pemicu 3

7/17/2019 pemicu 3

http://slidepdf.com/reader/full/pemicu-3-568d8b214e49d 1/37

LO 1

Macam-macam batuk kronik

7/17/2019 pemicu 3


Bronkiektasis

• Bronchiectasis is an abnormal andpermanent dilatation of bronchi.

• It may be either focal, involvingairays supplying a limited region ofpulmonary parenchyma, or di!use,involving airays in a more

idespread distribution.

7/17/2019 pemicu 3


• "hree di!erent patterns of bronchiectasishave been described# – cylindrical bronchiectasis, the involved bronchi

appear uniformly dilated and end abruptly atthe point that smaller airays are obstructedby secretions.

– varicose bronchiectasis, the a!ected bronchi

have an irregular or beaded pattern ofdilatation resembling varicose veins.

– saccular (cystic) bronchiectasis, the bronchihave a ballooned appearance at the periphery

7/17/2019 pemicu 3


• "he bronchial dilatation of bronchiectasis isassociated ith destructive andin$ammatory changes in the alls of

medium-si%ed airays, often at the level ofsegmental or subsegmental bronchi.

• &s a result of the in$ammation, vascularityof the bronchial all increases, ith

associated enlargement of the bronchialarteries and anastomoses beteen thebronchial and pulmonary arterial circulations.

7/17/2019 pemicu 3


'atogenesis dan etiologi

• Bronchiectasis is a conse(uence ofin$ammation and destruction of thestructural components of thebronchial all.

• Infection is the usual cause of thein$ammation) microorganisms such

as Pseudomonas aeruginosa andHaemophilus infuenzae

7/17/2019 pemicu 3


Manifestasi *linis

• 'atients typically present ithpersistent or recurrent cough andpurulent sputum production

• +emoptysis, yspnea, hee%ing

• &ny combination of crackles, rhonchi,and hee%es may be heard, all ofhich re$ect the damaged airayscontaining signicant secretions.

7/17/2019 pemicu 3


adiographic and Laboratory

/indings

• "he ndings are often nonspecic

• patients ith saccular bronchiectasis mayhave prominent cystic spaces either ith

or ithout air-li(uid levels• Other ndings are due to dilated airays

ith thickened alls#

–

0hen seen longitudinally, the airays appearas tram tracks

– hen seen in cross-section, they producering shados.

7/17/2019 pemicu 3


7/17/2019 pemicu 3


+istoplasmosis

7/17/2019 pemicu 3


• In most endemic areas, H. capsulatum var.capsulatum is the causative agent) in &frica, H.capsulatum var. duboisii is also found.

• Mycelia2the naturally infectious form ofHistoplasma2have a characteristic appearance,ith microconidial and macroconidial forms.

• Microconidia are oval and are small enough 3456m7 to reach the terminal bronchioles and alveoli.

• &fter infecting the host, mycelia transform intothe yeasts that are found inside macrophagesand other phagocytes.

7/17/2019 pemicu 3


8pidemiologi

• +istoplasmosis is the most prevalent endemicmycosis in 9orth &merica.

• Its endemicity is particularly notable in certainparts of 9orth, :entral, and ;outh &merica)&frica) and &sia.

• ;oil enriched ith bird or bat droppings promotesthe groth and sporulation of Histoplasma.

• &ctivities associated ith high-level e<posureinclude spelunking, e<cavation, cleaning ofchicken coops, demolition and remodeling of oldbuildings, and cutting of dead trees.

7/17/2019 pemicu 3


'atogenesis

• Infection follos inhalation of microconidia

• Once they reach the alveolar spaces, microconidiaare rapidly engulfed by alveolar macrophages.

•

"he microconidia transform into budding yeasts• "he yeasts are capable of groing and multiplying

inside resting macrophages.

• Before the development of cellular immunity,yeasts use the phagosomes as a vehicle fortranslocation to local draining lymph nodes,hence they spread hematogenously throughoutthe reticuloendothelial system.

7/17/2019 pemicu 3


• In the immunocompetent host, the immunecells form granulomas that contain theorganisms.

•

"hese granulomas typically brose and calcify• In patients ith impaired cellular immunity, the

infection is not contained and can disseminate.

• 'rogressive disseminated histoplasmosis 3'+7

can involve multiple organs, most commonlythe bone marro, spleen, liver, adrenal glands,and mucocutaneous membranes.

7/17/2019 pemicu 3


7/17/2019 pemicu 3


:linical Manifestations

• fever, chills, seats, headache, myalgia,anore<ia, cough, dyspnea, and chest pain.

• :hest radiographs sho signs of

pneumonitis ith hilar or mediastinaladenopathy

• In healed histoplasmosis, calciedmediastinal nodes or lung parenchyma

may erode through the alls of the airaysand cause hemoptysis. "his condition iscalled broncholithiasis.

7/17/2019 pemicu 3


iagnosis

• /ungal culture remains the gold standarddiagnostic test for histoplasmosis

• /ungal stains of cytopathology or biopsy

materials shoing Histoplasma yeasts '+

• "he detection of Histoplasma antigen in

body $uids is e<tremely useful in thediagnosis of '+ and acute di!usepulmonary histoplasmosis.

7/17/2019 pemicu 3


7/17/2019 pemicu 3


LO 4

"B:

7/17/2019 pemicu 3


"B:

• :aused by bacteria of the Mycobacteriumtuberculosis comple<, usually a!ects thelungs, although other organs are involved

in up to one-third of cases.• If untreated, the disease may be fatal

ithin 6 years in 6=5>6? of cases.

• "ransmission usually takes place through

the airborne spread of droplet nucleiproduced by patients ith infectiouspulmonary tuberculosis.

7/17/2019 pemicu 3


• Mycobacteria belong to the familyMycobacteriaceae and the order&ctinomycetales.

• &gent of human disease is M.tuberculosis. rod-shaped, non-spore-forming, thin aerobic bacterium

measuring =.6 m by @ m

7/17/2019 pemicu 3


• "he comple< includes #

– M. bovis 3resistant to pyra%inamide, once an importantcause of tuberculosis transmitted by unpasteuri%ed milk7,

– M. caprae 3related to M. bovis7,

–M. aricanum 3isolated from cases in 0est, :entral, and8ast &frica7,

– M. microti 3the vole bacillus, a less virulent and rarelyencountered organism7,

– M. pinnipedii 3a bacillus infecting seals and sea lions in the

southern hemisphere and recently isolated from humans7 – M. canettii 3a rare isolate from 8ast &frican cases that

produces unusual smooth colonies on solid media and isconsidered closely related to a supposed progenitor type7.

7/17/2019 pemicu 3


7/17/2019 pemicu 3


'atogenesis

• "he interaction of M. tuberculosis ith thehuman host begins hen droplet nucleicontaining microorganisms from infectious

patients are inhaled.• MaAority of inhaled bacilli are trapped in the

upper airays and e<pelled by ciliatedmucosal cells, a fraction 3usually 1=?7

reach the alveoli.• "here, alveolar macrophages that have not

yet been activated phagocyti%e the bacilli

7/17/2019 pemicu 3


• If the bacilli are successful inarresting phagosome maturation,then replication begins and the

macrophage eventually ruptures andreleases its bacillary contents.

• Cranulomatous lesions 3tubercles7

are formed.

7/17/2019 pemicu 3


• &ctivated macrophages aggregate aroundthe lesionDs center and e!ectively neutrali%etubercle bacilli ithout causing further

tissue destruction.• In the central part of the lesion, the necrotic

material resembles soft cheese 3caseousnecrosis)

• 8ven hen healing takes place, viable bacillimay remain dormant ithin macrophages orin the necrotic material for many years.

7/17/2019 pemicu 3


'ulmonary "uberculosis

• 'ulmonary tuberculosis can becategori%ed as primary orpostprimary 3secondary7

7/17/2019 pemicu 3


'rimary isease

• 'rimary pulmonary tuberculosis occurs soon after theinitial infection ith tubercle bacilli.

• "he lesion forming after infection is usually peripheral

and accompanied in more than half of cases by hilar or

paratracheal lymphadenopathy, hich may not bedetectable on chest radiography.

• "he lesion heals spontaneously and may later be evident

as a small calcied nodule 3Ghon lesion7.

• 'leural e!usion, results from the penetration of bacilli

into the pleural space from an adAacent subpleural focus.• In severe cases, the primary site rapidly enlarges, its

central portion undergoes necrosis, and cavitation

develops

7/17/2019 pemicu 3


• 8nlarged lymph nodes may compress bronchi,causing obstruction and subse(uent segmental orlobar collapse.

• 'artial obstruction may cause obstructive

emphysema, and bronchiectasis may also develop.

• Bacilli reach the bloodstream from the pulmonarylesion or the lymph nodes and disseminate intovarious organs, here they may produce

granulomatous lesions.• immunocompromised persons may develop miliary

tuberculosis andEor tuberculous meningitis.

7/17/2019 pemicu 3


'ostprimary isease

• &lso called adult-type, reactivation, orsecondary tuberculosis,

• results from endogenous reactivation of latent

infection and is usually locali%ed to the apicaland posterior segments of the upper lobes

• Massive involvement of pulmonary segmentsor lobes, produces tuberculous pneumonia.

•

;ome pulmonary lesions become brotic andmay later calcify, but cavities persist in otherparts of the lungs.

7/17/2019 pemicu 3


• ;ymptoms and signs are often nonspecic andinsidious# fever and night seats, eight loss,anore<ia, malaise, and eakness.

• :ough often initially nonproductive and subse(uently

accompanied by the production of purulent sputum,sometimes ith blood streaking.

• Massive hemoptysis may ensue as a conse(uence ofthe erosion of a blood vessel in the all of a cavity.

• 'leuritic chest pain sometimes develops in patientsith subpleural parenchymal lesions.

• 8<tensive disease may produce dyspnea and, in rareinstances, adult respiratory distress syndrome 3&;7.

7/17/2019 pemicu 3


7/17/2019 pemicu 3


Miliary or isseminated "uberculosis

• Miliary tuberculosis is due to hematogenousspread of tubercle bacilli.

• /ever, night seats, anore<ia, eakness,

and eight loss are presenting symptoms inthe maAority of cases.

• +epatomegaly, splenomegaly, andlymphadenopathy.

• 8ye e<amination may reveal choroidaltubercles

• Meningismus

pemicu 3

Documents