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Kuliah Pakar TUBERKULOSIS

Kuliah Pakar TUBERKULOSIS. Febtarini . R, dr. Sp.PK IKT- FKUWKS Sabtu , 12- April- 2014. Tuberkulosis ( Global Health Emergency ). 1/3 pdd dunia terinfeksi kuman TB 5-10% TB non HIV 11-13% HIV + TB 80% TB+ HIV Afrika. Kematian utama HIV krn TB. Usia produktif 20 – 49 tahun. MDR

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Kuliah Pakar TUBERKULOSIS

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  1. KuliahPakarTUBERKULOSIS Febtarini. R, dr. Sp.PK IKT- FKUWKS Sabtu, 12- April- 2014

  2. Tuberkulosis(Global Health Emergency) 1/3 pddduniaterinfeksikuman TB 5-10% TB non HIV 11-13% HIV + TB 80% TB+ HIV Afrika Kematianutama HIV krn TB Usiaproduktif 20 – 49 tahun MDR Asia tenggara 35% Afrika 30% Pasifikbarat 20% Vaksin BCG BaccilleCalmette-Guerin Indonesia, TB tertinggikelimadidunia PenyebabkematiantertingginomertigadiInd 1

  3. Peran Lab : deteksicepat/ dini identifikasiMycobacterium 2

  4. MTBMycobacterium tuberculosis 3

  5. Penularan Inhalasi Droplet infection Lingkunganpadatpenduduk Pemukimanperkotaan Lembab Gelap Kurangkebersihan MTBSal.npsmakrofagalveolarmaturasifagosom- (survive, berkembangbiak dlmmakrofag) produksifaktor ESAT 6/ Early secreted antigenic target InaktivasiLimfosit T, respons – (pengenalan & eliminasiintraseluler -) 4

  6. Responsimunygbisaterjadi : 5

  7. Infeksi primer/ Ghon ke jar. Tbh lain mellsistemik vena  pleura = efusi GIT, Limfe, orofaring, kulit otak, ginjal, tulang  Arteripulmonalisseluruhbagianparu TB Milier 6

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  9. TBC primerbakteridormantinfeksi endogen TB sekunder/ post primer Dx TB : • GxKlinis = respiratorik, sistemik, TB ekstraparu • Pemeriksaanfisik • Pemeriksaanbakteriologi bahan : sputum,cairanpleura,likuor,BAL,darah skriningserologikonfirmasi • Ro : Foto thorax PA berawansegmenapikal,posteriorlobusatas,superiorlobusbwh kavitas, efusi pleura, bercakmilier 8

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  12. PemeriksaanLaboratorium • Sputum = a. BTA mikroskopik b. Kultur, media Lowenstein Jensen • Kulturalatotomatis & teskepekaanantibiotika • PCR/ Polymerase chain reaction techniques • Antigen TB test • Antibodi TB rapid test (screening test) 11

  13. Pemeriksaan sputum 12

  14. Skalakuantitasirekomendasi WHO & IUATLD (International Union Against Tuberculosis and Lung Disease) 13

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  16. Kulturotomatis Deteksikumandanteskepekaan / resistensiantibiotika (4-21hr) Media kultur, misalnya : - Micobacteria Growth Indicator Tube (MGIT) - Bact/Alert - ESP Mice - MB Redox - KRD Niche B - Biphasic Septic-Check AFB & Mice-Acid - Bactec MGIT960 15

  17. Polymerase Chain Reaction (PCR) EkstraksiDNAamplifikasiregio DNA spesifik (thermal cycler)pembacaanmenggunakanelektroforesis gel ygdiwarnai dg Ethidium bromide) sensitivitas 71 – 98% spesifisitasmendekati 100% Deteksi antigen 3 – 3,5 jam 16

  18. Ag TB Rapid Test Deteksi Ag denganmenggunakan : ELISA Latex agglutination Reverse Passive Haemagglutination test 17

  19. Antibodi TB Rapid test Immunochromatographic assay/ Lateral-flow test/ Simply strip test (pengembanganmetodeagglutination test) Tesserologiuntukskrining/ penyaring, deteksidini Keuntungan : • Penderitaygtidakbanyakproduksi sputum • Bilamikroskopiknegatif (sulitmendapatkan BTA) • TB ekstraparu • Waktusingkat, mudahdigunakan, stabil,relatifekonomis. 18

  20. THANKS,..

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