Pediatric Pulmonary

Tuberculosis
Rumusan Masalah
Anak laki-laki berusia 5 tahun dengan keluhan
batuk 2 minggu yang lalu.
Hipotesis
Anak laki-laki 5 tahun menderita tuberkulosis paru.
Anamnesis
Personal data
Keluhan utama
Riwayat penyakit sekarang
Riwayat penyakit dahulu
Riwayat penyakit keluarga
Status sosioekonomi
Riwayat Imunisasi
Pemeriksaan fisik
Inspeksi
Palpasi
Perkusi
Auskultasi
Pemeriksaan Penunjang
Tuberculin skin tests
Bacteriological Examination
Imaging techniques
Molecular techniques
Haematological and biochemical
Investigations
Mantoux test
Inject intradermally 0.1ml of 5TU PPD
tuberculin
Produce wheal 6mm to 10mm in diameter
Represent DTH(delayed type hypersensitivity
Read reaction 48-72 h


Acid Fast Bacilli Smear and Culture
Radiology
Diagnosis
Working diagnosis
Primary Pulmonary Tuberculosis
Differential Diagnosis
Bronchitis
Pneumonia
Symptoms Acute bronchitis Tuberculosis Pneumonia
Cough
Dry cough at first
(does not produce
mucus)
After a few days,
cough may bring up
mucus from the lungs.
The mucus may be
clear, yellow, or
green, and may be
tinged with blood.
Progressive cough
Sputum production
Haemoptysis
Cough often brings
up mucus from the
lungs.
Mucus may be rusty
or green or tinged
with blood.
Fever
Fever is not present
or is mild.
High fever
Fever is often higher
than 101F (38.5C).
Other
X-rays appear
normal.
Usually goes away in
2 to 3 weeks
Night sweats
Lympocytosis
Hilar adenopathy
Anorexia
Weight loss
X-ray- abnormal
Last longer than 2-3
weeks

Heart rate faster
than 100 beats a
minute
Breathing faster than
24 breaths a minute
Shaking, "teeth-
chattering" chills
X-rays do not appear
normal.
May last longer than
2 to 3 weeks
Epidemiology
1.3 million annual cases with 450000 deaths
Rates of TB highest among
Urban, low income populations
The homeless
Hispanics
Blacks
Asians
First generation immigrants from high risk
countries
Risk factors
Level of immunocompetence
Malnutrition
Crowding and poor ventilation
Steroid therapy
Chemotherapy
Hematologic malignancy

Transmission
Usually from adults
Young children rare
Tubercle bacilli are
sparse in the
endobronchial
secretions
Cough is weak or absent

Pathophysiology

Clinical Manisfestation
Tuberculosis Infection
Tuberculosis Disease
Pulmonary
Extrapulmonary

Signs and symptoms
Cough
Persistent fatigue
Fever
Night sweats
Anorexia
Weight loss
Management

Recommended Treatment Schedules
for Tuberculosis Disease in Children
Hilar adenopathy 2 months of RHZ ; 4 months of RH
Pulmonary tuberculosis 2 months of RHZE ; 4 months of RH
Extrapulmonary tuberculosis 2 months of RHZE ; 4 months of RH
TB meningitidis 2 months of RHZS ; 4 months of RH
HIV 2 months of RHZE ; 4 months of HR or 6
months of HE
Drug Resistant TB
Primary
Secondary
Prevention and Control
DOTS
Sustained political commitment
Access to quality-assured TB sputum microscopy
Standardized short-course chemotherapy to all
cases of TB
Uninterrupted supply of quality assured drugs
Reporting and recording system
Vaccination -bCG
Complication
Miliary disease
Pleural effusions
Pneumothorax
Atelectasis

Prognosis
Mortality rate
5 years 20%
Increases with MDR-TB
Illness lasting > 2 months 50%
Kesimpulan
Hipotesis diterima
Sekian, terima kasih.