Definisj

TB is an infectious disease caused by micobacterium tuberculosis. Most TB germs invade the lungs, but
can also affect other organs.

Tuberculosis is a disease caused by Mycobacterium tuberculosis that is almost all the organs of the body

Penyebab

Pulmonary TB disease is caused by TB (Mycobacterium Tuberculosis) bacteria. These germs are rod-
shaped, have special properties that are resistant to acid in staining. Therefore it is also referred to as
Acid Basil Basil (BTA), TB germs quickly die to direct sunlight, but can survive for several hours in a dark
and humid.

Factors that cause a person to be infected by Myobacterium Tuberculosis:

Hereditary: a person's resistance to infection may be lowered.

Gender: By the end of childhood and adolescence, mortality and morbidity are more prevalent among
girls.

Age: in infancy the possibility of infection is very high.

Klasifikasi

Pulmonary TB is a tuberculosis that attacks lung tissue, not including the pleura (lung membrane). Based
on the results of sputum examination, Pulmonary TB is divided into 2, namely:

Positive BTA Pulmonary TB, called smear pulmonary TB (+) if at least 2 of 3 sputum specimens of SPS (at
Morning Time) is positive, or 1 sputum positive SPS specimen accompanied by pulmonary radiology
examination shows active TB picture.

BTA Negative Lung TB, if in 3 sputum smear specimen negative smear SPS and chest rectologic
examination shows active tuberculosis picture. Pulmonary TB with BGA (-) and positive radiographic
images are divided according to the severity, when indicating the severity ie extensive damage is
considered severe.

Extra pulmonary TB is tuberculosis that attacks other organs other than the lungs, such as the pleura, the
brain swab, the pericardium, the lymph nodes, the joint bone, the skin, the intestines, the kidneys, the
urinary tract and the genitals. Extra pulmonary TB is divided according to the severity of the disease,
namely:

Excessive pulmonary tuberculosis that attacks the lymph glands, the pleura, the bone (except the spine),
the joints and the adrenal glands.

Excessive pulmonary tuberculosis such as meningitis, pericarditis, peritonitis, Tb spinal, Tb urethra and
genitals.
By Type Patient

The type of patient is determined based on previous medical history. There are several types of sufferers:

New cases are patients who have not been treated with OAT or have ever taken Anti Tuberculosis (OAT)
less than a month.

Relapse (TB) is a patient who has never received TB treatment and has been declared cured, then re-
treated with the results of positive smear examination.

Transfer (transfer in) ie patients who are receiving treatment in another district then moved to treatment
district. The transfer patient must bring a referral / move letter.

Cases after treatment default (default / drop out) is patient who had treatment palig less 1 month attau
more and stop 2 months or more then come back treatment.

Tanda dan gejala

SIGNS AND SYMPTOMS

Common symptoms of lung TB are coughing more than 4 weeks with or without sputum, malaise, flu
symptoms, mild fever, chest pain, coughing up blood. (Mansjoer, 1999)

Other symptoms include fatigue, anorexia, weight loss (Luckman et al, 93)

Fever: subfebril resembles influenza.

Cough: dry cough (non productive), productive cough (sputum)

Hemaptoe

Shortness of Breath: in advanced TB disease where the infiltration is ½ lung part.

Chest pain

Malaise: anorexia, decreased appetite, headache, muscle aches,

Komplikasi

COMPLICATIONS

Complications that often occur in patients with TB disease if not treated properly will cause
complications, including:

Early complications: pleuritis, pleural effusion, empyema, pharyngitis.

Advanced complications:

Airway obstruction, such as SOPT (Post Tuberculosis Obstruction Syndrome)

Severe parenchymal damage, such as SOPT or Cor pulmonal Pulmonary Fibrosis, amylosis, pulmonary
carcinoma, ARDS.

Cara penularan

Tuberculosis (TB) can be transmitted by direct contact with tuberculosis patients, such as exposure to
breath, body fluids, and when using spoons and towels simultaneously.

Pengobatan

Type of drug used

a. Primary Drugs b. Secondary Drugs

1. Isoniazid (H) 1. Ekonamid

2. Rifampicin (R) 2. Protionamide

3. Pyrazinamide (Z) 3. Cycloserine

4. Streptomycin 4. Kanamycin

5. Etambutol (E) 5. PAS (The Amino Salicyclyc Acid)

6. Tiasetazone

7. Viomycin

8. Kapreomisin

TB treatment there are 2 stages according to DEPKES 2000 that is:

INTENSIVE STAGE

Patients receive daily medication and are directly supervised to prevent immunity from rifampicin. When
the intensive time is given properly, the infectious patient becomes not infectious within 2 weeks. Most
people with smear positive TBA become negative (conversion) at the end of intensive treatment. Strict
supervision in the intensive stage is very important to prevent the occurrence of drug resistance.

Advanced stage

At an advanced stage the patient gets longer drug duration and fewer drugs to prevent tenderness.
Follow-up is important to kill persistent germs (dormant) to prevent recurrence.

Cara pencegahan
How TB transmission needs to be taken care of by taking appropriate preventive measures to prevent
drip infections from patient to person. One way is to cough and sneeze while covering the mouth / nose
with a handkerchief or tissue to then be disinfected with lysol or burned. If the patient is talking, do not
be too close to the other person. Good ventilation from the room also minimizes the danger of
transmission.

Children under the age of one year from families with TB need to be vaccinated against BCG, along with
isoniazid 2-10 mg / kg for 6 buan (chemoprophylaxis)

Examination of contacts, ie examination of individuals who closely associate with patients with
pulmonary tuberculosis positive. Examination includes tuberculin, clinical and radiological tests. If the
tuberculin test is positive, then the radiological examination of the thorax photo is repeated in the next 6
and 12 months. When a negative mass is given BCG vaccination. If positive, it means the conversion of
tuberculin test results and given kemoprofilaksis.

Mass chest x-ray, which is a mass inspection of certain population groups such as hospital employees /
puskesmas / clinics, inmates and pesantren students.

FOR PATIENTS:

Drink the medicine until it runs out as directed

Closing your mouth when coughing or sneezing

No spitting anywhere

Spit in places exposed to direct sunlight or in an already existing place of carbolic / lisol

FOR FAMILY :

Dry the mattress once a week

Open the window wide for air and direct sunlight

OTHER PREVENTION:

Immunization of BCG in infants

nurse: assalamu'alaikum father and mother of the patient: Waalaikumsalam nurse nurse: introduce my
name nurse afni and this ternan i namarraita how is the current situation sir? I am still coughing up
phlegm and feeling breathless nurse nurse: yes sir, if father still feel shortness of breath father can do
deep breath that ever we taught before nurse: well, father and mother today I and I will do health
education for father and mother about tuberculosis disease that my father suffered, I will need more
than 5sarnpai 10 minutes please pay attention pack. what father and mother are willing? the nurse as for
the purpose so that father and mother can know what is okay and not bolch in doing related to
tuberculosis disease and can more control again nurse as I explain everything father and mother can give
question related to discussion which we give if father and mother not yet understand. patient: good
nurse