TUBERCULOSIS
Definition:
Transmitted diseases caused by
Mycobacterium Tuberculosis wich
usually infected the lung.
Transmittion routes :
Air droplet
Oral
Direct contact
TUBERCULOSIS
PULMONARY
EKSTRAPULMONARY :
Lymphnode
Skin
Bone
Meningen
Pleura
Eyes
Larynx
GI tract
Uro-genital tract
Kidney
Milier
Etc
India, China, Indonesia Estimated TB burden (incidence all forms) = 3,688,000 (41 %)
Afghanistan, Bangladesh, Myanmar, Cambodia, Vietnam, Pakistan, Philippines, Thailand Estimated TB burden (incidence all forms) = 1,327,000 (15 %)
Total estimated TB burden (incidence all forms) in Asia high burden countries = 5,015,000 (56 %)
Background
Indonesian situation :
Population : 222,781,000
Global rank : 3
Incidence : 239 (239/100,000/year)
Incidence of new cases : 108 (108/100,000/yr)
Prevalence : 262 (262/100,000/year)
Mortality : 41 (41/100,000/year)
Co-infection TB/HIV : 0,8%
MDR-TB : 1,6%
PHATOGENESIS
WEEKNESS OF IMMUNITY:
ENTERING WAYS:
Respiratory Tract
Intestinal Tract Open
wound
POSTPRIMARY
TUBERCULOSIS
PRIMARY
TUBERCULOSIS
Childhood
DORMANT
Adult
DISSEMINATED TUBERCULOSIS
(EXTRAPULMONARY TB)
..
CLINIC
DIAGNOSIS
BACTERIOLOGIS
RADIOLOGIS
CLINIS :
DIAGNOSIS
Sign:
Thin body
Related to the lesions
of the lung
Extra pulmonary sign
related to the of extra
pulmonary lesion
BACTERIOLOGIES :
DIAGNOSIS
AFB sputum
Very important
No sputum
Expectorant
Nebulizer
Culture AFB
long time
PCR
AFB
EKSTRAPULMONARY TB
AFB secrete
PATHOLOGY SPECIMEN
AFB
RADIOLOGIS :
Infiltrate
Fibro infiltrate
Cavity
Fibrosis
Calsification
Granulome
Destroyed lung
Atelectasis
Effusion
Pneumothorax
DIAGNOSIS
Man, 27 years,
New case. AFB
(+) Haemoptisis.
Man, 28 years,.
TB Milier
AFB
+--
AFB
--Antibiotik Non - ATD
responce
NO responce
Sputum AFB
AFB
+++
+++--
AFB
---
No TB
THERAPY :
ATD Principle :
Pasien Category:
AFB status
Radiologis
Severity
Previously ATD therapy
Drugs Combination
Continuous program
THERAPY :
ATD Principle :
Course :
Sort Course (6
month)
(Rifampicin core):
Intensive Phase
Intermittent
Phase
Example:
2RHZE/4R3H3
2RHZE/4R2H2
2RHZE/4R H
3SHE/9S3H3
3SHE/9H E
3SHE/9H3 E3
WHO/CDS/TB/2003.313
WHO-recommended formulations of
essential antituberculosis drugs (1)
WHO/CDS/TB/2003.313
Recommended
treatment
regimens for
each diagnostic
category
AFB
AFB
AFB
AFB
AFB
INTENSIVE
PHASE
INTERMITTEN (CONTINOUS)
PHASE
R/H/Z/E
R/H
( R3 H3 )
2 Month
3 Month
5 Month 6
Month
INTENSIF PHASE
2 MONTH
4FDC, EVERYDAY
(R=150 mg; H=75 mg;
Z=400mg; E=275 mg)
CONTINOUS
4 PHASE
2FDC, 3X/WEEK
(R=150 mg; H=150 mg),
30-37
2 Tablet 4FDC
2 Tablet 2FDC
38-54
3 Tablet 4FDC
3 Tablet 2FDC
55-70
4 Tablet 4FDC
4 Tablet 2FDC
>71
5 Tablet 4FDC
5 Tablet 2FDC
3 MONTH
PHASE
(Kg)
2 Month;
Everyday
1 Month;
Everyday
30-37
2(4FDC) +
500 mg S
2 Tab. 4FDC
2 Tab. 2FDC + 2
E
38-54
3(4FDC) +
750 mg S
3 Tab. 4FDC
3 Tab. 2FDC + 3
E
55-70
4(4FDC) +
1000 mg S
4 Tab. 4FDC
4 Tab. 2FDC + 4
E
5(4FDC) +
1000 mg S
5 Tab. 4FDC
5 Tab. 2FDC + 5
E
>71
5 month.
3x/Week
TUBERKULOSIS THERAPY :
Goals :
1.
2.
3.
4.
5.
DOTS (WHO)
Direct Observation Therapy Short Course
Strategy recommended by WHO for
ensuring high care rate in TB patients.
It has 5 components :
1. Government commitment in sustainable NTP
2. Passive case detection through smear
microscopy
3. Administration of Standardizes short-course
chemotherapy under direct observation
4. Regular drug supply.
5. Standardize recording and reporting to
facilitate assessment of treatment outcome.
Standard 2.
Standard 3.
Standard 4.
Standard 5.
Standard 12.
HIV counseling and testing is indicated for all tuberculosis.
Standard 13.
Tuberculosis and HIV infection evaluated to determine if
antiretroviral therapy
Standard 14.
An assessment of the likelihood of drug resistance
Standard 15.
TB Patients caused by MDR TB second-line anti
tuberculosis.
Standard 16.
Close contact with patients who have infectious tuberculosis are
evaluated and managed in line with international
recommendations.
Standard 17.
All providers must report both new and retreatment tuberculosis
cases and their treatment outcomes.
STANDARD 3.
For all patients (adults, adolescents, and
children) suspected of having extra
pulmonary tuberculosis, appropriate
specimens from the suspected sites of
involvement should be obtained for
microscopy and, where facilities and
resources are available, for culture and
histopathological examination.
STANDARD 4.
All persons with chest radiographic findings
suggestive of tuberculosis should have
sputum specimens submitted for
microbiological examination.
STANDARD 5.
The diagnosis of sputum smear-negative
pulmonary tuberculosis should be based on
the following criteria: at least three negative
sputum smears (including at least one early
morning specimen); chest radiography
findings consistent with tuberculosis; and
lack of response to a trial of broad-spectrum
antimicrobial agents.
(NOTE: Because the fluoroquinolones are
active against M. tuberculosis complex and,
thus, may cause transient improvement in
persons with tuberculosis, they should be
avoided.) For such patients, if facilities for
STANDARD 6.
STANDARD 6.
STANDARD 8.
All patients (including those with HIV
infection) who have not been treated
previously should receive an internationally
accepted first-line treatment regimen using
drugs of known bioavailability.
The initial phase should consist of two months of
isoniazid, rifampicin, pyrazinamide, and ethambutol.
The preferred continuation phase consists of
isoniazid and rifampicin given for four months.
Isoniazid and ethambutol given for six months is an
alternative continuation phase regimen that may be
used when adherence cannot be assessed, but it is
associated with a higher rate of failure and relapse,
especially in patients with HIV infection. The doses of
antituberculosis drugs used should conform to
international recommendations. Fixed-dose
STANDARD 9.
To foster and assess adherence, a patient-centered
approach to administration of drug treatment, based
on the patients needs and mutual respect between
the patient and the provider, should be developed for
all patients. Supervision and support should be
gender-sensitive and age-specific and should draw on
the full range of recommended interventions and
available support services, including patient
counseling and education. A central element of the
patient-centered strategy is the use of measures to
assess and promote adherence to the treatment
regimen and to address poor adherence when it
occurs. These measures should be tailored to the
individual patients circumstances and be mutually
acceptable to the patient and the provider. Such
measures may include direct observation of
medication ingestion (directly observed therapy
STANDARD 10.
STANDARD 11.
STANDARD 12.
STANDARD 13.
STANDARD 14.
STANDARD 15.
STANDARD 17.