SlideShare a Scribd company logo
1 of 57
World
PneumoniaDay!
Dimas Fujiansyah โ€“ 2108260090
table of contents
01
04
02
05
03
06
COUGH DD FOR PRODUCTIBE
COUGH
Defenition and
etiology of tb
RISK FACTOR OF TB CLASSIFICATION OF TB PATOPGYSIOLOGY OF
TB
table of contents
07
10
08 09
PHYSICAL EXAMINATION
OF TB
LAB. EXAMINATION OF
TB
COMUNICATION TO
PATIENT
COMPLICATION
COUGH
01
Definition
Cough is physiological protective
mechanism which is characterized
by explosive expectoration
following a deep inspiration. Its
function is to clear the
tracheobronchial tree of excessive
secretions and foreign body.
Cough mechanism
DD FOR PRODUCTIBE COUGH
02
Cough History
โ— Acute
โ—‹ Less than 3 wk
โ—‹ Aspiration, Inhalation of noxious chemical or smoke
โ— Sub-acute
โ—‹ 3-8 wk
โ—‹ Tracheobronchiti-spertussis
โ—‹ post viral tussive syndrome
โ— Chronic
โ—‹ More than 8 wk
โ—‹ Cardiopulmonary dโ€™s
โ—‹ Inflammatory
โ—‹ Infectious
โ—‹ neoplastic and cardiovascular etiology
Cough History
โ— Acute cough occurring in context of more serious disease such as
pneumonia, aspiration, CHF, pulmonary embolism is usually easy
to diagnose due to the presence of other clinical features.
โ— Cough of less than 8 wk duration may be the early manifestation of
a disease causing chronic cough.
โ— Chronic cough with a normal chest radiograph
โ—‹ Cough variant asthma
โ—‹ Gastro-esophageal reflux
โ—‹ Post-nasal drainage
โ—‹ Medication (ACE inhibitor)
DI
FR
EN
TI
AL
DI
AG
NO
SE
Sputum color associated with various conditions
Defenition and etiology of tb
03
TUBERCULOSIS
โ— Is the most prevalent communicable infectious disease
on earth and remains out of control in many developing
nations
โ— It is a chronic specific inflammatory infectious disease
caused by Mycobacterium tuberculosis in humans
โ— Usually attacks the lungs but it can also affect any parts
of the body
โ— Also Known as โ€œ KOCHโ€™s Diseaseโ€, โ€œwasting diseaseโ€
and the โ€œwhite plague.โ€
ETIOLOGY
โ— MYCOBACTERIUM TUBERCULOSIS
โ—‹ It presents either
โ–  as latent TB infection (LTBI) or
โ–  as progressive active disease.
โ—‹ typically causes progressive destruction of the lungs,
death in most patients (do not receive treatment)
CHARACTERISTICS OF M. TUBERCULOSIS
โ— Rod shaped,
โ— 0.2-0.5 ยต in D, 2-4 ยต in L
โ— Mycolic acid present in its cell
wall,
โ— makes it acid fast
โ— It resists decolourization with
acid & alcohol
โ— Aerobic and non motile
โ— It multiplies slowly, can
remain
โ— dormant for decades
Main species of mycobacterium causing tuberculosis:
๏ฑ TYPICAL MYCOBACTERIA
๏ฑ Mycobacterium
tuberculosis
๏ฑ Mycobacterium hominis
๏ฑ Mycobacterium bovine
๏ฑ ATYPICAL MYCOBACTERIA
๏ฑ Saprophytic mycobacteria
๏ฑ Mycobacterium avium
RISK FACTOR OF TB
04
RISK FACTORS OF TUBERCULOSIS
๏ƒ˜ Low socioeconomic status
๏ƒ˜ Crowded living conditions
๏ƒ˜ Diseases that weakens immune
๏ƒ˜ system like HIV
๏ƒ˜ Person on immunosuppressant like steroid
๏ƒ˜ Health care workers
๏ƒ˜ Migration from a country with a high number
of cases
๏ƒ˜ Alcoholism
๏ƒ˜ Recent Tubercular infection
๏ƒ˜ (within last 2 years)
CO-INFECTIONWITH
HUMAN IMMUNODEFICIENCYVIRUS (HIV)
โ— HIV is the most important risk factor for active TB,
because the immune deficit prevents patients from
containing the initial infection
โ— Coinfection with HIV
โ—‹ Accelerates the progression of both diseases
โ—‹ Requiring rapid diagnosis and treatment of both
diseases
CLASSIFICATION OF TB
05
Classification of TB
TB
Pulmonary (85-90%) Extra-pulmonary (10-15%)
Sputum
PositiveTB
(Those who
have bacteria
in sputum)
Sputum
NegativeTB
(Those who do
not have
bacteria in
sputum)
๏ƒผ Lymph Nodes
๏ƒผ Bones & Joints
๏ƒผ Genitourinary tract
๏ƒผ Meninges
๏ƒผ Intestines
๏ƒผ Skin
Typeof tuberculosis infection
Pulmonary TB :
1. PRIMARY TUBERCULOSIS :
The infection of an individual who has not been previously infected or
sensitized is called Primary tuberculosis or Ghonโ€™s complex or childhood
tuberculosis.
2. SECONDARY TUBERCULOSIS :
The infection that individual who has been previously infected or
sensitized is called secondary or post primary or reinfection or chronic
tuberculosis.
Typeof tuberculosis infection
Pulmonary TB :
1. PRIMARY TUBERCULOSIS :
The infection of an individual who has not been previously infected or
sensitized is called Primary tuberculosis or Ghonโ€™s complex or childhood
tuberculosis.
2. SECONDARY TUBERCULOSIS :
The infection that individual who has been previously infected or
sensitized is called secondary or post primary or reinfection or chronic
tuberculosis.
EXTRAPULMONARYTUBERCULOSIS
In tissues or organs seeded hematogenously
Commonly involved organs include:
๏ƒ˜ Intestinal tuberculosis (Primary, Secondary and hyperplastic)
๏ƒ˜ Meninges (Tuberculous meningitis)
๏ƒ˜ Kidneys (Renal tuberculosis)
๏ƒ˜ Adrenals (Addison disease)
๏ƒ˜ Bones (Osteomyelitis)
๏ƒ˜ Vertebrae (Pott disease)
๏ƒ˜ Fallopian tubes (Salpingitis)
Patohysiology of tb
06
DIAGNOSTIC STEPS
07
SYMPTOMSOFTB
Most common symptom of TB
โ€ข Cough for 2 weeks or more Other
symptoms of TB are:
โ€ข Fever, especially evening rise
โ€ข Pain in the chest
โ€ข Loss of weight
โ€ข Loss of appetite
โ€ข Coughing up blood-stained sputum
โ€ข Shortness of breath,
โ€ข Tiredness
RARRADIOGRAPHIC FEATURES
HISTORY AND CLINICAL EXAMINATION
BACTERIAL EVALUATION
History and Symptoms
Pulmonary Tuberculosis
In case of active tuberculosis, 75% of the
cases present with lung involvement.
Suspect Pulmonary tuberculosis in any
individual who has the following
symptoms:
โ— Cough (most common symptom)
โ—‹ Initially dry cough which
progresses to productive.
โ—‹ Persistent cough, often for more
than three weeks.
โ— Fever
โ— Night sweats
โ— Unexplained weight loss
โ— Hemoptysis
โ— Chest pain
โ— Anorexia
โ— Malaise
โ— Chills
โ— Fatigue
โ— Dyspnea
โ— Lymphadenopathy
Physical Examination
โ— Appearance of the Patient
โ—‹ Cachexia
โ—‹ Pallor
โ— Vitals
โ—‹ Tachypnea
โ—‹ Tachycardia
โ—‹ Fever
โ— Lungs
โ—‹ Decreased breath sounds
โ—‹ Rales
โ—‹ Rhonchi
โ—‹ Bronchial breath sounds
Physical Examination
โ— Appearance of the Patient
โ—‹ Cachexia
โ—‹ Pallor
โ— Vitals
โ—‹ Tachypnea
โ—‹ Tachycardia
โ—‹ Fever
โ— Lungs
โ—‹ Decreased breath sounds
โ—‹ Rales
โ—‹ Rhonchi
โ—‹ Bronchial breath sounds
Chest X-Ray
Chest X-Ray
Chest X-Ray
BACTERIOLOGIC
EVALUATION
BACTERI
OLOGI
C
EVALU
ATION
SPUTUM EXAMINATION
โ— Essential to confirm TB
โ— Best collected in morning before any meal
โ— Stained with ziehl-neelson technique
Acid Fast Bacilli โ€œAFBโ€ Smear Test
Specimen examined for acid fast bacilli by staining:
Ziehl-neelsonAcidFast
Staining
Tuberculin skin Test / Mantoux test / PPD test
โ— Standard method for screening & measuring of a personโ€™s Cellular
response.
โ— Measuring the size of induration 48-72 hours
Tuberculin skin Test / Mantoux test / PPD test
โ— Positive If โ‰ฅ 10 mm Induration Size.
Positive Reaction
โ— Person infected in the past or latent TB infection.
โ— After BCG vaccination, but this may last for only 3-7 years
Treatment of tb
08
Tahapan pengobatan TB
Tahap awal
โ— Pengobatan tahap awal pada semua pasien baru, harus diberikan
selama 2 bulan
โ— Secara efektif menurunkan jumlah kuman yang ada dalam tubuh
pasien
Tahap lanjutan
โ— membunuh sisa-sisa kuman yang masih ada dalam tubuh,
khususnya kuman persisten
โ— Durasi tahap lanjutan selama 4 bulan
Dosis rekomendasi OAT lini pertama untuk dewasa
โ— Pasien tinggal di daerah dengan prevalensi tinggi resisten
isoniazid
โ— Terdapat riwayat kontak dengan pasien TB resistan obat >
cenderung memiliki pola resistensi obat yang sama dengan kasus
sumber
โ— Paduan obat standar pasien TB kasus baru (dengan asumsi atau
diketahui peka OAT)
COMUNICATION
09
ComPLICATION
09
THANK
YOU
References
1. Kementerian Kesehatan Republik Indonesia.Strategi Nasional Penanggulangan Tuberkulosis di Indonesia
2020- 2024
2. Terracciano E, Amadori F, Zaratti L, Franco E. [Tuberculosis: an ever present disease but difficult to
prevent]. Ig Sanita Pubbl. 2020 Jan-Feb;76(1):59-66. [PubMed]
3. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial
diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European
Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).
Eur Heart J 2015; 36: 2921-64.
4. Ahmad S. Pathogenesis, Immunology, and Diagnosis of LatentMycobacterium tuberculosisInfection. Clinical
and Developmental Immunology 2011; 2011: 1-17.

More Related Content

Similar to PULMO 1 - DIMAS FUJIANSYAH.pptx

tuberculosis1-211129063858.pdf
tuberculosis1-211129063858.pdftuberculosis1-211129063858.pdf
tuberculosis1-211129063858.pdf
Racheal66
ย 
6.TUBERCLOSIS in respiratory part of study..pptx
6.TUBERCLOSIS in respiratory part of study..pptx6.TUBERCLOSIS in respiratory part of study..pptx
6.TUBERCLOSIS in respiratory part of study..pptx
Juma675663
ย 
PARULYADAV_BSCNURSING2NDYR_1912196 tuberculosis
PARULYADAV_BSCNURSING2NDYR_1912196 tuberculosisPARULYADAV_BSCNURSING2NDYR_1912196 tuberculosis
PARULYADAV_BSCNURSING2NDYR_1912196 tuberculosis
PARULYADAV71
ย 
GR 12 tuberculosis in pediatrics.pptx222
GR 12 tuberculosis in pediatrics.pptx222GR 12 tuberculosis in pediatrics.pptx222
GR 12 tuberculosis in pediatrics.pptx222
KelfalaHassanDawoh
ย 
routine immunization in india( from gov.in) .ppt
routine immunization in india( from gov.in) .pptroutine immunization in india( from gov.in) .ppt
routine immunization in india( from gov.in) .ppt
SauravKumar927915
ย 
Adult1 05c ptb
Adult1 05c ptbAdult1 05c ptb
Adult1 05c ptb
WesamMagh
ย 
12 Tuberculosis Tanweiping
12 Tuberculosis Tanweiping12 Tuberculosis Tanweiping
12 Tuberculosis Tanweiping
ghalan
ย 
Communicable
CommunicableCommunicable
Communicable
weak
ย 

Similar to PULMO 1 - DIMAS FUJIANSYAH.pptx (20)

tuberculosis1-211129063858.pdf
tuberculosis1-211129063858.pdftuberculosis1-211129063858.pdf
tuberculosis1-211129063858.pdf
ย 
Tuberculosis TB
Tuberculosis TBTuberculosis TB
Tuberculosis TB
ย 
Tuberculosis
TuberculosisTuberculosis
Tuberculosis
ย 
Seminar on cns tubercuosis by Dr.Pradeep Singh
Seminar on cns tubercuosis by Dr.Pradeep SinghSeminar on cns tubercuosis by Dr.Pradeep Singh
Seminar on cns tubercuosis by Dr.Pradeep Singh
ย 
Tuberculosis 2.pptx
Tuberculosis 2.pptxTuberculosis 2.pptx
Tuberculosis 2.pptx
ย 
Tb
TbTb
Tb
ย 
Tuberculosis by Faith Chelang'at
Tuberculosis by Faith Chelang'atTuberculosis by Faith Chelang'at
Tuberculosis by Faith Chelang'at
ย 
6.TUBERCLOSIS in respiratory part of study..pptx
6.TUBERCLOSIS in respiratory part of study..pptx6.TUBERCLOSIS in respiratory part of study..pptx
6.TUBERCLOSIS in respiratory part of study..pptx
ย 
Tuberculosis
TuberculosisTuberculosis
Tuberculosis
ย 
PARULYADAV_BSCNURSING2NDYR_1912196 tuberculosis
PARULYADAV_BSCNURSING2NDYR_1912196 tuberculosisPARULYADAV_BSCNURSING2NDYR_1912196 tuberculosis
PARULYADAV_BSCNURSING2NDYR_1912196 tuberculosis
ย 
Tuberculosis pharmacotherapy
Tuberculosis pharmacotherapy Tuberculosis pharmacotherapy
Tuberculosis pharmacotherapy
ย 
GR 12 tuberculosis in pediatrics.pptx222
GR 12 tuberculosis in pediatrics.pptx222GR 12 tuberculosis in pediatrics.pptx222
GR 12 tuberculosis in pediatrics.pptx222
ย 
Typhoid Final.pptx
Typhoid Final.pptxTyphoid Final.pptx
Typhoid Final.pptx
ย 
routine immunization in india( from gov.in) .ppt
routine immunization in india( from gov.in) .pptroutine immunization in india( from gov.in) .ppt
routine immunization in india( from gov.in) .ppt
ย 
Adult1 05c ptb
Adult1 05c ptbAdult1 05c ptb
Adult1 05c ptb
ย 
12 Tuberculosis Tanweiping
12 Tuberculosis Tanweiping12 Tuberculosis Tanweiping
12 Tuberculosis Tanweiping
ย 
Communicable
CommunicableCommunicable
Communicable
ย 
Organization of detection and diagnostics of tuberculosis
Organization of detection and diagnostics of tuberculosisOrganization of detection and diagnostics of tuberculosis
Organization of detection and diagnostics of tuberculosis
ย 
13.Tuberculosis... management
13.Tuberculosis...                          management13.Tuberculosis...                          management
13.Tuberculosis... management
ย 
Tb presentation
Tb presentationTb presentation
Tb presentation
ย 

More from dimasfujiansyah1

fibroids-150512150851-lva1-app6892.pptx
fibroids-150512150851-lva1-app6892.pptxfibroids-150512150851-lva1-app6892.pptx
fibroids-150512150851-lva1-app6892.pptx
dimasfujiansyah1
ย 
pph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptxpph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptx
dimasfujiansyah1
ย 
pneumothorax-150828120943-lva1-app6891.pptx
pneumothorax-150828120943-lva1-app6891.pptxpneumothorax-150828120943-lva1-app6891.pptx
pneumothorax-150828120943-lva1-app6891.pptx
dimasfujiansyah1
ย 
antenatalcarefinal-190503155705 (1).pptx
antenatalcarefinal-190503155705 (1).pptxantenatalcarefinal-190503155705 (1).pptx
antenatalcarefinal-190503155705 (1).pptx
dimasfujiansyah1
ย 

More from dimasfujiansyah1 (20)

Critical Appraisal
Critical AppraisalCritical Appraisal
Critical Appraisal
ย 
Data presentation .pptx
Data presentation .pptxData presentation .pptx
Data presentation .pptx
ย 
PICO (1).pptx
PICO (1).pptxPICO (1).pptx
PICO (1).pptx
ย 
vaginaldischarge2-180305141234.pptx
vaginaldischarge2-180305141234.pptxvaginaldischarge2-180305141234.pptx
vaginaldischarge2-180305141234.pptx
ย 
infectionsofthegenitaltract-partiii-iv-160202100956 (2).pptx
infectionsofthegenitaltract-partiii-iv-160202100956 (2).pptxinfectionsofthegenitaltract-partiii-iv-160202100956 (2).pptx
infectionsofthegenitaltract-partiii-iv-160202100956 (2).pptx
ย 
kontrasepsi.pptx
kontrasepsi.pptxkontrasepsi.pptx
kontrasepsi.pptx
ย 
infectionsofthegenitaltract-parti-160202092417.pptx
infectionsofthegenitaltract-parti-160202092417.pptxinfectionsofthegenitaltract-parti-160202092417.pptx
infectionsofthegenitaltract-parti-160202092417.pptx
ย 
uterinefibroids-180412190811.pptx
uterinefibroids-180412190811.pptxuterinefibroids-180412190811.pptx
uterinefibroids-180412190811.pptx
ย 
fibroids-191226053031.pptx
fibroids-191226053031.pptxfibroids-191226053031.pptx
fibroids-191226053031.pptx
ย 
fibroids-150512150851-lva1-app6892.pptx
fibroids-150512150851-lva1-app6892.pptxfibroids-150512150851-lva1-app6892.pptx
fibroids-150512150851-lva1-app6892.pptx
ย 
uterinefibroids-130120064643-phpapp02.pptx
uterinefibroids-130120064643-phpapp02.pptxuterinefibroids-130120064643-phpapp02.pptx
uterinefibroids-130120064643-phpapp02.pptx
ย 
postnatalassessmentppt-190522071905.pptx
postnatalassessmentppt-190522071905.pptxpostnatalassessmentppt-190522071905.pptx
postnatalassessmentppt-190522071905.pptx
ย 
pph-210510090823.pptx
pph-210510090823.pptxpph-210510090823.pptx
pph-210510090823.pptx
ย 
pph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptxpph-150512151237-lva1-app6892.pptx
pph-150512151237-lva1-app6892.pptx
ย 
PPH
PPHPPH
PPH
ย 
maternal screening in pregnancy
maternal screening in pregnancymaternal screening in pregnancy
maternal screening in pregnancy
ย 
obstetricalultrasound-120122082419-phpapp01.pptx
obstetricalultrasound-120122082419-phpapp01.pptxobstetricalultrasound-120122082419-phpapp01.pptx
obstetricalultrasound-120122082419-phpapp01.pptx
ย 
pneumothorax-150828120943-lva1-app6891.pptx
pneumothorax-150828120943-lva1-app6891.pptxpneumothorax-150828120943-lva1-app6891.pptx
pneumothorax-150828120943-lva1-app6891.pptx
ย 
antenatalcare-171226080558.pptx
antenatalcare-171226080558.pptxantenatalcare-171226080558.pptx
antenatalcare-171226080558.pptx
ย 
antenatalcarefinal-190503155705 (1).pptx
antenatalcarefinal-190503155705 (1).pptxantenatalcarefinal-190503155705 (1).pptx
antenatalcarefinal-190503155705 (1).pptx
ย 

Recently uploaded

๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...
๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...
๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...
Sheetaleventcompany
ย 
Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...
Sheetaleventcompany
ย 
Dehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Dehradun
Dehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service DehradunDehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Dehradun
Dehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Dehradun
Sheetaleventcompany
ย 
Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...
Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...
Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...
dishamehta3332
ย 
๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...
๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...
๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...
Sheetaleventcompany
ย 
๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...
๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...
๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...
gragneelam30
ย 
๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...
๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...
๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...
Sheetaleventcompany
ย 
Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...
Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...
Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...
Sheetaleventcompany
ย 
โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...
โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...
โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...
Sheetaleventcompany
ย 

Recently uploaded (20)

๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...
๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...
๐Ÿ’šChandigarh Call Girls Service ๐Ÿ’ฏPiya ๐Ÿ“ฒ๐Ÿ”8868886958๐Ÿ”Call Girls In Chandigarh No...
ย 
Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...
Premium Call Girls Dehradun {8854095900} โค๏ธVVIP ANJU Call Girls in Dehradun U...
ย 
Dehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Dehradun
Dehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service DehradunDehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Dehradun
Dehradun Call Girl Service โค๏ธ๐Ÿ‘ 8854095900 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Dehradun
ย 
Intramuscular & Intravenous Injection.pptx
Intramuscular & Intravenous Injection.pptxIntramuscular & Intravenous Injection.pptx
Intramuscular & Intravenous Injection.pptx
ย 
VIP Hyderabad Call Girls KPHB 7877925207 โ‚น5000 To 25K With AC Room ๐Ÿ’š๐Ÿ˜‹
VIP Hyderabad Call Girls KPHB 7877925207 โ‚น5000 To 25K With AC Room ๐Ÿ’š๐Ÿ˜‹VIP Hyderabad Call Girls KPHB 7877925207 โ‚น5000 To 25K With AC Room ๐Ÿ’š๐Ÿ˜‹
VIP Hyderabad Call Girls KPHB 7877925207 โ‚น5000 To 25K With AC Room ๐Ÿ’š๐Ÿ˜‹
ย 
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ย 
Circulatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanismsCirculatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanisms
ย 
Shazia Iqbal 2024 - Bioorganic Chemistry.pdf
Shazia Iqbal 2024 - Bioorganic Chemistry.pdfShazia Iqbal 2024 - Bioorganic Chemistry.pdf
Shazia Iqbal 2024 - Bioorganic Chemistry.pdf
ย 
Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...
Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...
Whitefield { Call Girl in Bangalore โ‚น7.5k Pick Up & Drop With Cash Payment 63...
ย 
๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...
๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...
๐Ÿ’šCall Girls In Amritsar ๐Ÿ’ฏAnvi ๐Ÿ“ฒ๐Ÿ”8725944379๐Ÿ”Amritsar Call Girl No๐Ÿ’ฐAdvance Cash...
ย 
Most Beautiful Call Girl in Chennai 7427069034 Contact on WhatsApp
Most Beautiful Call Girl in Chennai 7427069034 Contact on WhatsAppMost Beautiful Call Girl in Chennai 7427069034 Contact on WhatsApp
Most Beautiful Call Girl in Chennai 7427069034 Contact on WhatsApp
ย 
๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...
๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...
๐Ÿ’ฐCall Girl In Bangaloreโ˜Ž๏ธ63788-78445๐Ÿ’ฐ Call Girl service in Bangaloreโ˜Ž๏ธBangalo...
ย 
๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...
๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...
๐Ÿ‘‰ Amritsar Call Girls ๐Ÿ‘‰๐Ÿ“ž 8725944379 ๐Ÿ‘‰๐Ÿ“ž Just๐Ÿ“ฒ Call Ruhi Call Girl Near Me Amri...
ย 
Gastric Cancer: ะกlinical Implementation of Artificial Intelligence, Synergeti...
Gastric Cancer: ะกlinical Implementation of Artificial Intelligence, Synergeti...Gastric Cancer: ะกlinical Implementation of Artificial Intelligence, Synergeti...
Gastric Cancer: ะกlinical Implementation of Artificial Intelligence, Synergeti...
ย 
Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...
Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...
Chandigarh Call Girls Service โค๏ธ๐Ÿ‘ 9809698092 ๐Ÿ‘„๐ŸซฆIndependent Escort Service Cha...
ย 
Kolkata Call Girls Shobhabazar ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ Top Class Call Gir...
Kolkata Call Girls Shobhabazar  ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ  Top Class Call Gir...Kolkata Call Girls Shobhabazar  ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ  Top Class Call Gir...
Kolkata Call Girls Shobhabazar ๐Ÿ’ฏCall Us ๐Ÿ” 8005736733 ๐Ÿ” ๐Ÿ’ƒ Top Class Call Gir...
ย 
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
Ahmedabad Call Girls Book Now 9630942363 Top Class Ahmedabad Escort Service A...
ย 
Bhawanipatna Call Girls ๐Ÿ“ž9332606886 Call Girls in Bhawanipatna Escorts servic...
Bhawanipatna Call Girls ๐Ÿ“ž9332606886 Call Girls in Bhawanipatna Escorts servic...Bhawanipatna Call Girls ๐Ÿ“ž9332606886 Call Girls in Bhawanipatna Escorts servic...
Bhawanipatna Call Girls ๐Ÿ“ž9332606886 Call Girls in Bhawanipatna Escorts servic...
ย 
Call Girls Bangalore - 450+ Call Girl Cash Payment ๐Ÿ’ฏCall Us ๐Ÿ” 6378878445 ๐Ÿ” ๐Ÿ’ƒ ...
Call Girls Bangalore - 450+ Call Girl Cash Payment ๐Ÿ’ฏCall Us ๐Ÿ” 6378878445 ๐Ÿ” ๐Ÿ’ƒ ...Call Girls Bangalore - 450+ Call Girl Cash Payment ๐Ÿ’ฏCall Us ๐Ÿ” 6378878445 ๐Ÿ” ๐Ÿ’ƒ ...
Call Girls Bangalore - 450+ Call Girl Cash Payment ๐Ÿ’ฏCall Us ๐Ÿ” 6378878445 ๐Ÿ” ๐Ÿ’ƒ ...
ย 
โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...
โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...
โค๏ธAmritsar Escorts Serviceโ˜Ž๏ธ9815674956โ˜Ž๏ธ Call Girl service in Amritsarโ˜Ž๏ธ Amri...
ย 

PULMO 1 - DIMAS FUJIANSYAH.pptx

  • 2. table of contents 01 04 02 05 03 06 COUGH DD FOR PRODUCTIBE COUGH Defenition and etiology of tb RISK FACTOR OF TB CLASSIFICATION OF TB PATOPGYSIOLOGY OF TB
  • 3. table of contents 07 10 08 09 PHYSICAL EXAMINATION OF TB LAB. EXAMINATION OF TB COMUNICATION TO PATIENT COMPLICATION
  • 5. Definition Cough is physiological protective mechanism which is characterized by explosive expectoration following a deep inspiration. Its function is to clear the tracheobronchial tree of excessive secretions and foreign body.
  • 7. DD FOR PRODUCTIBE COUGH 02
  • 8. Cough History โ— Acute โ—‹ Less than 3 wk โ—‹ Aspiration, Inhalation of noxious chemical or smoke โ— Sub-acute โ—‹ 3-8 wk โ—‹ Tracheobronchiti-spertussis โ—‹ post viral tussive syndrome โ— Chronic โ—‹ More than 8 wk โ—‹ Cardiopulmonary dโ€™s โ—‹ Inflammatory โ—‹ Infectious โ—‹ neoplastic and cardiovascular etiology
  • 9. Cough History โ— Acute cough occurring in context of more serious disease such as pneumonia, aspiration, CHF, pulmonary embolism is usually easy to diagnose due to the presence of other clinical features. โ— Cough of less than 8 wk duration may be the early manifestation of a disease causing chronic cough. โ— Chronic cough with a normal chest radiograph โ—‹ Cough variant asthma โ—‹ Gastro-esophageal reflux โ—‹ Post-nasal drainage โ—‹ Medication (ACE inhibitor)
  • 11. Sputum color associated with various conditions
  • 13. TUBERCULOSIS โ— Is the most prevalent communicable infectious disease on earth and remains out of control in many developing nations โ— It is a chronic specific inflammatory infectious disease caused by Mycobacterium tuberculosis in humans โ— Usually attacks the lungs but it can also affect any parts of the body โ— Also Known as โ€œ KOCHโ€™s Diseaseโ€, โ€œwasting diseaseโ€ and the โ€œwhite plague.โ€
  • 14. ETIOLOGY โ— MYCOBACTERIUM TUBERCULOSIS โ—‹ It presents either โ–  as latent TB infection (LTBI) or โ–  as progressive active disease. โ—‹ typically causes progressive destruction of the lungs, death in most patients (do not receive treatment)
  • 15. CHARACTERISTICS OF M. TUBERCULOSIS โ— Rod shaped, โ— 0.2-0.5 ยต in D, 2-4 ยต in L โ— Mycolic acid present in its cell wall, โ— makes it acid fast โ— It resists decolourization with acid & alcohol โ— Aerobic and non motile โ— It multiplies slowly, can remain โ— dormant for decades
  • 16. Main species of mycobacterium causing tuberculosis: ๏ฑ TYPICAL MYCOBACTERIA ๏ฑ Mycobacterium tuberculosis ๏ฑ Mycobacterium hominis ๏ฑ Mycobacterium bovine ๏ฑ ATYPICAL MYCOBACTERIA ๏ฑ Saprophytic mycobacteria ๏ฑ Mycobacterium avium
  • 17. RISK FACTOR OF TB 04
  • 18. RISK FACTORS OF TUBERCULOSIS ๏ƒ˜ Low socioeconomic status ๏ƒ˜ Crowded living conditions ๏ƒ˜ Diseases that weakens immune ๏ƒ˜ system like HIV ๏ƒ˜ Person on immunosuppressant like steroid ๏ƒ˜ Health care workers ๏ƒ˜ Migration from a country with a high number of cases ๏ƒ˜ Alcoholism ๏ƒ˜ Recent Tubercular infection ๏ƒ˜ (within last 2 years)
  • 19. CO-INFECTIONWITH HUMAN IMMUNODEFICIENCYVIRUS (HIV) โ— HIV is the most important risk factor for active TB, because the immune deficit prevents patients from containing the initial infection โ— Coinfection with HIV โ—‹ Accelerates the progression of both diseases โ—‹ Requiring rapid diagnosis and treatment of both diseases
  • 21. Classification of TB TB Pulmonary (85-90%) Extra-pulmonary (10-15%) Sputum PositiveTB (Those who have bacteria in sputum) Sputum NegativeTB (Those who do not have bacteria in sputum) ๏ƒผ Lymph Nodes ๏ƒผ Bones & Joints ๏ƒผ Genitourinary tract ๏ƒผ Meninges ๏ƒผ Intestines ๏ƒผ Skin
  • 22. Typeof tuberculosis infection Pulmonary TB : 1. PRIMARY TUBERCULOSIS : The infection of an individual who has not been previously infected or sensitized is called Primary tuberculosis or Ghonโ€™s complex or childhood tuberculosis. 2. SECONDARY TUBERCULOSIS : The infection that individual who has been previously infected or sensitized is called secondary or post primary or reinfection or chronic tuberculosis.
  • 23. Typeof tuberculosis infection Pulmonary TB : 1. PRIMARY TUBERCULOSIS : The infection of an individual who has not been previously infected or sensitized is called Primary tuberculosis or Ghonโ€™s complex or childhood tuberculosis. 2. SECONDARY TUBERCULOSIS : The infection that individual who has been previously infected or sensitized is called secondary or post primary or reinfection or chronic tuberculosis.
  • 24. EXTRAPULMONARYTUBERCULOSIS In tissues or organs seeded hematogenously Commonly involved organs include: ๏ƒ˜ Intestinal tuberculosis (Primary, Secondary and hyperplastic) ๏ƒ˜ Meninges (Tuberculous meningitis) ๏ƒ˜ Kidneys (Renal tuberculosis) ๏ƒ˜ Adrenals (Addison disease) ๏ƒ˜ Bones (Osteomyelitis) ๏ƒ˜ Vertebrae (Pott disease) ๏ƒ˜ Fallopian tubes (Salpingitis)
  • 26.
  • 28. SYMPTOMSOFTB Most common symptom of TB โ€ข Cough for 2 weeks or more Other symptoms of TB are: โ€ข Fever, especially evening rise โ€ข Pain in the chest โ€ข Loss of weight โ€ข Loss of appetite โ€ข Coughing up blood-stained sputum โ€ข Shortness of breath, โ€ข Tiredness
  • 29.
  • 30. RARRADIOGRAPHIC FEATURES HISTORY AND CLINICAL EXAMINATION BACTERIAL EVALUATION
  • 31. History and Symptoms Pulmonary Tuberculosis In case of active tuberculosis, 75% of the cases present with lung involvement. Suspect Pulmonary tuberculosis in any individual who has the following symptoms: โ— Cough (most common symptom) โ—‹ Initially dry cough which progresses to productive. โ—‹ Persistent cough, often for more than three weeks. โ— Fever โ— Night sweats โ— Unexplained weight loss โ— Hemoptysis โ— Chest pain โ— Anorexia โ— Malaise โ— Chills โ— Fatigue โ— Dyspnea โ— Lymphadenopathy
  • 32. Physical Examination โ— Appearance of the Patient โ—‹ Cachexia โ—‹ Pallor โ— Vitals โ—‹ Tachypnea โ—‹ Tachycardia โ—‹ Fever โ— Lungs โ—‹ Decreased breath sounds โ—‹ Rales โ—‹ Rhonchi โ—‹ Bronchial breath sounds
  • 33. Physical Examination โ— Appearance of the Patient โ—‹ Cachexia โ—‹ Pallor โ— Vitals โ—‹ Tachypnea โ—‹ Tachycardia โ—‹ Fever โ— Lungs โ—‹ Decreased breath sounds โ—‹ Rales โ—‹ Rhonchi โ—‹ Bronchial breath sounds
  • 39. SPUTUM EXAMINATION โ— Essential to confirm TB โ— Best collected in morning before any meal โ— Stained with ziehl-neelson technique
  • 40. Acid Fast Bacilli โ€œAFBโ€ Smear Test Specimen examined for acid fast bacilli by staining: Ziehl-neelsonAcidFast Staining
  • 41. Tuberculin skin Test / Mantoux test / PPD test โ— Standard method for screening & measuring of a personโ€™s Cellular response. โ— Measuring the size of induration 48-72 hours
  • 42. Tuberculin skin Test / Mantoux test / PPD test โ— Positive If โ‰ฅ 10 mm Induration Size.
  • 43. Positive Reaction โ— Person infected in the past or latent TB infection. โ— After BCG vaccination, but this may last for only 3-7 years
  • 45. Tahapan pengobatan TB Tahap awal โ— Pengobatan tahap awal pada semua pasien baru, harus diberikan selama 2 bulan โ— Secara efektif menurunkan jumlah kuman yang ada dalam tubuh pasien Tahap lanjutan โ— membunuh sisa-sisa kuman yang masih ada dalam tubuh, khususnya kuman persisten โ— Durasi tahap lanjutan selama 4 bulan
  • 46. Dosis rekomendasi OAT lini pertama untuk dewasa
  • 47. โ— Pasien tinggal di daerah dengan prevalensi tinggi resisten isoniazid โ— Terdapat riwayat kontak dengan pasien TB resistan obat > cenderung memiliki pola resistensi obat yang sama dengan kasus sumber
  • 48. โ— Paduan obat standar pasien TB kasus baru (dengan asumsi atau diketahui peka OAT)
  • 49.
  • 51.
  • 52.
  • 54.
  • 55.
  • 57. References 1. Kementerian Kesehatan Republik Indonesia.Strategi Nasional Penanggulangan Tuberkulosis di Indonesia 2020- 2024 2. Terracciano E, Amadori F, Zaratti L, Franco E. [Tuberculosis: an ever present disease but difficult to prevent]. Ig Sanita Pubbl. 2020 Jan-Feb;76(1):59-66. [PubMed] 3. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2015; 36: 2921-64. 4. Ahmad S. Pathogenesis, Immunology, and Diagnosis of LatentMycobacterium tuberculosisInfection. Clinical and Developmental Immunology 2011; 2011: 1-17.