kelainan fungsi paru pasca pengobatan tb
TRANSCRIPT
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KELAINAN FUNGSI PARU PASKA PENGOBATAN TUBERKULOSIS PARU
dr. Oea Khairsyaf, Sp.P(K)
Bagian Pulmonologi dan Kedokteran Respirasi FK Unand / RS M Djamil Padang
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TUBERKULOSIS
Mycobacterium tuberculosis intra sel
Pengobatan lama putus berobat >>
Terapi tb sesuai guideline pengobatan lengkap atau sembuh dengan/atau tanpa gejala sisa
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Komplikasi / Gejala Sisa Tb Paru
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BATUK DARAH
Bisa fatal Semua usia
Insiden 30-35 %
Penyebab aneurisma rasmussen, scar Ca,
Bronkiektasis, aspergiloma
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Penanganan Batuk Darah
Bed rest
Anti Fibronilitik
Bronkoskopi : diagnostik dan terapeutik
Pembedahan
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BRONKIEKTASIS
• Pelebaran bronkus terutama ukuran sedang (cabang 8-10) • Laennec, 1819 mendengar crackles pasien tB dan pneumonia. • Gracher, 1878 BE terjadi pada tb fibrokaseosa, gejala tertutupi oleh gejala klinis tb yang lebih dominan. • Reid, 1950 mengklasifikasikan BE menjadi kistik/sakuler (seperti balon), tubuler/silindris (pelebaran bronkus yang uniform) dan varikosa (seperti manik-manik atau varises).
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BRONKIEKTASIS
Angka kejadian BE
paska tb : 30 - 60 %
Risiko kematian
koinfeksi tb paru dengan BE 1,25 kali
BE kongenital, dektrokardi dan sinusitis syndrome
Kartegener 1 kasus per
32.000 kelahiran
hidup
Diagnosis : Chest X-ray, CT
Scan, bronkografi
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Traction bronchiectasis in a 52-year-old man. High-resolution CT scan shows dilatation of bronchi (black arrows) within the collapsed right upper lobe.
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Fibrotic lungs in a 36-year-old man with postprimary tuberculosis. High-resolution CT scan shows parenchymal bands (arrows), traction bronchiectasis (arrowheads), and mild volume loss in both upper lobes. The large cystic lesions in the posterior aspects of both upper lobes represent cystic bronchiectasis. There is a spiculated,
marginated, subpleural nodule (N) in the right upper lobe.
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Managemen Bronkiektasis
Postural drainage
Infection control
Complication management
Surgery
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ASPERGILOMA
ASPERGILLUS
Saprofit Tangkai-tangkai panjang (connidiospora) dengan kepala besar dan spora Tumbuh di daerah tropik dengan kelembaban yang tinggi Hifa bercabang 450 terlihat dengan pewarnaan perak tumbuh pada suhu tubuh normal dan bertahan sampai suhu 500C
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fungus ball (misetoma) karena terdapat kavitas di parenkim
paru akibat penyakit paru sebelumnya
Angka kejadian aspergiloma pada pasien tb dengan kavitas
adalah 17 %
Gejala Klinis : hemoptisis berulang (50-90%), sesak
nafas, demam, ↓ BB
Diagnosis : gejala klinis, anamnesis, faktor predisposisi, radiologi, kultur jamur sputum
Diagnosis pasti : histopatologi dan biakan jaringan
ASPERGILOMA
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Aspergilloma
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CT Scan pasien Aspergiloma
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Disebabkan oleh obstruksi saluran nafas, penurunan
volume paru karena cavitas, destruksi parenkim dan
fibrosis pleura
Hipertensi arteri pulmonal kerusakan vascular bed, oklusi karena fibrosis, vaskulitis dan
endarteritis
Biasanya terlambat diketahui
EKG dan gambaran radiologi sulit untuk mendeteksinya
karena “architectural distortion”
CPC
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Problem for the clinician
• Mengenali tanda-tanda bekas TB, yang juga bisa menimbulkan gejala (hemoptisis, respiratory insuffisiency, bacterial non tb infection...) Tapi tidak memerlukan OAT
• Mengenali tanda-tanda Tb aktif, kadangkala mixed sequele Tb, yang membutuhkan OAT
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Problem for the clinician: Active or inactive sequela ? To treat or not to treat
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Tuberculous, Retractil evolution with
sequelae despite treatment
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Excavated lesions with AFB+ in right superior lobe
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Evolution during and after treatment: 18 months
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Right severe bronchiectasis, sequela of extensive TB of the right lung
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Decision of TB treatment or not:
Past history ( correct TB treatment or not) If available comparison with past CXR (each patient should
have a CXR at the end of primary tratment and educated to keep it with
him ) sputum analysis+++ Clinical symptoms evolution with non specific
antibiotic CXR analysis by experienced physician In case of typical TB sequela and sure notion of no tb
treatment in past history, one complete TB treatment should be considered
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TERIMA KASIH