ALUR DIAGNOSTIK DAN

MANAJEMEN TERAPI TBC PADA

ANAK

Edward Surjono
Departemen Ilmu Kesehatan Anak
Fakultas Kedokteran dan Ilmu Kesehatan
UNIKA Atma Jaya

7/10/2019
MANIFESTASI KLINIS
 Tidak spesifik
 Manifestasi sistemik
 Demam lama tanpa sebab jelas
 Anorexia
 Malnutrisi
 malaise
 Manifestasi pada organ tertentu
 Respirasi
 Neurologi
 Orthopedi
 Pencernaan
LABORATORIUM
 Pemeriksaan darah
 Peningkatan laju endap darah
 peningkatan limfosit, kadang monosit
 Polymerase chain reaction (PCR)
 Immunologic assay (ELISA, latexparticle agglutination, radioimmunoassay,
immunoblotting)
 Adenosine deaminase levels
 BAL fluid levels of CD4+ T-lymphocytes, immunoglobulins, and fibronectin
IGRA

• Prinsip: merangsang limfosit T dengan antigen kuman

TB. Antigen spesifik yang digunakan untuk uji ini adalah
ESAT-6 dan CFP-10
• Cara kerja: mengkalkulasi interferon gamma yang
dihasilkan oleh sel T CD4+, CD8+, dan sel NK yang
tersensitiasi oleh M. tuberculosis
PEMERIKSAAN MIKROBIOLOGI
 Baku emas
 Lowenstein Jensen
 Hasil positif pada 10-62 %
 Hasil negative tidak menyingkirkan TBC
 Pemeriksaan sputum, bilas lambung, PA
 Dapat menggunakan Bactec
 Pemeriksan Radiologi
 Bervariatif, seringkali di anak tidak ditemukan tanda spesifik
 Mantoux test, (PPD RT 23 TU)
 0,1 ml , volar lengan bawah, dibaca 48-72 jam
Definitions of Positive Tuberculin Skin Test (TST) Results in
Infants, Children, and Adolescents

 Induration 5 mm or greater
 Children in close contact with known or suspected
contagious people with tuberculosis disease
 Children suspected to have tuberculosis disease:
• Findings on chest radiograph consistent with active or
previous tuberculosis disease
• Clinical evidence of tuberculosis disease
 Children receiving immunosuppressive therapy or with
immunosuppressive conditions, including human
immunodeficiency (HIV) infection
 Induration 10 mm or greater

 Children at increased risk of disseminated tuberculosis disease:

• Children younger than 4 years of age
• Children with other medical conditions, including Hodgkin disease,
lymphoma, diabetes mellitus, chronic renal failure, or malnutrition
 Children with likelihood of increased exposure to tuberculosis
disease:
• Children born in high-prevalence regions of the world
• Children frequently exposed to adults who are HIV infected,
homeless, users of illicit drugs, residents of nursing homes,
incarcerated or institutionalized, or migrant farm workers
• Children who travel to high-prevalence regions of the world
 Induration > 15 mm
 Children 4 years of age or older without
any risk factors
PERMENKES RI 67,2016
 0 1 2 3 Skor

Kontak Tidak jelas - Laporan ortu, BTA (-) BTA (+)

PPD negatif - - positif

Berat badan - BB/U < 80% BB/U < 60% -

Demam - > 2 minggu, penyebab - -

tidak jelas

Batuk <3minggu >3 minggu - -

Pembesaran - multipel , >1cm, nyeri (-) - -

limfonodi

Sendi - bengkak - -

Rontgen dada normal sugestive - -

Total score
Kelas kontak Mantoux Gejala tindakan
test/infeksi klinis

0 - - - -

1 + - - P1

2 + + - P2

3 + + + OAT
TERIMA KASIH

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