Pencatatan dan pelaporan program penanggulangan TB
TUBERKULOSIS EKSTRAPARU
J. Pengobatan Tuberkulosis Ekstraparu
Paduan terapi adekuat dapat dimulai tanpa menunggu hasil biakan bila histologi dan gambaran klinis sesuai dengan diagnosis tuberkulosis. Seluruh pasien TB ekstraparu harus melakukan foto toraks untuk menyingkirkan TB paru. Paduan
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terapi adekuat harus diteruskan meskipun hasil biakan negatif. Tuberkulosis paru dan TB ekstraparu diterapi dengan paduan obat yang sama namun beberapa pakar menyarankan 9-12 bulan untuk TB meningitis karena mempunyai risiko serius pada disabilitas dan mortalitas dan 9 bulan untuk TB tulang dan sendi karena sulitnya memonitor respons terapi. Kostikosteroid direkomendasikan untuk TB perikardial dan TB meningitis. Pada TB meningitis etambutol diganti dengan streptomisin. Terapi bedah mempunyai peran kecil dalam penatalaksanaan TB ekstraparu. Terapi bedah dilakukan pada komplikasi lanjut penyakit seperti hidrosefalus, uropati obstruktif, perikarditis konstriktif dan keterlibatan neurologis akibat penyakit Pott (TB spinal). Apabila terdapat pembesaran kelenjar getah bening yang cukup banyak maka drainase, aspirasi maupun insisi dapat membantu.
Pasien dengan TB ekstraparu, paduan obat selama 6-9 bulan (2 bulan INH, RIF, PZA, dan EMB diikuti dengan 4-7 bulan INH dan RIF)
Pengecualian rekomendasi 6-9 bulan untuk TB ekstraparu pada sistem saraf pusat (tuberkuloma atau meningitis) dan TB tulang dan sendi, yaitu selama 9-12 bulan
Terapi ajuvan kortikosteroid harus ditambahkan pada TB sistem saraf pusat dan perikardial
Rekomendasi A
Terapi dengan kortikosteroid dimulai secara intravena secepatnya, kemudian disulih oral tergantung perbaikan klinis. Rekomendasi kortikosteroid yang digunakan adalah deksametason 0,3-0,4 mg/kg di tapering-off selama 6-8 minggu atau prednison 1 mg/kg selama 3 minggu, lalu tapering-off selama 3-5 minggu.Evaluasi pengobatan TB ekstraparu dilakukan dengan memantau klinis pasien, tanpa melakukan pemeriksaan histopatologi ataupun biakan.
Pada pasien tuberkulosis ekstra paru dan pada anak, respon pengobatan terbaik dinilai secara klinis
Standar 10 ISTC
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1. Definitions of tuberculosis cases. [cited 2013 March 3 ]. Available from:
http://www.who.int/tb/publications/global_report/2007/table_5/en/
2. NICE. Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control.2011. [cited 2012 October 17 ]. Available from: http://www.nice.org.uk/guidance/CG117.
3. Schluger, N. W. Rom WL The host immune response to tuberculosis. State of the Art Am J Respir Crit Care Med. 1998;157:679-691.
4. Seibert, A. F, Haynes, J, & Middleton, R. Bass JB Tuberculous pleural effusion: twenty years experience. Chest. 1991;99:883-886
5. Ghanei M, Aslani J, Bahrami H, Adhami H. Simple method for rapid diagnosis of tuberculosis pleuritis: a statistical approach. Asian Cardiovasc Thorac Ann. 2004;12(1):23-9.
6. Kumar P, Sen MK, Chauhan DS, Katoch VM, Singh S, Prasad HK. Assessment of the N-PCR assay in diagnosis of pleural tuberculosis: detection of M. tuberculosis in pleural fluid and sputum collected in tandem. PLoS One. 2010;5(4):e10220.
7. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med. 2003;167(4):603-62.
8. Kandala V, Kalagani Y, Kondapalli NR, Kandala M. Directly observed treatment short course in immunocompetent patients of tuberculous cervical lymphadenopathy treated in revised national tuberculosis control programme. Lung India. 2012;29(2):109-13.
9. Fontanilla JM, Barnes A, von Reyn CF. Current diagnosis and management of peripheral tuberculous lymphadenitis. Clin Infect Dis. 2011;53(6):555-62. 10. Cek M, Lenk S, Naber KG, Bishop MC, Johansen TE, Botto H, et al. EAU
guidelines for the management of genitourinary tuberculosis. Eur Urol. 2005;48(3):353-62.
11. Madeb R, Marshall J, Nativ O, Erturk E. Epididymal tuberculosis: case report and review of the literature. Urology. 2005;65(4):798.
12. Wise GJ, Shteynshlyuger A. An update on lower urinary tract tuberculosis. Curr Urol Rep. 2008;9(4):305-13.
13. Brancusi F, Farrar J, Heemskerk D. Tuberculous meningitis in adults: a review of a decade of developments focusing on prognostic factors for outcome. Future Microbiol. 2012;7(9):1101-16.
14. Cherian A, Thomas SV. Central nervous system tuberculosis. Afr Health Sci. 2011;11(1):116-27.
15. Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J. British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children. J Infect. 2009;59(3):167-87.
16. Agrawal V, Patgaonkar PR, Nagariya SP. Tuberculosis of spine. J Craniovertebr Junction Spine. 2010;1(2):74-85.
17. Mousa HA-L. Bones and Joints Tuberculosis. Bahrain Med Bull. 2007;29(1):1-9.
83
18. Mukewar S, Ravi R, Prasad A, K SD. Colon tuberculosis: endoscopic features and prospective endoscopic follow-up after anti-tuberculosis treatment. Clin Transl Gastroenterol. 2012;3:e24.
19. Karanikas M, Porpodis K, Zarogoulidis P, Mitrakas A, Touzopoulos P, Lyratzopoulos N, et al. Tuberculosis in the peritoneum: not too rare after all. Case Rep Gastroenterol. 2012;6(2):369-74.
20. Gungorduk K, Ulker V, Sahbaz A, Ark C, Tekirdag AI. Postmenopausal tuberculosis endometritis. Infect Dis Obstet Gynecol. 2007;2007:1-3.
21. Maestre MA, Manzano CD, Lopez RM. Postmenopausal endometrial tuberculosis. Int J Gynaecol Obstet. 2004;86(3):405-6.
22. Gatongi DK, Kay V. Endometrial tuberculosis presenting with postmenopausal pyometra. J Obstet Gynaecol. 2005;25(5):518-20.
23. Tripathy SN, Tripathy SN. Gynaecological Tuberculosis - an update. Ind J Tub. 1998;45:193-7.
24. Jindal UN, Verma S, Bala Y. Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Hum Reprod. 2012;27(5):1368-74.
25. Yoon SA, Hahn YS, Hong JM, Lee OJ, Han HS. Tuberculous pericarditis presenting as multiple free floating masses in pericardial effusion. J Korean Med Sci. 2012;27(3):325-8.
26. Reuter H, Burgess LJ, Louw VJ, Doubell AF. The management of tuberculous pericardial effusion: experience in 233 consecutive patients. Cardiovasc J S Afr. 2007;18(1):20-5.
27. Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, et al. Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology. Eur Heart J. 2004;25(7):587-610.
28. Dwari BC, Ghosh A, Paudel R, Kishore P. A clinicoepidemiological study of 50 cases of cutaneous tuberculosis in a tertiary care teaching hospital in pokhara, Nepal. Indian J Dermatol. 2010;55(3):233-7.
29. Varaine F, Rich ML. Tuberculosis: Practical guide for clinicians, nurses, laboratory technicians and medical auxiliaries. Paris: Partners in Health; 2013
[cited 2013 July 24]. Available from:
http://www.refbooks.msf.org/msf_docs/en/tuberculosis/tuberculosis_en.pdf
.
30. Bravo FG, Gotuzzo E. Cutaneous tuberculosis. Clin Dermatol. 2007;25(2):173-80.
31. Almaguer-Chavez J, Ocampo-Candiani J, Rendon A. Current panorama in the diagnosis of cutaneous tuberculosis. Actas Dermosifiliogr. 2009;100(7):562-70.
32. Turan E, Yurt N, Yesilova Y, Celik OI. Lupus vulgaris diagnosed after 37 years: a case of delayed diagnosis. Dermatol Online J. 2012;18(5):13.
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