Infeksi MycobacteriumTuberculosa

Lepra

Tuberculosis Cutis

Progresif Localized :Primary inoculation tuberculosis Lupus vulgaris Tuberkulosis verrucosa cutis Scrofuloderma Orificial tuberculosis

GeneralizedAcute miliary tuberculosis Metastatic tuberculous abscess Papulonecrotic tuberculid Lichen scrofulosorum ( tbc likenoides )

Tuberculosis veruccosa cutisLocation : dorsum manus, lower extremitiesLesion : discoid, sharply marginated, numular plaque Anatomist's wart DD : Verucca, Swimmingpool Granuloma

Scrofuloderma

Tuberculoid limfadenitisLocation : neck, Axilla, InguinalLesion : firm, subcutaneous nodule, redness, oedema, exudate, fistule, ulcer, keloid DD: Syphilitic gummmas, sporotrichosis, blastomycosis, LGV, actinomycosis

Treatments of cutaneous tuberculosis1. Isoniazid (300 mg / day) for 6 moths.2. Rifampisin (450 mg/ day, for weight < 50 kg; and 600 mg/ day, for weight > 50 kg) for 6 months3. Pyrasinamide untuk first 2 months (1,5 g / day for weight < 50 kg; 2 g / day for weight 50-74 kg ; 2,5 g / day for weight > 75 kg )4. Ethambutol untuk first 2 months(15 mg/ kg weight/day)

LEPROSYKUSTA, MORBUS HANSENInfectiousGreat Imitator clinical variantImmunological processDisability Early diagnosed

Leprosy

A chronic granulomatous infection and caused by Mycobacterium leprae Manifestation : Skin Peripheral nerve Upper respiratory tract mucous membrane Eyes

LEPROSY PROBLEMInfectiousDisabilityRejection Isolated from community

Route of transmissionRoute of transmission : Close contact Airborne infection Droplet infectionNot related with sexual intercourse, food, meal tools, dress Incubation periode 5 years

Mycobacterium leprae

EPIDEMIOLOGY

Gerakan Eliminasi Kusta (GEK) 2005Gerakan Eliminasi Kusta (GEK) 2005 akan mengintensifkan Gerakan Penemuan Penderita (GPP) dengan mengoptimalkan kegiatan kontak intensif pada 16 kabupaten/kota di Jatim yaitu Kabupaten Sampang, Sumenep,, Bangkalan, Pamekasan, Situbondo, Lumajang, Pasuruan, Jember, Ngawi, Bojonegoro, Lamongan, Tuban, Gresik dan Jombang serta Kabupaten/Kota Probolinggo.

LEPROSYS CLINICAL FINDINGS

DiagnosisCardinal signs :1. Specific lesion : macule, papule, plaque, nodule, infiltrate 2. Sensibility disorders at skin lession3. Nerve enlargement4. Acid-fast bacillus Based on 2 diagnosis from first 3 cardinal signs or acid-fast bacillus (+)

Complication

ContracturMutilationMadarosis BlindnessUlcer

Disability

ClassificationLeprosy classification according to WHO (1988) :Single lesion : only 1 lesionPausibasiler leprosy (PB) : 2-5 lesions, acid-fast bacillus (-)Multibasiler leprosy (MB) : more than 5 lesion, symetric, acid-fast bacillus (+)

Multi Drug Therapy

MDT Regimen WHO

1. Multibasiler Leprosy (MB)Rifampicin : 600 mg monthlyDapsone : 100 mg dailyClofazimin : 50 mg daily and 300 mg monthlyDuration : 12 months

2. Paucibasiler Leprosy (PB)Rifampicin : 600 mg monthlyDapsone : 100 mg dailyDuration : 6 months

3. Single lesion leprosyRifampicin : 600 mgOfloxacin : 400 mgMinocycline : 100 mg

Reactional States2 kinds of reactional leprosy :ENL / Erythema Nodusum Leprosum (Type II Reaction)Reversal reaction (Type I Reaction)

Signs and symptomsHigh feverNeuritisMalaiseArthralgias and arthritisReactional states dismissed as complications of treatment, may occur before or after completed treatmentLocalized erythema or generalized

Reactional States treatmentLeprosy treatment as usualNeuritis sign (+) symptomatic and rest Analgesic - antipyretikLampren 3 X 100 mg