LBM 4 Penyakit Tropik Sgd 2

8/18/2019 LBM 4 Penyakit Tropik Sgd 2

1/15

LBM 4

BERCAK DI KULIT KARENA INFEKSI MIKROBAKTERIUM

STEP 1

1; HIPOTENAR : penonjolan bent! otot pa"a telapa! tan#an $epanjan# tep% lna&

2; HIPOASTHESI :!&an#n'a $en$a$% pe&abaan3; CLA( HAND : )le!$% "an at&o)% tan#an "an ja&%*+ t%,bl pa"a le$% $a&a) lna&%$

4; MORBUS HANSEN : na,a la%n lep&a -pen'.%n)e!$% !&on%! 'an# "%$ebab!an ole/

,%!&oba!te&%, lep&ae0

5; MAKULA HIPOPIMENTASI : le$% "ata& be&bata$ te#a$ 'an# be&2a&na leb/ p3at

"a&% $e!%ta&n'a

STEP *

Anal%$a !a$$

1; be&3a! 'an# ,at% &a$a "% tan#an !%&%

2; len#an !%&% ba2a/ ,en#e3%l "an a"a !ele,a/an pa"a tan#an !%&%

3; ,a!la /%pop%#,enta$%

4; at&op% otot /%potena& 5; 3la2 /an"

6; /%poa%$t/e$% pa"a !l%t $e!%ta& !el%n#!%n# "an ja&% ,an%$

DD:

,o&b$ /an$en

TBC !t%$

MORBUS HANSEN

1; "e)%n%$%

2; ep%"e,%olo#%

3; et%olo#%

4; )a!to& &e$%!o

5; !la$%)%!a$%

6; pato#ene$%$

7; pato)%$%olo#%

8; ,an%)e$ta$% !l%n%$

9; "%a#no$%$

10; DD

11; penatala!$anaan

12; !o,pl%!a$%

13; p&o#no$%$

14; pen3e#a/anTBC KUTIS

1; "e)%n%$%

2; ep%"e,%olo#%

3; et%olo#%

4; )a!to& &e$%!o

5; !la$%)%!a$%

6; pato#ene$%$

7; pato)%$%olo#%

8; ,an%)e$ta$% !l%n%$

9; "%a#no$%$

10; DD11; penatala!$anaan


2/15

12; !o,pl%!a$%

13; p&o#no$%$

14; pen3e#a/an

STEP

Anal%$a !a$$1; be&3a! 'an# ,at% &a$a "% tan#an !%&%

!a&ena ,en#ena% $a&a) pe&%)e&

2; len#an !%&% ba2a/ ,en#e3%l "an a"a !ele,a/an pa"a tan#an !%&%

!a&ena ba!te&%n'a ,en#ena% n.,e"%an$

3; ,a!la /%pop%#,enta$%

4; at&op% otot /%potena&

!a&ena ba!te&%n'a ,en#ena% n.,e"%an$

5; 3la2 /an"

6; /%poa%$t/e$% pa"a !l%t $e!%ta& !el%n#!%n# "an ja&% ,an%$

!a&ena ,en#ena% n.lna&%$

DD:

,o&b$ /an$en

TBC !t%$

MORBUS HANSEN

1; "e)%n%$% :

pen'.%n)e!$% !&on%! 'an# "%$ebab!an ole/ ,%!&oba!te&%, lep&ae+ te&ta,a "%tan"a%

"en#an !e&$a!an $a&a) pe&%)e&+!l%t+$elapt len"%& /%"n#+ te$t%$ "an ,ata

2; ep%"e,%olo#% :

"apat ,en'e&an# $e,a ,&+ ana!* leb%/ &entan "a&% o&an# "e2a$a

"% In"one$%a pen"e&%ta ana!* 5 14 ta/n : !&an# leb%/ 16 tetap% ana! 51ta/n

ja&an# $e!al%

"% In"one$%a : "% "ae&a/ t&op%$ "an $bt&op%$ te&ta,a "% 7a2a T%,&+ 7a2a Ba&at+

Sl$el0

"% "n%a : 189* jta

,e&pa!an pen'a!%t en"e,%$ "% "ae&a/ t&op%$ "an $bt&op%$ -a$%a+ a)&%!a+ a,e&%!a

lat%n0

3; et%olo#%

,%3oba!te&%, lep&ae bent! : ba$%l

!&an : 9; ,%!&on < .8 ,%!&on

ta/an a$a, "an al!o/ol

#&a, =

4; )a!to& &e$%!o

; $o$%al e!ono,% &en"a/

; t&op%$ "an $b t&op%$

; ana!* $%a 514 ta/n

; %,n%ta$ &en"a/

5; !la$%)%!a$%

; be&"a$a&!an (HO


3/15

i; pa$% ba$%le& : ,en#an"n# $e"%!%t ba$%l -BT "an TT0

ii; ,lt% ba$%le& : ,en#an"n# ban'a! ba$%l -BB+BL+LL0

; be&"a$a&!an Ma"&%"

; tbe&!lo%" : TT

; bo&"e& l%ne : BB -86 tbe&!lo%" 86 lep&a,ato$a0+ BT "an TI -leb%/

ban'a! tbe&!lo%"0+ BL "an LI -leb%/ ban'a! lep&a ,ato$a0

; lep&a ,ato$a : LL

6; pato#ene$%$

LL: ,.lep&ae ,a$! !e !l%t ,elal% ,!o$a 'an# le3et ,en'e&an# ,a!&o)a# ata $el

$3/2an SIS ,en&n ,a!&o)a# ta! ,a,p ,en#/an3&!an ,lt%pl%!a$% beba$

,e&$a! ja&%n#an

BB : ,.lep&ae ,a$! !e !l%t ,elal% ,!o$a 'an# le3et ,en'e&an# ,a!&o)a# ata

$el $3/2an SIS ,en%n#!at ,a!&o)a# ,a,p ,en#/an3&!an ,.lep&ae ,enja"% $el

ep%telo%" ,enja"% $el "at%a lan#e&/an$ !e&$a!an $a&a) "an !e&$a!an p&o#&e$%)

7; ,an%)e$ta$% !l%n%$

; t%pe tbe&!lo%" : ,a!la "an pla!at+3ent&al /ell%n#+ pe&,!aan le$% be&$%$%!

; &a, !l%t be&pa $at ata bebe&apa "ae&a/ pt%/ 'an# "ata&

; !ebal te&/a"ap $ent/an

; lep&ae ,ato$a :te&ja"% !e&onto!an &a,bt tb/+te&"apat benjolan !e3%l ata

&a, ,enonjol 'an# leb%/ be$a& "#n be&ba#a% !&an "an bent!

; lep&a bo"e&l%ne : b%la ,e,ba%! ja"% lep&ae tbe&!lo%" "an b%la ,e,b&!

,enja"% lep&a ,ato$a

8; "%a#no$%$ana,ne$%$ : !el/an -&a$a n'e&%+ !ele,a/an otot+ bebal &a$a+ /%poae$t/e$%+&%2a'at

!onta! "en#n pen"e&%ta lep&ae0

PF : %n$pe!$% : ,a!la /%pop%#,enta$%+ 3la2 /an". At&op% otot /%potena&+ tan#an

ln#la%

Palpa$% : a"an'a n'e&% te!an ata t%"a!+ pe,e&%!$aan ton$ otot

PP : BTA+te$ $en$o&%$+ te$ otono,+ te$ ,oto&%!

9; DD

TBC !t%$

De&,at%t%$ $ebo&o%!a

T%nea >e&$%!olo&

P%t/%&%a$%$ &o$eaP%t%&%a$%$ alba

Le!e,%a !t%$

10; penatala!$anaan

)a&,a!olo#% :

"ap$on+&%)a,p%$%n+!lo)a?%,%n+p&ot%ona,%". M%no$%!l%n

11; !o,pl%!a$%

!e3a3atan+ pe&ba/an bent! an##ota tb/

12; p&o#no$%$

13; pen3e#a/an

TBC KUTIS


4/15

1; "e)%n%$%

2; ep%"e,%olo#%

3; et%olo#%

4; )a!to& &e$%!o

5; !la$%)%!a$%

6; pato#ene$%$7; pato)%$%olo#%

8; ,an%)e$ta$% !l%n%$

9; "%a#no$%$

10; DD

11; penatala!$anaan

12; !o,pl%!a$%

13; p&o#no$%$

14; pen3e#a/an

STEP 4

Gejala

Be&3a! ,at% &a$a

Ma!la /%pop%#,enta$%

At&op% otot@3la2 /an"

H%poat/e$%

BTA =

Lep&a tbe&!lo%"

B&! Ba%!

Lep&a

Penatala!$anaan

Lep&a Mato$a

Ko,pl%!a$%

PF

D%a#no$%$

Lab


5/15

STEP

1; penatala!$anaan

Tjan ta,a p&o#&a, pe,be&anta$an !$ta

Me,t$ &anta% penla&an pen'a!%t "en#an 3a&a a.l:

Men&n!an %n$%"en pen'a!%t -"ete!$% "%n% pen3e#a/an0

Men#obat% "an ,en'e,b/!an pen"e&%ta

Men3e#a/ t%,bln'a 3a3at

Re/ab%l%ta$% ,e"%!+ p$%!olo#%$ $o$%al

Te&ap%

Obat DDS -4+4 "%a,%no9"%)en%l9$l)on+ Dap$on0

Be&$%)at ba!te&%o$tat%! ,en#/a,bat en?%, "%/%"&o)olat $%nteta$e+ be!e&ja $b#

ant%,etabol%t PABA

Do$%$ tn##al -$a,pa% blan0:

8 1 ,#@ /a&% t! "e2a$a

* ,#@ !#BB nt! ana!9ana!

E)e! $a,p%n#

In$o,n%a+ ne&opat%a

E&p$% obat ne!&ol%$%$ ep%"e&,al to!$%!a

Hepat%t%$

Le!open%a+ane,%a /e,ol%t%!+ ,et/e,o#lob%ne,%a

Rifampisin

,e&pa!an obat pal%n# a,p/ "# $%)at ba!te&%o$tat%! !at t! BTA

be!e&ja ,en#/a,bat en?%, pol%,e&a$e RNA "en#an %!atan %&e>e&$%bel+ /aa

,a/al

Do$%$:

,#@ /a&% -8 18 ,#@ !#BB@/a&%0

1* ,#@ ,%n## flu like syndrome

600 atau 1200/ bulan e)e! tole&an$% ba%!


6/15

E)e! $a,p%n#

#n a$t&o%nte$t%nal

E&p$% !l%t

Hepatoto!$%! ne)&oto!$%!

Klofasimin -B9+ Lamprene)

Me&pa!an "e&%>at ?at 2a&na %,%no)ena?%n "en#an e)e! ba!te&%o$tat%!+ 3a&a

,en##an# ,etabol%$,e &a"%!al o!$%#en

E)e! ant%9%n)la,a$% bena t! &ea!$% lep&a+ /aa &elat%) ,a/al

Do$%$:

8 ,#@ /a&% ata 1 ,#@ < $e,%n## -1 ,#@ !#BB $e/a&%0

,#@ blan t! 3e#a/ &ea!$% lep&a

E)e! $a,p%n#

P%#,enta$% !l%t !e&%n#at a%& ,ata ,e&a/

an##an IT ano&eo,%t$+ "%a&e+ !a"an#9!a"an# n'e&%

ab"o,en

S!e,a Rej%,en MDT9(HOUnt! Pausi-basiler

R%)a,p%$%n ,#@ blan -"%a2a$%0

Dap$on 1 ,#@/a&% -$2a!elola0 bln -"o$%$ 1 * ,#@!#BB@/a&%0

Unt! ulti-basiler

R%)a,p%$%n ,#@ blan -"%a2a$%0

Dap$on 1 ,#@ /a&% -$2a!elola0

La,p&ene 8 ,#@ /a&% ata 1 ,#@< $e,%n## ata ,#@ blan-"%a2a$%0

OBAT KUSTA BARU

O!LOKS"S#$

Me&pa!an obat t&nan )lo&o!%nolon 'an# pal%n# e)e!t%) t/" M.lep&ae

Ke&ja ,elal% /a,batan t/"p en?%, #%&a$e DNA ,%!oba!te&%,

Do$%$ pe&3obaan: 4 ,#@ /a&% $ela,a 1 blan

#$OS#KL#$


7/15

Me&pa!an t&nan tet&a$%!l%n 'an# a!t%) t/"p M.lep&a !a&ena $%)at l%po)%l%!n'a

,a,p ,ene,b$ "%n"%n# $el !,an

Ca&a !e&jan'a ,en#/a,bat $%nte$%$ p&ote%n

Obat %n% "apat ,ene,b$ !l%t "an ,en3apa% ja&%n#an $a&a) 'an# ,en#an"n# ban'a! !,an

Do$%$ j% !l%n%$: 1 ,#@ /a&% $ela,a * blan

KL"R#%RO#S#$

Me&pa!an obat #olon#an ,a!&ol%" -$pt e&%t&o,%$%n &o!$%t&o,%$%n0

Me,pn'a% e)e! ba!te&%$%"al $eta&a "en#an o)lo!$a$%n ,%no$%!l%n a"a

,en3%t

Be!e&ja "en#an ,en#/a,bat $%nte$%$ p&ote%n

Do$%$ j% !l%n%$: 8 ,#@ /a&%

Dr.Danny A. Hermawan, Dip DermMedical Faculty of Ukrida

7a!a&ta

14; p&o#no$%$

$e,a!%n 3epat "%tan#an%+&e$%!o !e3a3atan $e,a!%n !e3%l

Putus Obat

Pada pasien kusta tipe PB yang tidak minum obat sebanyak dosisdari yang se!arusnya maka dinyatakan D", sedangkan pasien kustatipe MB dinyatakan D" bila tidak minum obat #$ dosis dari yangse!arusnya.

Evaluasi Pengobatan%&aluasi pengobatan menurut Buku Panduan PemberantasanPenyakit 'usta Depkes (#)))* adala! sebagai berikut +1; Pasien PB yang tela! mendapat pengobatan MD - dosis dalam

waktu -) bulan dinyatakan /F (Released From Treatment =ber!enti minum obat kusta* tanpa di!aruskan men0alani

pemeriksaan laboratorium.2; Pasien MB yang tela! mendapat pengobatan MD $ dosis dalam

waktu $1- bulan dinyatakan /F tanpa di!aruskan men0alanipemeriksaan laboratorium.

3; /F dapat dilaksanakan setela! dosis dipenu!i tanpa diperlukanpemeriksaan laboratorium. Dikeluarkan dari register pasien dandimasukkan dalam register pengamatan (surveillance* dan dapatdilakukan ole! petugas kusta.

4; Masa pengamatan.Pengamatan setela! /F dilakukan secara pasif +a; ipe PB selama $ ta!un.b; ipe MB selama 2 ta!un tanpa diperlukan pemeriksaan

laboratorium


8/15

5; Hilang3Out of Control (""4*Pasien PB maupun MB dinyatakan !ilang bilamana dalam # ta!untidak mengambil obat dan dikeluarkan dari register pasien.

6; /elaps (kambu!* er0adi bila lesi aktif kembali setela! perna! dinyatakan sembu!

atau /F.

Kap%ta Sele!ta Ke"o!te&an e"%$% !et%#a j%l%" II

K$ta ,e&pa!an pen'a!%t 'an# ,en'e&a,!an "an "%ta!t% ole/ !a&ena "apat

te&ja"% l$e&a$%+ "e)o&,%ta$ "an ,t%la$%. Pen"e&%ta !$ta b!an ,en"e&%ta !a&ena

pen'a!%tn'a $aja+ tetap% j#a !a&ena "%!3%l!an ,a$'a&a!at $e!%ta&n'a. Hal %n%

a!%bat !e&$a!an $a&a) be$a& 'an# %&&e>e&$%ble "% 2aja/ "an e!$t&e,%ta$+ ,oto&%!

"an $en$o&%!+ $e&ta "en#an a"an'a !e&$a!an 'an# be&lan#9lan# pa"a "ae&a/

ane$tet%! "%$e&ta% pa&al%$%$ "an at&o)% otot.

Il, Pen'a!%t Kl%t Dan Kela,%n e"%$% !ee,pat FKUI

15; pen3e#a/an

D%la!!an nt! ,en3e#a/ !e3a3atan :

; "en#an ,ela!$ana!an "%a#no$%$ "%n% !$ta "en#an pen#obatan MDT 'an#

3epat "an tepat.

; Men#enal% #ejala "an tan"a &ea!$% !$ta 'an# "%$e&ta% #an##an $a&a) $e&ta

,e,la% pen#obatan !o$t%!o$te&o%" $e$e#e&a ,n#!%n.

; B%la te&"apat #an##an $en$%b%l%ta$+ pen"e&%ta "%be&% petnj! $e"e&/ana

,%$aln'a ,e,a!a% $epat nt! ,el%b"n#% !a!% 'an# te&!ena+ ,e,a!a%

$a&n# tan#an b%la be!e&ja "en#an ben"a 'an# taja, ata /an#at "an ,e,a!a%

!a3a,atan'a nt! ,el%n"%n#% ,atan'a.

; Sela%n %t "%anj&!an pla pe&a2atan !l%t $e/a&%9/a&%+ /al %n% "%,la% "en#an

,e,e&%!$a a"a t%"a!'a ,e,a&+ l!a+ ata l!$.$etela/ %t tan#an "an !a!%

"%&en"a,+ "%$%!at "an "%,%n'a!% a#a& t%"a! !e&%n# "an pe3a/9pe3a/.

(56MU P%78A'5 'U6'%6 F'U5 %D595 '%%MPA*

7an#an t%n##al la,a "en#an pen"e&%ta

Me"%3a$to&e

Dl pe&ba/an bent! an##ota tb/ a!%bat lep&a ,en'ebab!an pen"e&%tan'a

"%a$%n#!an "an "%%$ola$%.

Pen#obatan "%n% b%$a ,en3e#a/ ata ,e,pe&ba%!% !ela%nan bent!+ tetap% pen"e&%ta

3en"e&n# ,en#ala,% ,a$ala/ p$%!%$ "an $o$%al.

T%"a! pe&l "%la!!an %$ola$%. Lep&a /an'a ,enla& j%!a te&"apat "ala, bent!

lep&o,ato$a 'an# t%"a! "%obat% "an %tpn t%"a! ,"a/ "%tla&!an !epa"a o&an# la%n.

Sela%n %t+ $eba#%an be$a& $e3a&a ala,% ,e,%l%!% !e!ebalan te&/a"ap lep&a "an /an'a

o&an# 'an# t%n##al $e&,a/ "ala, jan#!a 2a!t 'an# la,a 'an# ,e,%l%!% &e$%!ote&tla&.


9/15

Do!te& "an pe&a2at 'an# ,en#obat% pen"e&%ta lep&a ta,pa!n'a t%"a! ,e,%l%!% &e$%!o

te&tla&.

222.,e"%3a$to&e.3o,

TBC KUTIS

1; De)%n%$%Tuberkulosis kutis merupakan penyakit kulit yang disebabkan olehMycobacterium tuberculosis dan Mycobacterium bovis padakeadaan dan pada keadaan tertentu vaksin BCGManifestasi berupa beberapa perubahan pada kulit yang dapatdiklasifikasikan pada penyakit yang berbeda.

uberculosis pada kulit yg di 5ndonesia disebabkan ole!Mycobacterium uberculosis dan mikrobakteria atipikal

-ILMU PENGAKIT KULKEL FKUI EDISI KEEMPAT0

uberculosis pada kulit, ter0adi sebagai akibat dari infeksi eksogen(autoinokulasi* atau endogen (melalui perluasan infeksi yang suda!ada* atau melalui penyebaran infeksi secara limfogen atau!ematogen : dengan gambaran klinis yang sangat ber&ariasi,meliputi lupus &ulgaris, tuberculosis &errucosa cutis, scrofuloderma,tuberculosis c!ancre, dan tuberkulid papulonekrotik.'amus 'edokteran Dorland edisi $) %;4

2; Et%olo#%

Pen'ebab ta,a tbe&!lo$%$ !t%$ "% RSCM %ala/ Mycobacterium tuberculosis -jen%$

/,an0 be&j,la/ 1+86+ $%$an'a -;+860 "%$ebab!an ole/ M.at%p%!al+ 'an# te&"%&%ata$ #olon#an II ata $!oto&o,o#en+ 'a!n% Mycobacterium scrofulaceum -;60 "an

#olon#an I ata &ap%" #&o2e&$ -*60.

Il, Pen'a!%t Kl%t Kela,%n FK UI

MIKOBAKTERIA ATIPIKAL

M%!oba!te&%a at%p%!al ,e&pa!an !,an ta/an a$a, 'an# a#a! la%n $%)atn'a "a&% M.

tbe&3lo$%$+ 'a!n% pato#en%ta$n'a &en"a/+ pa"a pe,b%a!!an ,,n'a ,e,bent!

p%#,en "an t,b/ pa"a $/ !a,a&. Men&t !la$%)%!a$% RUNGON -180 !,an

te&$ebt "%ba#% ,enja"% 4 #olon#an :

; ;olongan 5 + fotokromogen

'oloni dapat membentuk pigmen bila mendapat ca!aya,misalnya + M. marinum dan M. ulcerans.

; ;olongan 55 + skotokromogen'oloni dapat membentuk pigmen dengan atau tanpa ca!aya,yakni + M. scrofuloceum.

; ;olongan 555+ nonfotokromogen'oloni tidak dapat atau sedikit membentuk pigmen, walaupunmendapat ca!aya, conto!nya + M. battery dan M.intracellulars.

; ;olongan 5< + rapid growers'oloni tumbu! dalam beberapa !ari, misalnya + M. fortuitum

dan M. chelonei (da!ulu disebut M. abscessus*.


10/15

Il, Pen'a!%t Kl%t Kela,%n e"%$% !ee,pat FKUI

3; )a!to& &e$%!o

Fa!to& p&e"%$po$%$% te&ja"%n'a tbe&!lo$%$ !t%$ "%anta&an'a a"ala/ !e,%$!%nan+ #%?%

!&an#+ pen##naan obat9obatan $e3a&a %nt&a>ena+ "an $tat$ %,no"e)%$%en$%

4; !la$%)%!a$%. tbe&!lo$%$ $ejat%

1. tbe&3lo$%$ !t%$ p&%,e&

9 %no!la$% tbe&!lo$%$ p&%,e&

*. tbe&3lo$%$ !t%$ $e!n"e&

9 tbe&!lo$%$ !t%$ ,%l%a&%$

9 $!&o)lo"e&,a

9 tbe&!lo$%$ !t%$ >e&!o$a

9 tbe&3lo$%$ !t%$ #,o$a

9 tbe&3lo$%$ !t%$ o&%)%$%al%$

9 Lp$ >l#a&%$

B. tbe&!l%"1; bent! papl

9 lp$ ,%l%a&%$ "%$e,%nat$ )a$e%

9 tbe&!l%" paplone!&ot%!a

9 l%!en $!&o)lo$o&,

2; bent! #&anlo,a "an l$e&ono"l$

9 e&%te,a no"$,

9 e&%te,a %n"&at,.

Il, !l%t !ela,%n ta/n **

5; pato#ene$%$

Cara infeksi ada 6 macam (1

; !en"alaran langsung ke kulit dari organ di ba#ah kulit yangtelah dikenai penyakit tuberkulosis$ misalnyaskrofuloderma.

; %nokulasi langsung pada kulit sekitar orifisium alat dalam yang dikenai penyakit tuberkulosis$ misalnya tuberkulosiskutis orifisialis.

; !en"alaran secara hematogen$ misalnya tuberkulosis kutismiliaris.

; !en"alaran secara limfogen$ misalnya lupus vulgaris.; !en"alaran langsung dari selaput lendir yang sudah

diserang penyakit tuberkulosis$ misalnya lupus vulgaris.; &uman langsung masuk ke kulit yang resistensi lokalnya

telah menurun atau "ika ada kerusakan kulit$ contohnyatuberkulosis kutis verukosa.

6; ,an%)e$ta$% !l%n%$ = DD


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#no&ulasi tuber&ulosis primer 'tuber&ulosis (an(re)

Ko,ple!$ le$% p&%,e& ,el%pt% !l%t "an no"$ l%,)at%!$ te&ta,a pa"a ba'% "an ana!9

ana!. 7alan ,a$! ba$%l tbe&!el a"ala/ pa&9pa& + l!a !e3%l+ !! 'an# te&b!a+ ata

l!a t$! -40. A)e! p&%,e& "apat be&bent! papl+ p$tl ata l!$ %n"olen+ be&"%n"%n#

tean# "an "%$e!%ta&n'a l%>%". Ma$a tna$ *9 ,%n##+ l%,)an#%t%$ "an l%,)a"en%t%$

t%,bl bebe&apa ,%n## /%n##a bebe&apa blan $etela/ a)e! p&%,e&+ pa"a 2a!t te&$ebt&ea!$% tbe&!l%n ,enja"% po$%t%). Ke$el&/ann'a ,e&pa!an !o,ple!$ p&%,e&. Pa"a

l!$ te&$ebt "apat te&ja"% %n"&a$%+ !a&ena %t "%$ebt tbe&3lo$ 3/an3&e. Ma!%n ,"a

$%a pen"e&%ta ,a!%n be&at #ejalan'a. Ba#%an 'an# $e&%n# te&!ena a"ala/ 2aja/ "an

e!$t&e,%ta$ 'an# be&/bn#an "en#an l%,p/a"enopat' &e#%onal B%a$an'a "%te,!an

pa"a "ae&a/ !l%t 'an# ,"a/ te&!ena t&a,a

%uber&ulosis &utis miliaris

T%pe %n% b%a$an'a te&ja"% pa"a ba'% "an ana!9ana! "en#an $tat$ %,no!o,p&o,%$e .

Fo!$ %n)e!$% te&"apat $e3a&a !/$$ pa"a pa&9pa& ata $elapt ota! . Te&ja"% !a&ena

penjala&an !e !l%t "a&% )o!$ "% ba"an. Rea!$% te&/a"ap tbe&!l%n b%a$an'a ne#at%)

-ane%0. Ra, be&pa e&%te,a be&bata$ te#a$+ papl+ >e$%!el+ p$tl+ $!a,a ata p&p&a'an# ,en'el&/. Pa"a ,,n'a p&o#no$%$n'a b&! .

S&rofulo*erma

Tbe&!lo$%$ !t%$ ,&n% $e!n"e& 'an# te&ja"% $e3a&a pe!ont%n%tat, "a&% ja&%n#an "%

ba2a/n'a+ ,%$aln'a !elenja& #eta/ ben%n#+ otot "an tlan# . S!&o)lo"e&,a te&ja"%

te&ta,a pa"a ana!9ana! "an "e2a$a ,"a pa"a ba#%an !l%t 'an# be&a"a "%ata$ no"$

l%,)at%!$ "an "ae&a/ 'an# !el%/atan tlan#n'a . Pe&jalanan pen'a!%t te&,a$! !el/an

ta,a "an !el/an ta,ba/an. D%,la% "en#an %n)e!$% $eba/ !elenja& 'an# $elanjtn'a

,enja"% be&!e,ban# ,enja"% pe&%a"en%t%$. Bebe&apa !elenja& !e,"%an "apat ,e&a"an#+

$e/%n##a ,e,bent! $at !anton# !elenja& !l%e& pa3!etJ. Pa"a $ta"%, $elanjtn'a

te&ja"% pe&!ejan "an pe&lna!an+ ,en3a&% jalan !ela& "en#an ,ene,b$ !l%t "%ata$n'a+

"en#an "e,%!%an te&bent! )%$tel. F%$tel te&$ebt !%an ,eleba&+ ,e,bent! l!$ 'an#

,e,pn'a% $%)at9$%)at !/a$ .

%uber&ulosis &utis +eru&osa

T%pe %n% te&ja"% te&ta,a pa"a o&an# "e2a$a+ ana!9ana! "an %n"%>%" 'an# &e$%$ten

te&/a"ap te&ja"%n'a %no!la$% e!$te&nal ba$%l tbe&!el . In)e!$% te&ja"% $e3a&a e!$o#en+ ja"%

!,an ,a$! !e "ala, !l%t+ ole/ $ebab %t te,pat p&e"%le!$%n'a pa"a tn#!a% ba2a/

"an !a!%+ te,pat 'an# leb%/ $e&%n# ,en"apat t&a,a . a,ba&an !l%n%$ b%a$an'a

be&bent! blan $ab%t a!%bat penjala&an $e3a&a $e&p%#%no$a+ 'an# be&a&t% pen'a!%t ,enjala&

!e $at j&$an "%%!t% pen'e,b/an "% j&$an 'an# la%n. Ra, te&"%&% ata$ papl9papllent%!le& "% ata$ !l%t 'an# e&%te,ato$a. Pa"a ba#%an 'an# 3e!n# te&"apat $%!at&%!$ .

%uber&ulosis &utis ,umosa

Tbe&!lo$%$ %n% te&ja"% a!%bat penjala&an $e3a&a /e,ato#en+ b%a$an'a "a&% pa&. Kela%nan

!l%t be&pa %n)%lt&at $b!tan+ be&bata$ te#a$ 'an# ,ena/n+ !e,"%an ,elna! "an

be&$%)at "e$t&!t%) . Pa"a a2aln'a !l%t be&2a&na no&,al "an la,a9!ela,aan ,enja"%

,e&a/ !eb%&an . Le$% te&$eba& be&bent ,a!la "an papl be&!&an !e3%l ata le$%

be&2a&na !e,e&a/an. Ka"an#9!a"an# >e$%!le& "an te&"apat !&$ta

%uber&ulosis &utis orifisialis

Pa"a ,,n'a te&ja"% pa"a pa$%en "en#an pen'a!%t tbe&!lo$a pa"a oan9oan"ala, . Se$a% "en#an na,an'a ,a!a lo!a$%n'a "% $e!%ta& o&%)%$%,. Pa"a tbe&!lo$%$


12/15

pa& "apat te&ja"% l!$ "% ,lt+ b%b%& ata "% $e!%ta&n'a. Pa"a tbe&!lo$%$ $al&an 3e&na+

l!$ "apat "%te,!an "% $e!%ta& an$. Pa"a tbe&!lo$%$ $al&an !e,%/+ l!$ "apat

"%te,!an "% $e!%ta& o&%)%$%, &et&a e!$te&n,. Ul!$ be&"%n"%n# tean#+ !e,e&a/an+

/e,o&a#%!+ p&len "an $e!%ta&n'a l%>%" .

Lupus +ul,arisLp$ >l#a&%$ ,e&pa!an bent! 'an# $e&%n# "an ,en#ena% te&ta,a pa"a ba#%an 'an#

$e&%n# te&papa& ,%$aln'a pa"a 2aja/ "an e!$t&e,%ta$ . Ca&a %n)e!$% "apat $e3a&a en"o#en

ata e!$o#en. a,ba&an !l%n%$ 'an# ,, a"ala/ !elo,po! no"$ e&%te,ato$a 'an#

be&ba/ 2a&na ,enja"% !n%n# pa"a pene!anan -apple jell' 3olo&0 . No"$9no"$

te&$ebt be&!on)len$% be&bent! pla!+ be&$%)at "e$t&!t%)+ $e&%n# te&ja"% l!$. Pa"a 2a!t

te&ja"% %n>ol$% te&bent! $%!at&%!$. B%la ,en#ena% ,!a tlan# &a2an /%"n# "apat

,en#ala,% !e&$a!an . Pen'e,b/an $pontan te&ja"% pe&la/an9la/an "% $at te,pat+

tetap% te&ja"% pe&jalanan "% te,pat la%n+ 'an# "apat !e pe&%)e& ata $e&p%#%no$a

Lupus milliaris *iseminatus fasiel

Men#ena% ,!a+ t%,bln'a $e3a&a beelo,ban#. Ra, be&pa papl9papl blat+ b%a$an'a "%a,ete&n'a t%"a! ,eleb%/% 8 ,,+ e&%te,ato$a !e,"%an ,en%n##al!an

$%!at&%!$. Pa"a "%a$!op% ,e,be&% #a,ba&an apple jell' 3olo& $epe&t% pa"a lp$

>l#a&%$ .

%uber&ulosis papulone&roti&a

Le$% t%pe %n% te&ta,a te&ja"% pa"a ana!9ana! "an "e2a$a 'an# ,en"e&%ta TB pa"a ba#%an

tb/ la%n. Kea"aan %n% te&ja"% !a&ena a"an'a &ea!$% ale% te&/a"ap ba$%l tbe&!el. Ba$%l

,en'eba& $e3a&a /e,ato#en pa"a o&an# "en#an $at$ %,n%ta$ $e"an# ata ba%!+ a!an

tetap% )o!$ tbe&!lo$%$ $e3a&a !l%n%$ t%"a! a!t%) pa"a $aat te&ja"%n'a e&p$%+ "an pa$%en

$e"an# be&a"a "ala, !ea"aan $e/at . Sela%n be&bent! paplone!&ot%!a j#a "apat

be&bent! paplop$tl. Te,pat p&e"%le!$% pa"a ,!a+ an##ota ba"an ba#%an e!$ten$o&+

"an ba"an . Mla9,la te&"apat papl e&%te,ato$a 'an# t%,bl $e3a&a beelo,ba#+

,e,be$a& pe&la/an9la/an "an !e,"%an ,enja"% p$tl+ lal ,e,e3a/ ,enja"% !&$ta

"an ,e,bent! ja&%n#an ne!&ot%! "ala, 2a!t ; ,%n##+ lal ,en'e,b/ "an

,en%n##al!an $%!at&%!$. Ke,"%an t%,bl le$%9le$% ba&. La,a pen'a!%t "apat be&ta/n9

ta/n .

Li&en s&rofulosorum

Le$% b%a$an'a te&ja"% "% "ae&a/ le/e& pa"a ana! 'an# ,en"e&%ta tbe&!lo$%$ tlan# ata

no"$ l%,)at%!$ . Kela%nan !l%t te&"%&% ata$ bebe&apa papl ,%l%a&+ 2a&na "apat $e&pa

"en#an !l%t ata e&%te,ato$a. Mla9,la te&$$n te&$en"%&%+ !e,"%an be&!elo,po!te&$$n $%&$%na&+ !a"an#9!a"an# "% $e!%ta&n'a te&"apat $!a,a /al$. Te,pat p&e"%le!$%

pa"a "a"a+ pe&t+ pn##n# "an "ae&a/ $a3&,. Pe&jalanan pen'a!%tn'a "apat be&blan9

blan "an &e$%"%)+ j%!a $e,b/ t%"a! ,en%n##al!an $%!at&%!$

ritema no*usum

Kela%nan !l%t be&pa no"$9no"$ %n"olen te&ta,a pa"a e!$t&e,%ta$ ba#%an e!$ten$o&.

D%ata$n'a te&"apat e&%te,a. Ban'a! pen'a!%t 'an# j#a "apat ,e,be&% #a,ba&an !l%n%$

$eba#a% E.N.+ 'an# $e&%n#: lep&a $eba#a% e&%te,a no"$, lep&o$,+ &ea!$% %" !a&ena

St&epto3o33$ B He,ol't%3$+ ale% obat $e3a&a $%$te,%!+ "an "e,a, &e,at%! .

ritema in*uratumE&%te,a %n"&at, a"ala/ $at pe&a"an#an !&on%$ "a&% pe,bl/ "a&a/ a&te&% "an >ena


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be&$%)at j%na!+ "an "%$e&ta% ne!&o$%$ le,a! -4+0. Kela%nan !l%t be&pa no"$9no"$

%n"olen. Te,pat p&e"%le!$%n'a pa"a "ae&a/ )le!$o&. Te&ja"% $p&a$% $e/%n##a te&bent!

l!$9l!$. Ka"an#9!a"an# t%"a! ,en#ala,% $p&a$%+ tetap% &e#&e$% $e/%n##a te&ja"%

/%pot&o)% be&pa le!!an9le!!an. Pe&jalanan pen'a!%t !&on%! &e$%"%)

7; "%a#no$%$a; LED ,en%n#!at

b; Ba!te&%olo#%! nt! ,enent!a et%olo#%

c; H%$topatolo#%! pent%n# nt! ,ene#a!!an "%a#no$%$

d; Te$ tbe&!l%n

(56MU P%78A'5 'U6'%6 F'U5 %D595 '%%MPA*; Anamnesis +

; Afek primer dapat berupa papul, pustul, atau ulkus indolen.

; P= Bakteriologik +

a; 9ediaan mikroskopik; Ba!an berupa pus, 0aringan kulit dan 0aringan kelen0ar geta!

bening. Pada pewarnaan dengan >ie!l 7eelsen ataumodi?kasinya, 0ika positif kuman tampak berwarna mera! padadasar yang biru. 'alau positif belum berarti kuman tersebutM.tuberculosis, ole! karena ada kuman lain yang ta!an asam,misalnya M. 6eprae

b; 'ultur; 'ultur dilakukan pada media 6owenstein@ensen,

pengeraman pada su!u 1 o 4. @ika positif koloni tumbu!dalam waktu minggu. 'alau !asil kultur positif, berartipasti kuman tuberkulosis

c; Binatang percobaano Dipakai marmut, percobaan tersebut memerlukan waktu $ bulan

d; es biokimia; Ada beberapa macam, misalnya tes niasin dipakai untuk

membedakan 0enis !uman dengan yang lain. @ika tes niasinpositif berarti 0enis !uman

e; Percobaan resistensif; Ditemukan sel datia 6ang!an (inti berbentuk seperti tapal kuda*

8; Penatala!$anaan

P&%n$%p pen#obatan tbe&!lo$%$ !t%$ $a,a "en#an tbe&!lo$%$ pa&. Unt!

,en3apa% /a$%l 'an# ba%! /en"a!n'a "%pe&/at%!an $'a&at9$'a&at 'a%t pen#obatan

/a&$ "%la!!an $e3a&a te&at& tanpa te&pt$ a#a& t%"a! 3epat te&ja"% &e$%$ten$% "an

pen#obatan /a&$ "ala, !o,b%na$%. Dala, !o,b%na$% te&$ebt INH "%$e&ta!an+

"%anta&an'a !a&ena obat te&$ebt be&$%)at ba!te&%$%"al+ /aan'a ,&a/ "an e)e!

$a,p%n#n'a lan#!a. Se"apat9"apatn'a "%p%l%/ pal%n# $e"%!%t * obat 'an# be&$%)at

ba!te&%$%"al+ "an !ea"aan ,, "%pe&ba%!% -10.

Pe,%l%/an obat teantn# pa"a !ea"aan e!ono,% pen"e&%ta+ be&at9&%n#ann'a pen'a!%t+ "an a"a!a/ !ont&a%n"%!a$%. Do$%$ INH -H0 pa"a ana! 1 ,#@K# BB+ pa"a


14/15

o&an# "e2a$a 8,#@K# BB+ "o$%$ ,a!$%,, 4 ,# $e/a&%. R%)a,p%$%n -R0 1 ,#@!#

BB pal%n# la,a "%be&%!an blan. B%la "%#na!an /an'a $ela,a * blan+

!ont&a%n"%!a$%n'a pen'a!%t /epa&. P%&a?%na,%" -0 *8 ,#@!# BB+ $t&epto,%$%n -S0 18

,#@!# BB+ "o$%$ ,a!$%,n $t&epto,%$%n #&a,. Et/a,btol -E0 18 ,#@!# BB -1+0.

Pa"a pen#obatan tbe&!lo$%$ te&"apat * ta/apan+ 'a%t ta/apan a2al -%nten$%)0 "an

ta/apan lanjtan. Tjan ta/apan a2al a"ala/ ,e,bn/ !,an 'an# a!t%)

,e,bela/ $eban'a!9ban'a!n'a "an $e3epat93epatn'a "en#an obat 'an# be&$%)at

ba!te&%$%"al. Ta/apan lanjtan %ala/ ,elal% !e#%atan $te&%l%$a$% ,e,bn/ !,an

'an# t,b/ la,bat -10.

Sela,a )a$e %nten$%) 'an# b%a$an'a te&"%&% "a&% 4 obat+ te&ja"% pen#&an#an j,la/

!,an "%$e&ta% pe&ba%!an !l%n%$. Pa$%en 'an# %n)e!$% ,enja"% non%n)e!$% "ala, 2a!t

* ,%n##. Seba#%an be$a& pa$%en "en#an $pt, BTA po$%t%) a!an ,enja"% ne#at%)

"ala, 2a!t * blan. Sela,a )a$e lanjtan "%pe&l!an leb%/ $e"%!%t obat+ tap% "ala,

2a!t 'an# leb%/ panjan#. E)e! $te&%l%$a$% obat nt! ,e,be&$%/!an $%$a9$%$a !,an

"an ,en3e#a/ !e!a,b/an. Pa"a pa%en "en#an $pt, BTA po$%t%) a"a &e$%!o

te&ja"%n'a &e$%$ten$% $ele!t%). Pen##naan 4 obat $ela,a )a$e a2al "an * obat $ela,a

)a$e lanjtan a!an ,en#&an#% &e$%!o te&ja"%n'a &e$%$ten$% $ele!t%). Pa"a pa$%en

"en#an $pt, BTA ne#at%) ata TB e!$t&apl,one& t%"a! te&"apat &e$%!o &e$%$ten$%

$ele!t%) !a&ena j,la/ ba!te&% "% "ala, le$% &elat%) $e"%!%t. Pen#obatan )a$e a2al

"en#an obat "an )a$e lanjtan "en#an * obat b%a$an'a $"a/ ,e,a"a%. Pa"a pa$%en

'an# pe&na/ "%obat% a"a &e$%!o te&ja"%n'a &e$%$ten$%. Pa"an pen#obatan lan# te&"%&%

"a&% 8 obat nt! )a$e a2al "an obat nt! )a$e lanjtan. Sela,a )a$e a2al

$e!&an#9!&an#n'a * "%anta&a obat 'an# "%be&%!an /a&$la/ 'an# ,a$%/ $ele!t%).

Pen#obatan $tan"a& "en#an INH+ R%)a,p%$%n "an P%&a?%na,%" "apat "%be&%!an pa"a

2an%ta /a,%l "an ,en'$%+ "%anj&!an pe,be&%an p%&%"o!$%n. St&epto,%$%n t%"a!

bole/ "%be&%!an -0.

Men&t The Joint Tuberculosis Committee of the British Thoracic Society + )a$e a2al

"%be&%!an $ela,a * blan 'a%t INH 8 ,#@!#BB+ R%)a,p%$%n 1 ,#@!#BB+

P%&a?%na,%" 8 ,#@!#BB "an Eta,btol 18 ,#@!#BB. "%%!t% )a$e lanjtan $ela,a 4

blan "en#an INH "an R%)a,p%$%n nt! tbe&!lo$%$ pa& "an e!$t&a pa&. Eta,btol

"apat "%be&%!an pa"a pa$%en "en#an &e$%$ten$% te&/a"ap INH -;0.

9; Te&ap% pe,be"a/an be&pa e!$%$% "apat "%la!!an pa"a lp$ >l#a&%$+ tbe&!lo$%$

!t%$ >e&!o$a 'an# !e3%l+ $e&ta $!&o)lo"e&,a pa"a e!$t&e,%ta$ ba2a/-1+0

.

Pen#obatan top%!al pa"a tbe&!lo$%$ !t%$ t%"a! $epent%n# pen#obatan $%$te,%!. Pa"a


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$!&o)lo"e&,a+ j%!a l!$ ,a$%/ ,en#an"n# p$ "%!o,p&e$+ ,%$aln'a "en#an

la&tan !al%, pe&,an#ana$ 1@8 -10.

10; Ko,pl%!a$%Pen'eba&an !e pa&+"apat !a&ena &ea!t%>a$% !,an "o&,ant ata !a&ena %n/ala$%

M.tbe&!lo$%$ ba&

Patolo#% Robb%n$ Hemoptoe Pleuritis Pneumot!ora= %mpiema Bakteremia (0ika PD peca!* 5n&asi 0aringan parenkim paru yg meluas %fek !epatotoksik obat B4

11; P&o#no$%$

Pa"a ,,n'a $ela,a pen#obatan ,e,en/% $'a&at $epe&t% 'an# tela/ "%$ebt!an+

p&o#no$%$n'a ba%!.

12; Pen3e#a/an

a!$%n BC

P&o)%la!$% INH

LBM 4 Penyakit Tropik Sgd 2

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Transcript of LBM 4 Penyakit Tropik Sgd 2