TBDIAGNOSIS
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Presentasi Simposium IDAI, 6 April 2011. Judul presentasi : Tuberkolosis pada Anak.
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TBDIAGNOSIS
- 1. dr. Nastiti Kaswandani, SpA UKK Respirologi – PP IDAI
- 4. kelas kontak infeksi sakit tindakan 0 - - - - I + - - prof I II + + - prof II III + + + terapi
- 6. TB infection TB CMI
- 7. TB disease TB CMI
- 9. Age specific risk for disease after recent primary infection
- 13. TB infection risk Home Environment Adapted from Etkind S., Veen J., In Reichman-Hershfield: Tuberculosis: A Comprehensive International Approach, 2000 Index Case Close Casual Leisure Environment Work/School Environment
- 14. Shaw JB, Am Rev Tuberc 1954;69:724-32 Grzybowski S, et al. Bull Int Union Tuberc 1975;50:90-106 Van Geuns HA, Bull Int Union Tuberc 1975;50:107-21 Percent infected Risk of M.tb transmission
- 20. Berapa lama PPD dapat digunakan setelah dibuka ?
- 29. TB kelenjar TB kulit
- 30. TB tulang
- 36. Over diagnosis TB by CXR Over- diagnosis
- 39. Ghon focus
- 41. Lymph node disease AP
- 43. Lymph node disease Lat
- 44. Pleural effusion
- 48. QuantiFERON-TB QuantiFERON-TB Gold QuantiFERON-TB Gold in tube T-SPOT.TB www.cellestis.com www.oxfordimmunotec.com New Kits on the block…..
- 50. IDAI Pediatric TB scoring system Feature 0 1 2 3 Score Contact not clear - reported, AFB(-) AFB(+) TST - - - positive BW (KMS) - <red line, BW severe malnutrition - Fever - unexplained - - Cough <3weeks > 3weeks - - Node enlargemnt - > 1 node, > 1cm, painless - - Bone,joint - swelling - - CXR normal sugestive - - Total score
- 53. TB treatment many years ago … 04/06/11
- 54. Sun bathing ….. 04/06/11
- 55. TB treatment now … 04/06/11
- 56. FDC with IDAI formulation
- 60. IDAI FDC (H/R/Z:50/75/150 & H/R:50/75) Note: BW < 5kg should be referred and need tailored dosing B W (kg) Intensive , 2 mo (tablet) Continuation , 4 mo (tablet) 05 - 09 1 1 10 - 14 2 2 15 - 19 3 3 20 - 33 4 4
- 62. 3/4
- 63. From Epidemiology. Katzenellenbogen et al. OUP
- 64. *If TB is suspected, investigate as per guidelines ‡ unless the child is HIV-infected (in which case INH 6/12)
- 65. pasien TB anak Pasien TB dws sentri- petal sentri- fugal
- 68. M. tuberculosis inhalation phagocytosis by PAM live bacilli multiplies primary focus formation lymphogenic spread hematogenic spread 1) Primary complex 2) Cell mediated immunity (+) TST (+) incubation period (2-12 weeks) P r i m a r y T B 3) primary complex complication hematogenic spread complication lymphogenic complication TB disease Dead Optimal immunity TB infection Cured TB disease 4) immunity reactivation/reinfecktion bacilli dead TB pathogenesis
- 69. WHO FDC (H/R/Z:30/60/150 & H/R:30/60) B W ( kg) Intensive , 2 mo (tablet) Continuation , 4 mo (tablet) <7 1 1 8-9 1,5 1,5 10-14 2 2 15-19 3 3 20-24 4 4 25-29 5 5
Editor's Notes
- An evaluation of the reliability of x-ray diagnosis under programme conditions in India indicated that more than half of patients who were diagnosed as having tuberculosis on the basis of x-ray did not actually have the disease. These patients are subjected to unnecessary, expensive, and potentially toxic medicines. Source: Nair SS. Significance of patients with x-ray evidence of active tuberculosis not bacteriologically confirmed. Ind J Tub 1974;21:3-5.
- Nodes are part of the ghon complex
- uncommon in children younger than 6 years and rare in those younger than 2 years Other features of this effusion includes: WE WILL MENTION THE CHEMISTRY AND MICRO FINDINGS OF THE FLID AND HOW TO DISTINGUISE FROM PARAPNEUMONIC AND EMPYEMA specific gravity 1.012 to 1.025, protein 2 to 4 g/dL, glucose 20 to 40 mg/dL, white blood cell counts ranging from 100 to 1000 cells/mm3 , with early predominance of polymorphonuclear cells followed by a high proportion of lymphocytes.
- Usually with in 6 months after infection Incidence proven to be reduced by BCG in HIV negative children Tubercles can be in the lungs, meningitis , liver, spleen, kidney (rare), skin Look for features of dissemination in these children ie hepar, spleen, consider LP