Kuliah pakar tuberkulosis
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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

KuliahPakarTUBERKULOSIS

Febtarini. R, dr. Sp.PK

IKT- FKUWKS

Sabtu, 12- April- 2014


Tuberkulosis global health emergency
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


Peran Lab : deteksicepat/ dini

identifikasiMycobacterium

2


Mtb mycobacterium tuberculosis
MTBMycobacterium tuberculosis

3


Penularan
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


Respons imun yg bisa terjadi
Responsimunygbisaterjadi :

5


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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Tbc primer bakteri dormant infeksi endogen tb sekunder post primer
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

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Pemeriksaan laboratorium
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


Pemeriksaan sputum
Pemeriksaan sputum

12


Skala kuantitasi rekomendasi who iuatld international union against tuberculosis and lung disease
Skalakuantitasirekomendasi WHO & IUATLD (International Union Against Tuberculosis and Lung Disease)

13



Kultur otomatis
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


Polymerase chain reaction pcr
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


Ag tb rapid test
Ag TB Rapid Test

Deteksi Ag denganmenggunakan :

ELISA

Latex agglutination

Reverse Passive Haemagglutination test

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Antibodi tb rapid test
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.

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