&#& t/ 5&n! "e0n&/ $en#e0it&

te0'osis.

• D&0i #&&$ en#o!en 4 infe'si e0&s& #&0i &si 5&n! s#&/ e0&#& #&&$

t/6 $e0"&'&n "0oses &$& 5&n! "&#& $&n5& ten&n! #&n oe/ s&t

'e&#&&n $en7&#i &'tif 'e$&i. A#&"n "e$&!i&n "0i$e0 "&0 "ost "0i$e0

&#&&/ :

&. Te0'osis $ini$& te0#&"&t &#&n5& se&!i&n 'ei infit0&t non<'&;it&s "&#&

s&t "&0 $&"n 'e#& "&06 t&"i 7$&/n5& ti#&' $eei/i s&t os "&0.

. Moderately advanced tuberkulosis6 te0#&"&t '&;it&s #en!&n #i&$ete0 ti#&' ei/

#&0i % $. $&/ infit0&t &5&n!&n /&s ti#&' ei/ #&0i s&t &!i&n "&06 i&

&5&n!&n '&s&0 ti#&' ei/ #&0i se"e0ti!& &!i&n "&#& s&t "&0.

. ar advanced tuberculosis! te0#&"&t infit0&t #&n '&;it&s 5&n! $eei/i 'e&#&&n

"&#& moderately advanced tuberkulosis

2.( P#togenesis T%&e'$%losis p#d# An#$

P&0 $e0"&'&n port d entr"e "&#& ei/ #&0i *- '&ss infe'si te0'osis.

K&0en&'0&nn5& 5&n! s&n!&t 'ei @( $46 '$&n te0'osis#&&$ #0o"et 5&n!

te0/i0" #&"&t $en&"&i &;eos. P&#& se&!i&n '&ss6 &'te0i Te0'osis #&"&t

#i/&n0'&n se0/n5& oe/ $e'&nis$e i$noo!is non<s"esifi'.A'&n tet&"i "&#&

se&!i&n '&ss6 ti#&' se0/n5& #&"&t #i/&n0'&n. P&#& in#i;i# 5&n! ti#&' #&"&t

$en!/&n0'&n se0/ '$&n6 $&'0of&! &;eos &'&n $e$f&!osit &'te0i te0'osis

5&n! se&!i&n es&0 #i/&n0'&n. A'&n tet&"i6 se&!i&n 'ei '$&n te0'osis 5&n!

5



ti#&' #&"&t #i/&n0'&n &'&n te0s e0'e$&n! i&' #&&$ $&'0of&!6#&n &'/i0n5&

$en5e&'&n isis $&'0of&!. Se&n7tn5& &'te0i $e$ent' esi #ite$"&t te0set.-

D&0i "&0en'i$ "&0 5&n! te0infe'si6 &'te0i te0'osis $en5e&0 $e&i &i0&n

"&#& s&0&n i$fe $en7 'een7&0 i$fe 0e!ion&6 5&it 'een7&0 i$fe 5&n! $e$"n5&i

s&0&n i$fe 'e o'&si fo's "0i$e0. Pen5e&0&n ini $en5e&'&n te07&#in5& inf&$&si

#is&0&n i$fe i$f&n!itis4 #&n #i 'een7&0 i$fe i$f&#enitis4 5&n! te0'en&. i'& fo's

"0i$e0 te0et&' #i os &8&/ &t& ten!&/6 'een7&0 i$fe 5&n! &'&n te0i&t &#&&/

'een7&0 i$fe "&0&/is "e0i/ie046 se#&n!'&n 7i'& fo's "0i$e0 te0et&' #i&"e's "&06

5&n! &'&n te0i&t &#&&/ 'een7&0 "&0&t0&'e&. G&n!&n &nt&0& fo's "0i$e06 i$f&n!itis6

#&n i$f&#enitis #in&$&'&n 'o$"e's "0i$e0.-

&'t 5&n! #i"e0'&n se7&' $&s'n5& &'te0i te0'osis /in!!& te0ent'n5&

'o$"e's "0i$e0 se&0& en!'&" #iset se&!&i $&s& in'&si. M&s& in'&site0'osis

e0&n!sn! se&$& 2<12 $in!!6 i&s&n5& se&$& %<- $in!!.-

P&#& s&&t te0ent'n5& 'o$"e's "0i$e06 infe'si te0'osis "0i$e0 #in5&t&'&n

te&/ te07&#i.Sete&/ te07&#i 'o$"e's "0i$e06 i$nit&s see0 t/ te0/&#&" te0'osis

te0ent'6 5&n! #&"&t #i'et&/i #en!&n &#&n5& /i"e0sensiti;it&s te0/&#&" te0'o"0otein6

5&it7i te0'in "ositif. Se&$& $&s& in'&si 7i te0'in $&si/ ne!&tif. P&#&

se&!i&n es&0 in#i;i# #en!&n siste$ i$n 5&n! e0fn!si &i'6 "&#& s&&t siste$ i$n

see0 e0'e$&n!6 "0oife0&si &'te0i te0'osis te0/enti. A'&n tet&"i se&!i&n 'ei

&'&n #&"&t tet&" /i#" #&&$ !0&no$&. Bi& i$nit&s see0 te&/ te0ent'6 &'te0i

te0'osis &0 5&n! $&s' 'e#&&$ &;eoi &'&n se!e0& #i$sn&/'&n oe/ i$nit&s

see0 s"esifi' cellular mediated immunity4.-

Sete&/ i$nit&s see0 te0ent'6 fo's "0i$e0 #i7&0in!&n "&0 $en!&&$i 0esosi

se&0& se$"0n& $e$ent' fi0osis &t& '&sifi'&si sete&/ $en!&&$i ne'0osis "en!'e7&n #&n en'&"s&si6 tet&"i "en5e$/&nn5& i&s&n5& ti#&' sese$"0n& fo's

"0i$e0 #i7&0in!&n "&0. B&'te0i te0'osis #&"&t tet&" /i#" #&n$enet&" se&$&

e0t&/n<t&/n #&&$ 'een7&0 ini6 tet&"i ti#&' $eni$'&n !e7&& "en5&'it te0'osis.-

Ko$"e's "0i$e0 #&"&t 7!& $en!&&$i 'o$"i'&si. Ko$"i'&si 5&n! te07&#i #&"&t

#ise&'&n oe/ fo's "0i$e0 #i "&0 &t& #i 'een7&0 i$fe 0e!ion&.Fo's "0i$e0 #i "&0

#&"&t $e$es&0 #&n $en5e&'&n "ne$onitis &t& "e0itisfo'&. i'& te07&#i ne'0osis

"en!'e7&n 5&n! e0&t6 &!i&n ten!&/ esi &'&n $en&i0 #&n 'e&0 $e&i 0on's

se/in!!& $enin!!&'&n 0on!!& #i 7&0in!&n "&0'&;it&s4.-

6



Keen7&0 i$fe "&0&/is &t& "&0&t0&'e& 5&n! $&n5& e0'0&n no0$& "&#&

&8& infe'si6 &'&n $e$es&0 '&0en& 0e&'si inf&$&si 5&n! e0&n7t6se/in!!& 0on's &'&n

te0!&n!!. st0'si "&0si& "&#& 0on's &'i&t te'&n&n e'ste0n& $eni$'&n

/i"e0inf&si #i se!$en #ist& "&0 $e&i $e'&nis$e;enti. st0'si tot& #&"&t

$en5e&'&n &teet&'sis 'een7&0 5&n! $en!&&$i inf&$&si #&n ne'0osis "en!'e7&n

#&"&t $e0s&' #&n $eni$'&n e0osi #in#in! 0on's6 se/in!!& $en5e&'&n

te0'osis en#o0on'i& &t& $e$ent' fist&. M&ss& 'e7 #&"&t $eni$'&n

ost0'si 'o$"it "&#& 0on's se/in!!& $en5e&'&n !&n!!&n "ne$onitis #&n

&teet&'sis6 5&n! se0in! #iset se&!&i esi se!$ent&'o&"s<'onsoi#&si.-

Se&$& $&s& in'&si6 see$ te0ent'n5& i$nit&s see06 #&"&tte07&#i

"en5e&0&n i$fo!en #&n /e$&to!en.P&#& "en5e&0&n i$fo!en6 '$&n$en5e&0 'e

'een7&0 i$fe 0e!ion& $e$ent' 'o$"e's "0i$e0 &t& e0&n7t$en5e&0 se&0&

i$fo/e$&to!en.D&"&t 7!& te07&#i "en5e&0&n /e$&to!en&n!sn!6 5&it '$&n $&s' 'e

#&&$ si0'&si #&0&/ #&n $en5e&0 'e se0/t/. A#&n5& "en5e&0&n /e$&to!en

ini&/ 5&n! $en5e&'&n te0'osis #isetse&!&i "en5&'it siste$i'.-

Pen5e&0&n /e$&to!en 5&n! "&in! se0in! te07&#i &#&&/ #&&$ ent' "en5e&0&n

/e$&to!eni' te0s&$&0. Me&i &0& ini6 &'te0i te0'osis$en5e&0 se&0&s"o0&#i' #&n

se#i'it #e$i se#i'it se/in!!& ti#&' $eni$'&n !e7&& 'inis.&'te0i te0'osis

'e$#i&n $en&"&i e0&!&i o0!&n #ise0/ t/6 e0s&0&n! #io0!&n 5&n! $e$"n5&i

;&s'&0is&si &i'6 "&in! se0in! #i &"e's "&06 i$"& #&n'een7&0 i$fe s"e0fisi&is. Se&in

it6 #&"&t 7!& e0s&0&n! #i o0!&n &in se"e0tiot&'6 /e"&06 t&n!6 !in7&6 #&n &in<&in. P&#&

$$n5&6 '$&n #i s&0&n! te0settet&" /i#"6 tet&"i ti#&' &'tif6 #e$i'i&n "& #en!&n

"0oses "&too!i'n5&. S&0&n!#i &"e's "&0 #iset #en!&n fo's Si$on6 5&n! #i 'e$#i&n

/&0i #&"&t$en!&&$i 0e&'ti;&si #&n te07&#i te0osis "&#& &"e's "&0 s&&t #e8&s&.

-

P&#& &n&'6 ( t&/n "e0t&$& sete&/ te07&#i infe'si te0t&$& 1 t&/n "e0t&$&4

i&s&n5& se0in! te07&#i 'o$"i'&si te0'osis. Men0t &!0en6 &#& ti!& ent' #&s&0

te0'osis "&0 "&#& &n&'6 5&it "en5e&0&n i$fo/e$&to!en6 te0'osisen#o0on'i&6

#&n te0'osis "&0 '0oni'. Te0'osis "&0 '0oni' &#&&/ te0'osis "&s&"0i$e0

se&!&i &'i&t 0e&'ti;&si '$&n #i #&&$ fo's 5&n! ti#&' $en!&&$i 0esosi se$"0n&.

Re&'ti;&si ini 7&0&n! te07&#i "&#& &n&' tet&"i se0in!te07&#i "&#& 0e$&7& #&n #e8&s& $#&.-

7



Te0'osis e'st0&"$on&6 5&n! i&s&n5& 7!& $e0"&'&n

$&nifest&site0'osis "&s&"0i$e06 #&"&t te07&#i "&#& 2(<3, &n&' 5&n! te0infe'si

te0'osis. Te0'osis "&#&siste$ s'eet& te07&#i "&#& (<1, &n&' 5&n! te0infe'si6

"&in! &n5&' te07&#i#&&$ 1 t&/n "e0t&$&6 tet&"i #&"&t 7!& 2<3 t&/n sete&/ infe'si

"0i$e0. Te0'osis !in7& i&s&n5& te07&#i (<2( t&/n sete&/ infe'si "0i$e0.-

)#&#' 1. P#togenesis t%&e'$%losis.*

)#&#'

2.

"#lende' pe'+#l#n#n pen,#$it t%&e'$%losis p'ie'.*

8



P0oses infe'si te0'osis ti#&' &n!sn! $e$e0i'&n !e7&&. U7i te0'in

i&s&n5& "ositif #&&$ %<- $in!! sete&/ 'ont&' &8& #en!&n &'te0i

te0'osis.P&#&&8& te07&#in5& infe'si te0'osis6 #&"&t #i7$"&i #e$&$ 5&n! ti#&'

tin!!i #&n e0ite$&no#s$6 tet&"i 'e&in&n 'it ini e0&n!sn! sin!'&t se/in!!& 7&0&n!

te0#ete'si.te0'osis "0i$e0 #&"&t te07&#i '&"&n s&7& "&#& t&/&" ini.-

Te0'osis $iie0 #&"&t te07&#i seti&" s&&t6 tet&"i i&s&n5& e0&n!sn!#&&$ 3<)

&n "e0t&$& sete&/ infe'si te0'osis6 e!it 7!& #en!&n $enin!itis

te0'osis.Te0'osis "&#& "e0& te07&#i #&&$ 3<) &n "e0t&$& sete&/ infe'si

te0'osis.Te0'osis "&#& siste$ s'eet& te07&#i "&#& t&/n "e0t&$&6 8&&"n #&"&t

te07&#i "&#& t&/n 'e#& #&n 'eti!&.Te0'osis !in7& i&s&n5& te07&#i ei/ &$&65&it (<

2( t&/n sete&/ infe'si "0i$e0. Se&!i&n es&0 $&nifest&si 'inis s&'it te0osis te07&#i

"&#& ( t&/n "e0t&$&6 te0t&$& "&#& 1 t&/n "e0t&$&6 #&n *, 'e$&ti&n'&0en&

te0'osis te07&#i "&#& t&/n "e0t&$& sete&/ #i&!nosis te0'osis.-

2.- M#nifest#si $linis

M#nifest#si sistei$ %%/nonspesifi$0

&. De$&$ &$& 2 $in!!4 #&n=&t& e0&n! t&n"& se& 5&n! 7e&s '&n #e$&$

tifoi#6 infe'si s&0&n 'e$i/6 $&&0i&6 #&n &in<&in46 5&n! #&"&t #ise0t&i #en!&n

'e0in!&t $&&$. De$&$ $$n5& ti#&' tin!!i.

. B&t' &$& 3 $in!!6 #&n se& &in te&/ #isin!'i0'&n.

. Be0&t &#&n t0n t&n"& se& 5&n! 7e&s6 &t& ti#&' n&i' #&&$ 1 &n #en!&n

"en&n!&n&n !ii 5&n! &#e'&t.

#. N&fs $&'&n ti#&' &#& &no0e'si&4 #en!&n !&!& t$/ #&n BB ti#&' n&i' #en!&n

&#e'&t f&i0e to t/0i;e4.

e. Pe$es&0&n 'een7&0 i$fe s"e0fisi&is 5&n! ti#&' s&'it #&n i&s&n5& $ti"e

f. Les &t& $&&ise

!. Di&0e "e0sisten 5&n! ti#&' se$/ #en!&n "en!o&t&n &' #i&0e.

• M#nifest#si spesifi$ o'g#n/t%ngg#l *

M&nifest&si 'inis s"esifi' e0!&ntn! "&#& o0!&n 5&n! te0'en&6 $is&n5& 'een7&0

i$fe6 ssn&n s&0&f "s&t SSP46 t&n!6 #&n 'it.Se&0& 0in!'&s6 !e7&& s"esifi' ses&i o0!&n 5&n! te0'en& &#&&/ se&!&i e0i't :

9



&. TB 'een7&0 : te0&n5&' #i 0e!io 'oi6 $ti"e6 ti#&' n5e0i #&n s&in!

$ee'&t.

. TB ot&' #&n s&0&f : $enin!itis TB #&n te0'o$& ot&' !e7&& i0it&e6 '&'

'#'6 $nt&/<$nt&/ #&n 'es&#&0&n $en0n4.

. TB t&n! #&n sen#i : !e7&& e0"& "e$en!'&'&n sen#i6 !is6 "in&n!6

$"/ #&n sit $e$n!''.

#. TB 'it : s'0ofo#e0$&.

e. TB $&t& : 'on7n!ti;itis fi'ten&0is #&n te0'e 'o0oi# /&n5&

te0i/&t #en!&n fn#s'o"i4.

f. TB o0!&n<o0!&n &inn5&6 $is&n5& "e0itonitis TB6 TB !in7&6 #.

2. Di#gnosis TB P#'% An#$

T#&el 1. S$o'ing T%&e'$%losis p#d# #n#$

U+i t%&e'$%lin

Te0'in &#&&/ 'o$"onen "0otein "&#& &'te0i te0'osis 5&n! $e$"n5&i

sif&t &nti!eni' 5&n! '&t. i'& #isnti''&n se&0& int0&'t&n 'e"&#& seseo0&n! 5&n! te&/

te0infe'si te0'osis6 $&'& &'&n te07&#i 0e&'si e0"& in#0&si #i o'&si snti'&n.U7i

te0in #en!&n &0& mantou# #i&''&n #en!&n $en5nti''&n ,61 $ PPD RT<23 2TU

se&0& int0&'t&n #i &!i&n ;o&0 en!&n &8&/. Pe$&&&n #i&''&n %-<+2 7&$ sete&/

10



"en5nti'&n.Pen!'0&n #i&''&n te0/&#&" in#0&si 5&n! ti$. i'& ti#&' ti$

in#0&si s&$& se'&i /&sin5& #i&"o0'&n se&!&i ne!&tif6 #i&$ete0 in#0&si 1, $$

#in5&t&'&n "ositif t&n"& $en!/i0&'&n "en5e&n5&. H&si "ositif ini se&!i&n es&0

#ise&'&n oe/ infe'si te0'osis &&$i&/6 tet&"i $&si/ $n!'in #ise&'&n oe/

i$nis&si B?G &t& infe'si $5o&te0i$ &ti"i'. P&#& &n&' &it& 5&n! te&/ $en#&"&t

B?G6 #i&$ete0 in#0&si 1,<1% $ #in5&t&'&n 7i te0'in "ositif6 'e$n!'in&n es&0

'&0en& infe'si te0'osis &&$i&/6 tet&"i $&si/ $n!'in #ise&'&n oe/ "&s&

i$nis&si B?G6 n&$n i& '0&n in#0&sin5& 1( $$ s&n!&t $n!'in '&0en& infe'si

&&$i&/. A"&i& #i&$ete0 in#0&si ,<% $$ #in5&t&'&n 7i te0'in ne!&tif. Di&$ete0 (<*

$ #in5&t&'&n "ositif $e0&!'&n. P&#& 'e&#&&n immunocompromised &t& "&#&

"e$e0i's&&n foto t/o0&' te0#&"&t 'e&in&n 0&#ioo!is /&si "ositif 5&n! #i!n&'&n ($$.26(

Unt' $e$"e0$#&/ "e$&/&$&n $en!en&i 'onse" infe'si te0osis #&n s&'it

te0osis6 '&sifi'&si te0osis 5&n! #i&t oe/ $merican Thoracoc %ociety ATS4

#&n ?ente0s fo0 Dise&se ?ont0o &n# P0e;ention ?D?4 A$e0i'&.

Ke&s Kont&' Infe'si =tes

te0'is

S&'it Tin#&'&n

K&sifi'&si , < < < <

K&sifi'&si I < < P0ofi&'is I

K&sifi'&si II < P0ofi&'sis II

K&sifi'&si III Te0&"i

T#&el 2 "l#sifi$#si indi4id% &e'd#s#'$#n st#t%s t%&e'$%losis*

P&#& &n&' t&n"& 0isi'o tet&"i tin!!& #i #&e0&/ en#e$is TB6 7i te0'in "e0 #i&''&n

"&#& $0 1 t&/n6 %<) t&/n #&n 11<1) t&/n. Tet&"i6 "&#& &n&' #en!&n 0isi'o tin!!i #i

#&e0&/ en#e$is TB6 7i te0'in "e0 #i&''&n se&0& 0tin6 i& /&sin5& ne!&tif #&"&t

#i&n! seti&" t&/n. *

U7i te0'in "ositif #&"&t #i7$"&i "&#& 3 'e&#&&n se&!&i e0i't: *

1. Infe'si TB &&$i&/

&4 Infe'si TB t&n"& s&'it TB infe'si TB &ten4.

4 Infe'si TB #&n s&'it TB.

4 TB 5&n! te&/ se$/.

2. I$nis&si B?G infe'si TB &t&n4.

3. Infe'si $i'o&'te0i$ &ti"i'.

11



U7i te0'in ne!&tif "&#& 3 'e$n!'in&n 'e&#&&n e0i't: *

1. Ti#&' &#& infe'si TB.

2. D&&$ $&s& in'&si infe'si TB.

3. Ane0!i.

Ane0!i &#&&/ 'e&#&&n "ene'&n&n siste$ i$n oe/ e0&!&i 'e&#&&n6 se/in!!&

t/ ti#&' $e$e0i'&n 0e&'si te0/&#&" te0'in 8&&"n seen&0n5& s#&/ te0infe'si

TB. Bee0&"& 'e&#&&n #&"&t $eni$'&n &ne0!i6 $is&n5& !ii 0'6 'e!&n&s&n6

"en!!n&&n ste0oi# 7&n!'& "&n7&n!6 sitost&ti'&6 "en5&'it $o0ii6 "e0tsis6 ;&0ise&6

infen&6 TB 5&n! e0&t6 se0t& "e$e0i&n ;&'sin&si #en!&n ;&'sin ;i0s /i#". J&n!

#i$&'s# #en!&n infen& &#&&/ infe'si oe/ ;i0s infen&6 '&n &t'<"ie' "&n&s

i&s&6 5&n! $$n5& #ise&'&n oe/ rhinovirus #&n #iset se&!&i sees$& (common

cold)& *

#. R#diologis

Pe$e0i's&&n 0&#ioo!is #&"&t $e$"e0'&t #i&!nosis6 '&0en& ei/ *( infe'si

"0i$e0 te07&#i #i "&0<"&0 $&'& se&0& 0tin foto thora# /&0s #i&''&n. Ko$"e' "0i$e0

ei/ &n5&' #ite$'&n "&#& foto to0& "&0 &5i #&n &n&' 'ei #&0i"&#& #e8&s&. Se&0&

$$6 !&$&0&n 0&#ioo!is 5&n! s!estif TB &#&&/ se&!&i Pe$es&0&n 'een7&0 /is

&t& "&0&t0&'e& #en!&n=t&n"& infit0&te6 Konsoi#&si se!$ent&=o&06 Miie06 K&sifi'&si

#en!&n infit0&te6 Atee't&sis6 K&;it&s6 Efsi "e0&6 Te0'o$&.

Foto to0&'s ti#&' '" /&n5& #i&t se&0& &nte0o<"oste0io0 AP46 tet&"i /&0s

#ise0t&i #en!&n foto &te0&6 $en!in!&t &/8& "e$es&0&n KGB #i #&e0&/ /is i&s&n5&

ei/ 7e&s "&#& foto &te0&. *

&. Mi$'o&iologis

Pe$e0i's&&n $i'0oioo!i sit #i&''&n "&#& &n&' '&0en& sitn5& $en#&"&t'&n

s"ei$en e0"& s"t$. Se&!&i !&ntin5&6 #i&''&n "e$e0i's&&n i&s &$n! (gastric

lavage) 3 /&0i e0t0t<t0t6 $ini$& 2 /&0i. H&si "e$e0i's&&n $i'0os'o"i' &n!sn!

"&#& &n&' se&!i&n es&0 ne!&tif6 se#&n!'&n /&si i&'&n M& tuberculosis $e$e0'&n

8&'t 5&n! &$& 5&it se'it&0 )<- $in!!. S&&t ini &#& "e$e0i's&&n i&'&n 5&n! /&sin5&

#i"e0oe/ ei/ e"&t 1<3 $in!!46 5&it "e$e0i's&&n B&te6 tet&"i i&5&n5& $&/& #&n

se&0& te'noo!i ei/ 0$it. *

5. P#tologi #n#toi

12



Pe$e0i's&&n PA #&"&t $enn7''&n !&$&0&n !0&no$& 5&n! '0&nn5& 'ei6

te0ent' #&0i &!0e!&si se e"iteoi# 5&n! #i'eiin!i oe/ i$fosit. G0&no$& te0set

$e$"n5&i '&0&'te0isti' "e0'i7&n &t& &0e& ne'0osis '&seos& #i ten!&/ !0&no$&.

G&$&0&n '/&s &inn5& &#&&/ #ite$'&nn5& multinudeated giant cell se #&ti&

L&n!/&ns4. Di&!nosis /isto"&too!i' #&"&t #ite!&''&n #en!&n $ene$'&n "e0'i7&n

'&seos&46 se e"iteoi#6 i$fosit6 #&n se #&ti& L&n!/&ns. K&#&n!<'&#&n! #&"&t #ite$'&n

7!& BTA. *

2.* T#t#l#$s#n#

Medi$#entos#

&t TB t&$& (first line) s&&t ini &#&&/ 0if&$"isin R46 isoni&i# H46 "i0&in&$i#

46 et&$to E46 #&n st0e"to$isin S4. Rif&$"isin #&n isoni&i# $e0"&'&n o&t "ii/&n

t&$& #&n #it&$&/ #en!&n "i0&in&$i#6 et&$to6 #&n st0e"to$isin. &t TB &in

(second line) &#&&/ para'aminosalicylic acid PAS46 cycloserin terizidone! ethionamide!

prothionamide! oflo#acin! levoflo#acin! mo#iflok#acin! gatiflo#acin! ciproflo#acin! kanamycin!

amikacin! dan capreomycin! 5&n! #i!n&'&n 7i'& te07&#i MDR.1,

#. Isoni#6id INH0

INH &#&&/ o&t &ntite0'osis 5&n! s&n!&t efe'tif s&&t ini6 e0sif&t &'te0isi# #&n

s&n!&t efe'tif te0/&#&" '$&n #&&$ 'e&#&&n $et&oi' &'tif 5&it '$&n 5&n! se#&n!

e0'e$&n! #&n e0sif&t &'te0iost&ti' te0/&#&" '$&n 5&n! #i&$. &t ini efe'tif "&#&

int0&se #&n e'st0&se '$&n. INH '" $0&/ #&n s&n!&t efe'tif nt' $ene!&/

$ti"i'&si &si te0'osis. Te0#&"&t #&&$ se#i&&n o0& #&n int0&$s'e0 i.$4.

D&&$ se#i&&n o0&6 '&#&0 o&t #&&$ "&s$&6 s"t$ #&n &i0&n se0es0os"in& #&"&t

#i&"&i #&&$ 1<2 7&$ #&n e0t&/&n $ini$& ) C - 7&$. INH #ie0i'&n se&0& o0&6 dosis

7#'i#n ,#ng &i#s# di&e'i$#n ( 8 1( g/$g&&/7#'i09 #$si#l 3:: g/7#'i 6 #ie0i'&n

s&t '&i "e$e0i&n. INH 5&n! te0se#i& $$n5& #&&$ ent' t&et 1,,$! #&n 3,,$!6

#&n #&&$ ent' si0" 1,,$!=($. INH #i$et&ois$e $e&i &seti&si #i /&ti. INH

te0#&"&t "&#& ASI i 5&n! $en#&"&t isoni&i# #&n #&"&t $ene$s s&8&0 #&0&/

"&sent&6tet&"i '&#&0 o&t 5&n! $en&"&i 7&nin=&5i ti#&' $e$&/&5&'&n. 1,

&. Rif#pisin

Rif&$"isin e0sif&t &'te0isi# "&#& int0&se #&n e'st0&se6 #&"&t $e$&s'i se$&

7&0in!&n6 #&n #&"&t $e$n/ '$&n se$i#o0$&n 5&n! ti#&' #&"&t #in/ oe/

13



isoni&i#. Rif&$"isin #i&so0"si #en!&n &i' $e&i siste$ !&st0ointestin& "&#& s&&t

"e0t 'oson! 1 7&$ see$ $&'&n46 #&n '&#&0 se0$ "n&' te0&"&i #&&$ 2 7&$.

S&&t ini6 0if&$"isin #ie0i'&n #&&$ ent' o0& #en!&n dosis 1:;2: g/$gBB/7#'i9

dosis #$si#l -:: g/7#'i6 #en!&n #osis s&t '&i "e$e0i&n "e0 /&0i. i'&

#ie0i'&n e0s&$&&n #en!&n isoni&i#6 #osis 0if&$"isin ti#&' $eei/i 1( $!='!BB=/&0i #&n

#osis isoni&i# 1, $!='!BB=/&0i. Se"e0ti /&n5& isoni&i#6 0if&$"isin #i#ist0isi'&n se&0&

&s 'e 7&0in!&n #&n &i0&n t/6 te0$&s' ?SS. Dist0isi 0if&$"isin 'e #&&$ ?SS

ei/ &i' "&#& 'e&#&&n se&"t ot&' 5&n! se#&n! $en!&&$i "e0&#&n!&n #&0i"&#&

'e&#&&n no0$&. E's'0esi 0if&$"isin te0t&$& te07&#i $e&i t0&'ts iie0. K&#&0 5&n!

efe'tif 7!& #&"&t #ite$'&n #i !in7& #&n 0in. 1,

Rif&$"isin $$n5& te0se#i& #&&$ se#i&&n '&"s 1(,$!6 3,,$! #&n %(,$!

se/in!!& '0&n! ses&i nt' #i!n&'&n "&#& &n&'<&n&' #en!&n e0&!&i 'is&0&n e0&t

&#&n. Ss"ensi #&"&t #i&t #en!&n $en!!n&'&n e0&!&i 7enis &t "e$&8&6 tet&"i

se&i'n5& ti#&' #i$in$ e0s&$&&n #en!&n "e$e0i&n $&'&n&n '&0en& #&"&t ti$

$&&so0si. 1,

5. Pi'#6in#id

Pi0&in&$i# &#&&/ #e0i;&t #&0i ni'otin&$i#6 e0"enet0&si &i' "&#& 7&0in!&n #&n

&i0&n t/ te0$&s' ?SS6 &'te0isi# /&n5& "&#& int0&se "&#& s&s&n& &s&$6 #&n

#i0eso0si &i' "&#& s&0&n e0n&. Pe$e0i&n "i0&in&$i# se&0& o0& ses&i dosis

1(;3: g/$gBB/7#'i deng#n dosis #$si#l 2 g'#/7#'i. K&#&0 se0$ "n&' %( "!=$

#&&$ 8&'t 2 7&$. Pi0&in&$i# #ie0i'&n "&#& f&se intensif '&0en& "i0&in&$i# s&n!&t

&i' #ie0i'&n "&#& s&&t s&s&n& &s&$6 5&n! ti$ &'i&t 7$&/ '$&n $&si/ s&n!&t &n5&'.

Pen!!n&&n "i0&in&$i# &$&n "&#& &n&'. 1,

d. Et#&%tol

Et&$to 7&0&n! #ie0i'&n "&#& &n&' '&0en& "otensi to'sisit&sn5& "&#& $&t&.Pe0&n t&$& #&0i o&t ini &#&&/ nt' $ene!&/ 0esistensi o&t &in. Dosis 1( 8 2:

g/$gBB/7#'i9 dosis #$si#l 192( g'#/7#'i6 #en!&n #osis tn!!&. EMB te0se#i&

#&&$ t&et 2(,$! #&n (,,$!. Sif&t et&$to &#&&/ &'te0iost&ti' #&n &'te0isi#&.

To'sisit&s t&$& &#&&/ ne0itis o"ti'& e0"& 'et&&n te0/&#&" 8&0n& $e0&/</i7& 0e#<

!0een oo0 in#ness4. Efe' ini '" se0in! #i7$"&i "&#& o0&n! #e8&s&. Insi#ensi #&0i

to'sisit&s o"t&$oo!i'& '" 0en#&/. e/ '&0en& "e$e0i's&&n &"&n! "&n#&n! #&n

8&0n& "&#& &n&'<&n&' '" sit #i&''&n $&'& et&$to ti#&' #i0e'o$en#&si'&n

nt' te0&"i 0tin "&#& &n&'<&n&'. EMB #&"&t #ie0i'&n "&#& &n&' #en!&n TB e0&t #&n

14



'e0i!&&n TB 0esisten<o&t6 7i'& o&t<o&t&n &inn5& ti#&' te0se#i& &t& ti#&' #&"&t

#i!n&'&n.1,

e. St'eptoisin

St0e"to$isin e0sif&t &'te0iosi# #&n &'te0iost&ti' '$&n e'st0&se&0 "&#&

'e&#&&n &s& &t& net0&6 7&#i efe'tif $e$n/ '$&n int0&see0. St0e"to$isin #&"&t

#ie0i'&n se&0& int0&$s'&0 #en!&n dosis 1( 8 !: g/$gBB/7#'i9 #$si#l dosis 1

g'#/7#'i. &t ini #&"&t $ee8&ti se&"t ot&' 5&n! $e0&#&n!6 e0#ifsi #en!&n &i'

"&#& 7&0in!&n #&n &i0&n "e0&6 #ie's'0esi $e&i !in7&. To'sisit&s t&$& #&0i

st0e"to$isin te07&#i "&#& ne0;s '0&ni& 9III 5&n! $en!!&n!! 'esei$&n!&n #&n

"en#en!&0&n e0"& tinis$s #&n "sin!. 1,

P0insi" #&s&0 AT &#&&/ /&0s #&"&t $ene$s e0&!&i 7&0in!&n te0$&s'

se&"t ot&'. F&0$&'o'ineti' AT "&#& &n&' e0e#& #en!&n o0&n! #e8&s&. Toe0&nsi

&n&' te0/&#&" #osis o&t "e0 '!BB ei/ tin!!i. Se&0& 0in!'&s6 #osis #&n efe' s&$"in!

AT #&"&t #ii/&t "&#& !&$&0 #i&8&/ ini.1,

P#d%#n <&#t TB 1:

Pen!o&t&n TB #i&!i $en7&#i #& f&se6 5&it f&se intensif 2 &n "e0t&$&4 #&n

sis&n5& se&!&i f&se &n7t&n. P0insi" #&s&0 "en!o&t&n TB &#&&/ $ini$& ti!& $&&$ o&t

"&#& f&se intensif 2 &n "e0t&$&4 #&n #i&n7t'&n #en!&n #& $&&$ o&t "&#& f&se

&n7t&n % &n &t& ei/4. Pe$e0i&n "&#&n o&t ini e0t7&n nt' $ene!&/

te07&#in5& 0esistensi o&t #&n nt' $e$n/ '$&n int0&se&0 #&n e'st0&se&0.

15



Pe$e0i&n o&t 7&n!'& "&n7&n!6 se&in nt' $e$n/ '$&n 7!& nt' $en!0&n!i

'e$n!'in&n te07&#in5& 0e&"s.

Be0e#& #en!&n o0&n! #e8&s&6 AT "&#& &n&' #ie0i'&n seti&" /&0i6 '&n #& &t&

ti!& '&i #&&$ se$in!!. H& ini e0t7&n nt' $en!0&n!i 'eti#&'te0&t0&n $ene&n

o&t 5&n! ei/ se0in! te07&#i 7i'& o&t ti#&' #ite&n seti&" /&0i. S&&t ini "&#&n o&t 5&n!

&' nt' se&!i&n es&0 '&ss TB "&#& &n&' &#&&/ "&#&n 0if&$"isin6 isoni&i#6 #&n

"i0&in&$i#. P&#& f&se intensif #ie0i'&n 0if&$"isin6 isoni&i#6 #&n "i0&in&$i#6

se#&n!'&n "&#& f&se &n7t&n /&n5& #ie0i'&n 0if&$"isin #&n isoni&i#.

P&#& 'e&#&&n TB e0&t6 &i' TB "$on& $&"n e'st0&"$on& se"e0ti TB

$iie06 $enin!itis TB6 TB siste$ s'eet&6 #&n &in<&in6 "&#& f&se intensif #ie0i'&n

$ini$& e$"&t $&&$ o&t 0if&$"isin6 isoni&i#6 "i0&in&$i#6 #&n et&$to &t&

st0e"to$isin4. P&#& f&se &n7t&n #ie0i'&n 0if&$"isin #&n isoni&i# se&$& 1, &n.

Unt' '&ss TB te0tent 5&it $enin!itis TB6 TB $iie06 efsi "e0& TB6 "e0i'&0#itis TB6

TB en#o0on'i&6 #&n "e0itonitis TB6 #ie0i'&n 'o0ti'oste0oi# "0e#nisone4 #en!&n #osis 1<

2 $!='!BB=/&0i6 #i&!i #&&$ 3 #osis6 $&'si$& ), $! #&&$ 1 /&0i. L&$& "e$e0i&n

'o0ti'oste0oi# &#&&/ 2<% $in!! #en!&n #osis "en/6 #i&n7t'&n tappering off se&$& 1<2

$in!!.

Fi=ed Dose >o&in#tion 1,

S&&/ s&t $&s&&/ #&&$ te0&"i TB &#&&/ 'ete0&t0&n (adherence) "&sien

#&&$ $en7&&ni "en!o&t&n 5&n! 0e&tif &$& #en!&n 7$&/ o&t 5&n! &n5&'.

Unt' $en!&t&si /& te0set6 #i&t s&t se#i&&n o&t 'o$in&si #en!&n #osis 5&n!

te&/ #itent'&n6 5&it FD? &t& Ko$in&si Dosis Tet&" KDT4.

16



E4#l%#si H#sil Pengo&#t#n 1,

Se&i'n5& "&sien 'ont0o seti&" &n nt' $eni&i "e0'e$&n!&n /&si

te0&"i $e$&nt& ti$n5& efe' s&$"in! o&t. E;&&si /&si "en!o&t&n #i&''&n

sete&/ 2 &n te0&"i. E;&&si "en!o&t&n #i&''&n #en!&n ee0&"& &0&6 5&it e;&&si

'inis6 e;&&si 0&#ioo!is6 #&n "e$e0i's&&n LED.

&. Res"on "en!o&t&n &i' : !e7&& 'inis /i&n! #&n te07&#i "en&$&/&n e0&t &#&n6

$&'& "en!o&t&n #i&n7t'&n.

. Res"on ti#&' &#& : "en!o&t&n #i&n7t'&n #&n #ie0i t&$&/&n #en!&n $e07' 'e

s&0&n& 5&n! ei/ tin!!i. Ke$n!'in&n te07&#i $is#i&!nosis6 $ist0e&t$ent &t& 0esisten

te0/&#&" AT.

A"&i& "&#& s&&t #i&!nosis te0#&"&t 'e&in&n 0&#ioo!is6 $&'& #i&n70'&n

"e$e0i's&&n 0&#ioo!is &n!&n.

M%ltid'%g Resist#n5e MDR;TB01,

MDR<TB &#&&/ iso&t M& Tuberculosis 5&n! 0esisten te0/&#&" #& &t& ei/

AT ini "e0t&$& i&s&n5& isoni&i# #&n 0if&$"isin.

D&ft&0 AT ini 'e#& nt' MDR<TB #&"&t #ii/&t "&#& t&e :

17



Non Medi$#entos# 1:

Pende$#t#n D<TS

H& 5&n! "&in! "entin! "&#& t&t&&'s&n& TB &#&&/ 'e"&t/&n adherens4

$ene&n o&t. P&sien TB i&s&n5& te&/ $enn7''&n "e0&i'&n ee0&"& $in!!

sete&/ "en!o&t&n6 se/in!!& $e0&s& te&/ se$/ #&n ti#&' $e&n7t'&n "en!o&t&n.

Pen&n!!&n!&n TB #en!&n st0&te!i DTS #&"&t $e$e0i'&n &n!'& 'ese$/&n

5&n! tin!!i. Ses&i #en!&n 0e'o$en#&si H6 st0&te!i DTS te0#i0i &t&s i$& 'o$"onen6

5&it se&!&i e0i't :

&. Ko$it$en "oitis #&0i "&0& "en!&$i 'e"ts&n6 te0$&s' #'n!&n #&n&.

. Di&!nosis TB #en!&n "e$e0i's&&n s"t$ se&0& $i'0os'o"is.

. Pen!o&t&n #en!&n "&#&n AT 7&n!'& "en#e' #en!&n "en!&8&s&n &n!sn! oe/

"en!&8&s $ene&n o&t PM4.

#. Kesin&$n!&n "e0se#i&&n AT 7&n!'& "en#e' #en!&n $t te07&$in.

e. Pen&t&t&n #&n "e&"o0&n se&0& &' nt' $e$#&/'&n "e$&nt&&n #&n e;&&si

"0o!0&$ "en&n!!&n!&n TB.

• L#5#$ S%&e' Pen%l#'#n d#n Case Finding

A"&i& 'it& $ene$'&n seo0&n! &n&' #en!&n TB6 $&'& /&0s #i&0i s$e0

"en&0&n 5&n! $en5e&'&n &n&' te0set te0t&0 TB. S$e0 "en&0&n &#&&/ o0&n!

#e8&s& 5&n! $en#e0it& TB &'tif #&n 'ont&' e0&t #en!&n &n&' te0set. Pe&&'&n s$e0

infe'si sent0i"et& #i&''&n #en!&n &0& "e$e0i's&&n 0&#ioo!is #&n BTA s"t$. Bi&

te&/ #ite$'&n s$e0n5&6 "e0 "& #i&''&n "e&&'&n sent0if!&6 5&it $en&0i

&n&' &in #i se'it&0n5& 5&n! $n!'in 7!& te0t&06 #en!&n &0& 7i te0'in. 1,

18



Se&i'n5&6 7i'& #ite$'&n "&sien TB #e8&s& &'tif6 $&'& &n&' #i se'it&0n5& &t&

5&n! 'ont&' e0&t /&0s #ites0i &#& &t& ti#&'n5& infe'si TB "e&&'&n sent0if!&4.

Pe&&'&n te0set #i&''&n #en!&n &0& &n&$nesis6 "e$e0i's&&n fisis6 #&n "e$e0i's&&n

"enn7&n! 5&it 7i te0'in. 1,

2. Pen5eg#7#n 1,

I%nis#si B>)

I$nis&si B?G #ie0i'&n "&#& si& see$ 2 &n. Dosis nt' &5i sees&0 ,6,(

$ #&n nt' &n&' ,61, $6 #ie0i'&n se&0& int0&'t&n #i #&e0&/ inse0si otot #etoi#

'&n&n "en5nti'&n ei/ $#&/ #&n e$&' s'tis ei/ te&6 's ti#&'

$en!&n!! st0't0 otot #&n se&!&i t&n#& B&'4. Bi& B?G #ie0i'&n "&#& si& 3 &n6

se&i'n5& #i&''&n 7i te0'in te0ei/ #&/.

"eop'ofil#$sis

Te0#&"&t #& $&&$ 'e$o"0ofi&'sis6 5&it 'e$o"0ofi&'sis "0i$e0 #&n

'e$o"0ofi&'sis se'n#e0. Ke$o"0ofi&'sis "0i$e0 e0t7&n nt' $ene!&/ te07&#in5&

infe'si TB6 se#&n!'&n 'e$o"0ofi&'sis se'n#e0 $ene!&/ e0'e$&n!n5& infe'si

$en7&#i s&'it TB. P&#& 'e$o"0ofi&'sis "0i$e0 #ie0i'&n isoni&i# #en!&n #osis (<1,

$!='!BB=/&0i #en!&n #osis tn!!&. Ke$o"0ofi&'sis ini #ie0i'&n "&#& &n&' 5&n! 'ont&'

#en!&n TB $en&06 te0t&$& #en!&n BTA s"t$ "ositif6 tet&"i e$ te0infe'si 7i

te0'in ne!&tif4. &t #ie0i'&n se&$& ) &n. P&#& &'/i0 &n 'eti!& "e$e0i&n

"0ofi&'sis #i&''&n 7i te0'in &n!. i'& tet&" ne!&tif6 "0ofi&'sis #i&n7t'&n /in!!&

) &n. i'& te07&#i 'on;e0si te0'in $en7&#i "ositif6 e;&&si st&ts TB "&sien. P&#&

&'/i0 &n 'een&$ "e$e0i&n "0ofi&'sis6 #i&''&n &!i 7i te0'in6 7i'& tet&"

ne!&tif "0ofi&'sis #i/enti'&n6 7i'& te07&#i 'on;e0si te0'in $en7&#i "ositif6 e;&&sist&ts TB "&sien.

Ke$o"0ofi&'sis se'n#e0 #ie0i'&n "&#& &n&' 5&n! te&/ te0infe'si6 tet&"i e$

s&'it6 #it&n#&i #en!&n 7i te0'in "ositif6 se#&n!'&n 'inis #&n 0&#ioo!is no0$&. Ti#&'

se$& &n&' #ie0i 'e$o"0ofi&'sis se'n#e06 tet&"i /&n5& &n&' 5&n! te0$&s' #&&$

'eo$"o' 0isi'o tin!!i nt' e0'e$&n! $en7&#i s&'it TB6 5&it &n&'<&n&' "&#&

'e&#&&n i$no'o$"0o$&is. ?onto/ &n&'<&n&' #en!&n i$no'o$"0o$&is &#&&/ si&

&it&6 $en#e0it& $o0ii6 ;&0ise&6 &t& "e0tsis6 $en#&"&t o&t i$nos"0esif 5&n! &$&

sitost&ti' #&n 'o0ti'oste0oi#46 si& 0e$&7&6 #&n infe'si TB &0 'on;e0si 7i te0'in

19



#&&$ 8&'t '0&n! #&0i 12 &n4. L&$& "e$e0i&n nt' 'e$o"0ofi&'sis se'n#e0

&#&&/ )<12 &n.

2.1: "opli$#si T%&e'$%losis

Li$f&#enitis6 $enin!itis6 osteo$ieitis6 &0t/t0itis6 ente0itis6 "e0itonitis6 "en5e&0&n

'e !in7&6 $&t&6 tein!& ten!&/ #&n 'it #&"&t te07&#i.B&5i 5&n! #i&/i0'&n #&0i o0&n! t&

5&n! $en#e0it& te0'osis $e$"n5&i 0isi'o 5&n! es&0 nt' $en#e0it& te0'osis.

Ke$n!'in&n te07&#in5& !&n!!&n 7&&n n&f&s 5&n! $en!&n&$ 7i8& /&0s #i"i'i0'&n

"&#& "&sien #en!&n "ee&0&n $e#i&stin$ &t& &#&n5& esi "&#& #&e0&/ /is.11

2.11 P'ognosis T%&e'$%losisP0o!nosis #i"en!&0/i oe/ &n5&' f&'to0 se"e0ti $0 &n&'6 e0&"& &$& sete&/

$en#&"&t infe'si6 &sn5& esi6 'e&#&&n !ii6 'e&#&&n sosi& e'ono$i 'e&0!&6 #i&!nos&

#ini6 "en!o&t&n &#e'&t6 'e"&t/&n $in$ o&t6 #&n &#&n5& infe'si &in se"e0ti $o0ii6

"e0tsis6 #i&0e 5&n! e0&n! #&n &in C &in.

P&#& "&sien #en!&n siste$ i$n 5&n! "0i$&6 te0&"i $en!!n&'&n o&t &nti<

te0'osis $e$e0i'&n /&si 5&n! "otensi& nt' $en&"&i 'ese$/&n.i'& &'te0i

sensitif #&n "en!o&t&n en!'&"6 'e&n5&'&n &n&' se$/ #en!&n !e7&& sis& 5&n!

$ini$&.Te0&"i &n!&n ei/ sit #&n '0&n! $e$&s'&n /&sin5&.Pe0/&ti&n ei/ /&0s

#ie0i'&n "&#& "&sien #en!&n i$no#efisiensi6 5&n! 0esisten te0/&#&" e0&!&i 0e!i$en

te0&"i6 5&n! e0es"on 0' te0/&#&" te0&"i &t& #en!&n 'o$"i'&si &n7t.

Keti'& te07&#i 0esistensi &t& intoe0&nsi te0/&#&" Isoni&i# #&n Rif&$"iin6 &n!'&

'ese$/&n $en7&#i /&n5& (,6 &/'&n ei/ 0en#&/ &!i.11

DAFTAR PUSTAKA

1. A&t&s6 D0. Hsein et & : I$ Kese/&t&n An&'6 e#isi 'e +6 ' 26 &'&0t&

F&'t&s Ke#o'te0&n Uni;e0sit&s In#onesi& 1**+6 /& (+3 C +)1.

2. A$in6 'ifi #&n As0i B&/&0. Te0'osis P&0 #&&$ B' A7&0 I$ Pen5&'it

D&&$ E#isi'ei$& ii# III. &'&0t& : Ps&t Pene0it&n I$ Pen5&'it D&&$

F&'t&s Ke#o'te0&n Uni;e0sit&sIn#onesi&6 2,,* /. 223,<22%+2.

3. H. TB=HI9 & ini& $&n&. E#isi 'e<2. Gene;&: o0# He&t/

0!&ni&tion2,,%

%. ?o0056 S.6 &/i#i5&t6 I.6 S&st0o&s$o0o6 S. Di&!nosis Fisis "&#& An&'. ?9 S&!n!

Seto6 &'&0t&.2,,3

20



(. De"&0te$en Kese/&t&n Re"i' In#onesi&. Pe#o$&n N&sion& Pen&n!!&n!&n

Te0'osis. &'&0t& : De"'es RI6 2,,(

). Be/0$&n6 Kie!$&n6 A0;in6 e#ito0 P0of. D0. #0. A. S&$i' &/&6 S"AK4 et &:

Neson6 I$ Kese/&t&n An&'6 e#isi 1(6 ' 26 EG? 2,,,6 /& 1,2- C 1,%2.+. K&0t&s&s$it& ?B6 B&si0 D. E"i#e$ioo!i Te0'osis. D&&$ : B' A7&0

Res"i0oo!i An&'. E#isi Pe0t&$&. &'&0t& IDAI. 2,13. /.1)2<1))

-. R&/&7oe NN6 Set5&nto DB. P&to!enesis #&n Pe07&&n&n A&$i&/ Te0'osis.

D&&$ : B' A7&0 Res"i0oo!i An&'. E#isi Pe0t&$&. &'&0t& IDAI. 2,13. /.1)*<

1++

*. R&/&7oe NN6 Set5&nto DB. Di&!nosis Te0'osis "&#& An&'. D&&$ : B' A7&0

Res"i0oo!i An&'. E#isi Pe0t&$&. &'&0t& IDAI. 2,13. /.1*%<211

1,. R&/&7oe NN6 Set5&nto DB. T&t&&'s&n& Te0'osis. D&&$ : B' A7&0

Res"i0oo!i An&'. E#isi Pe0t&$&. &'&0t& IDAI. 2,13. /.21%<2++

11. P0ie6 S5;i& A ison6 Lo00&ine M. : P&tofisioo!i Kini'6 e#isi 'e (6

Te0'osis6 2,,( /& +(3 C +)1

21

Download - Referat Tb

Top Related