tb kutis ajeng pptx
DESCRIPTION
tbTRANSCRIPT
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TUBERKULOSIS KUTIS
Dr. Ismiralda Oke P, SpKK
FKIK Unsoed / RSMS
2013
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Mikobakteria
• Batang, non spora, tidak motil, aerob, tahan asam BTA.
• 50 Spesies Kebanyakan saprofit, yg patogen sedikit.
• Berdasarkan pertumbuhannya dibagi atas :– Tidak tumbuh.– Tumbuh lambat.– Tumbuh cepat.
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Berdasarkan Pertumbuhannya :
Tipikal
Atipik
Tidak tumbuh M. leprae
Tumbuhlambat
M. tuberkulosis var. humanus, bovinum asia, afrika I,II
Fotokromogen M. marinum, M. kansasiSkotokromogen M. scrofulaccum,
M. szulgeiNon kromogen M. avian, M.intracelulare
M. battey
Tumbuhcepat
M. fortuitumM. smegmatisM. cholanae
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Tuberkulosis Kutis
• Terjadi akibat :– perkontinuitatum– limfogen– hematogen– inokulasi– autoinokulasi
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KlasifikasiI. Tbc Kulit sejati : BTA (+)
1. Tbc primer - Inokulasi eksogen : Tbc chancre, Tbc Verukosa2. Tbc Sekunder - Inokulasi endogen
* kontagiosa : Skrofuloderma, Tbc orifisialis
* limfogen : lupus vulgaris* hematogen : Tbc gumma
Tbc kutis miliaris* autoinokulasi
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Klasifikasi
II . Tuberkulid (eruptive tuberkulosis)
- BTA (-)
- Hipersensitifitas, reaksi peradangan karena Tbc
* papula : Papulonekrotikan
* mikropapula : liken skrofulasorum
* noduler : Eritema induratum
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Uji Tuberkulin• Hiperergik
– Tbc. Verukosa– Lupus vulgaris– Liken skrofulosorum
• Normoergik– Skrofuloderma– Inokulasi Tbc primer– Papulonekrotikan
• Hipoergik : Eritema induratum
• Anergik : Tbc kutis milier
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Tbc kulit termasuk penyakit kulit yang jarang ditemukan karena :• OAT• Perbaikan sosial ekonomi
Amerika Serikat 1987 :
* Tbc. Ekstra pulmonal 18%
* Tbc. Kulit 1,5%
Indonesia :
* 1986 : Tbc penyebab † No 4
* 1992 : No 2 ; 80-85% Tbc Paru
Waspada Tbc kulit
RSCM : 84% Skrofuloderma ; 13% Tbc verukosa
RSDK 1985-1988 : 83% Skrofuloderma ; 17% Tbc verukosa
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1. Tuberkulosis Chancre
• Inokulasi M. tbc pada kulit orang yg belum dapat imunitas.
Pada anak :* lokalisasi : muka, anggota, tindakan (tindik, sunat, tatto),
deltoid / paha (BCG)* UKK:Nodul terbatas coklat,- ulserasi - menebal - keras - krusta
diaskopi : “apple Jelly” regional limfadenopati sembuh lama
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2. Tuberkulosis kutis verukosa
• Inokulasi M. tbc pada kulit orang dg imunitas moderat-tinggi
• Kuman masuk : – Eksogen (anak, dewasa- pekerjaan)– Endogen
• Lokalisasi : daerah terbuka yg didahului trauma (lutut, kaki, tangan, bokong)
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2. Tuberkulosis kutis verukosa• UKK :
– papula kecil - indurasi - permukaan kasar plakat verukosa serfiginosa- batas ireguler.
– Tengah involusi atrofi– warna merah - coklat– Teraba keras, tempat tertentu lunak,
keluar pus.– Kadang nampak keloidal
DD : - Veruka vulgaris
- Kromomikosis
- Misetoma aktinomikosis
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3. Skrofuloderma
skrofulosa
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3. Skrofuloderma
• Kelanjutan perjalanan limf.is tbc tulang, sendi.
• Limfadenitis leher (colliquativa), aksila, supraklavikula, inguinal skrofulosa skrofuloderma
• UKK : – Nodul, merah, biru ulserasi -
banyak fistel - jembatan kulit– Sembuh - skar - khas.
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4. Tbc kutis orifisialis
• Autoinokulasi Tbc organ dalam, paru, intestinal.
• Dewasa, Pria > , Kebersihan <
• Lokalisasi : junction mulut, anus, lidah.
• UKK : nodul, merah (terasa sakit)
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5. Tbc kutis miliaris
• Penyebaran hematogen• akut, sakit berat.• Infant, anak, orang tua dg
imunokompromais.• UKK :
– papula, nodula, menyebar. Merah vesikel, pustula hemoragik.
– Biopsi untuk diagnosis.
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6. Lupus vulgaris
• Inokulasi atau perluasan langsung sendi, kelenjar (limfogen)
• Orang dg imunitas sedang-tinggi.
• Eropa-India• Wanita >• Tbc kutis progresif
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6. Lupus vulgaris• Lokalisasi :
– kepala, hidung, muka, leher, tangan, kaki.
• UKK :– Plakat, merah-coklat halus,
gelatinosa, “apple yelley”– Bentuk :
• Plakat Eritem• Ulserasi, mutilasi• Vegetasi• Tumor like• Papula, nodula deseminata
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7. Tuberkulosis kutis gumosa
• Penyebaran hematogen dari fokus primer.
• Anak, yg kurang perawatan
• Lokalisasi : ekstremitas > badan.
• UKK : nodula terbatas, subkutan ulserasi dg sinus-sinus
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Tuberkulid
• Erupsi kulit berhubungan dg fokus internal, membaik dg OAT.
• Simetris, deseminata
1. Liken skrofulasorum
2. Papulonekrotikan tuberkulid
3. Noduler; Eritema induratum
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1. Liken skrofulosorum
• Anak, dewasa
• Badan
• Papula perifolikuler, kering merah,coklat
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2. Papulonekrotikan tuberkulid
• Dewasa muda
• Lutut, siku, kaki
• Papula keras, merah kotor, ulserasi, pigmentasi
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3. Noduler Eritema Induratum
• Fokus Tbc di tempat lain• Wanita > dewasa muda• Tungkai bawah, fleksor• Nodul-plakat subkutan• Merah merah biru.• Lunak, indolen• Kronik, rekurent
– Ulserasi - sembuh - atrofi
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Diagnosis• Diagnosis Pasti dg menemukan kuman penyebab :
– kultur– hewan coba marmut
• Terindikasi :– Tbc tempat lain– riwayat penyakit & UKK– BTA (+)– PA– Tuberkulin tes– Efek OAT
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Pengobatan
• OAT (Obat Anti Tuberkulosis)– R : rifampisin 10 mg/kgBB– H : isoniasid (INH) 10 mg/kgBB– Z : pirazinamid 20-35 mg/kgBB– E : ethambutol 25/15 mg/kgBB– S : streptomisin 25 mg/kgBB
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Pengobatan
• Rekomendasi Utama : 2RHZ / 4RH
• Variasi : - 2RHZ / 4R3H3 - 2RHZ / 4R2H2
• Diawasi : - 2R3H3E3Z3 / 4R3H3 - 2R3H3S3Z3 / 4R3H3
• Resisten : - 2RHZE / 4RH - 2RHZS / 4RH
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Prognosa :
- responsif terhadap OAT
Profilaksis :
- BCG
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Diaskopi