Post on 06-Jul-2018
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$$
1; be&3a! 'an# ,at% &a$a "% tan#an !%&%
2; len#an !%&% ba2a/ ,en#e3%l "an a"a !ele,a/an pa"a tan#an !%&%
3; ,a!la /%pop%#,enta$%
4; at&op% otot /%potena& 5; 3la2 /an"
6; /%poa%$t/e$% pa"a !l%t $e!%ta& !el%n#!%n# "an ja&% ,an%$
DD:
,o&b$ /an$en
TBC !t%$
MORBUS HANSEN
1; "e)%n%$%
2; ep%"e,%olo#%
3; et%olo#%
4; )a!to& &e$%!o
5; !la$%)%!a$%
6; pato#ene$%$
7; pato)%$%olo#%
8; ,an%)e$ta$% !l%n%$
9; "%a#no$%$
10; DD
11; penatala!$anaan
12; !o,pl%!a$%
13; p&o#no$%$
14; pen3e#a/anTBC KUTIS
1; "e)%n%$%
2; ep%"e,%olo#%
3; et%olo#%
4; )a!to& &e$%!o
5; !la$%)%!a$%
6; pato#ene$%$
7; pato)%$%olo#%
8; ,an%)e$ta$% !l%n%$
9; "%a#no$%$
10; DD11; penatala!$anaan
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
2/15
12; !o,pl%!a$%
13; p&o#no$%$
14; pen3e#a/an
STEP
Anal%$a !a$$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$a&!an (HO
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
3/15
i; pa$% 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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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%!
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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#$
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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&.
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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*.
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
11/15
#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$%$
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
13/15
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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
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
8/18/2019 LBM 4 Penyakit Tropik Sgd 2
15/15
$!&o)lo"e&,a+ j%!a l!$ ,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