TUBERCULOSIS

A. Definition

Tuberculosis (TB) is a potentially serious infectious disease that mainly affects your
lungs. The bacteria that cause tuberculosis are spread from one person to another through tiny
droplets released into the air via coughs and sneezes.

Once rare in developed countries, tuberculosis infections began increasing in 1985,

partly because of the emergence of HIV, the virus that causes AIDS. HIV weakens a person's
immune system so it can't fight the TB germs. In the United States, because of stronger
control programs, tuberculosis began to decrease again in 1993, but remains a concern.

Many strains of tuberculosis resist the drugs most used to treat the disease. People
with active tuberculosis must take several types of medications for many months to eradicate
the infection and prevent development of antibiotic resistance.

B. Symptoms

Although your body may harbor the bacteria that cause tuberculosis, your immune
system usually can prevent you from becoming sick. For this reason, doctors make a
distinction between:

Latent TB. In this condition, you have a TB infection, but the bacteria remain in your
body in an inactive state and cause no symptoms. Latent TB, also called inactive TB or TB
infection, isn't contagious. It can turn into active TB, so treatment is important for the person
with latent TB and to help control the spread of TB in general. An estimated 2 billion people
have latent TB.

Active TB. This condition makes you sick and can spread to others. It can occur in
the first few weeks after infection with the TB bacteria, or it might occur years later.

Signs and symptoms of active TB include:

1. Coughing that lasts three or more weeks

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 2. Coughing up blood

3. Chest pain, or pain with breathing or coughing

4. Unintentional weight loss

5. Fatigue

6. Fever

7. Night sweats

8. Chills

9. Loss of appetite

Tuberculosis can also affect other parts of your body, including your kidneys, spine or
brain. When TB occurs outside your lungs, signs and symptoms vary according to the organs
involved. For example, tuberculosis of the spine may give you back pain, and tuberculosis in
your kidneys might cause blood in your urine.

C. Classification

Based on the affected organs

1) Pulmonary Tuberculosis.
Pulmonary tuberculosis is an infectious disease caused by the bacillus
Mycobacterium tuberculosis humanus type, a type of rod-shaped bacteria with 1-4 mm
long and 0.3-0.6 mm thick. The structure of these bacteria occur on lipids (fats) that make
the bacteria more resistant to acid, as well as from a variety of chemical and physical
disorders. The bacteria are also resistant in dry air and cold conditions (such as in a
refrigerator) because it is dormant, that can bounce back and become more active.
Moreover, these germs also are aerobic.
Pulmonary tuberculosis is an infection of the respiratory tract that is vital.
Tuberculosis bacilli into the lungs via the airway tissue (dreplet infection) to the alveoli
and there onfeksi primary (Gbon). Then, there was the primary lymph dikelenjar complex
called primary tuberculosis. In most cases, the infected part can experience healing.

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 Inflammation occurs before the body has a specific immunity against the bacillus
Mycobacterium tuberculosis at the age of 1-3 years. Meanwhile, post-primary
tuberculosis (reinfection) is an inflammation of the lung tissue caused by re-infection.

2) Extrapulmonary tuberculosis.
Is tuberculosis that attacks the organs other than the lungs, such as the pleura, the
lining of the brain, the lining of the heart (pericardium), lymph nodes, bones, joints, skin,
intestine, kidney, urinary tract, genitals, and others. Diagnosis should be based on
positive cultures or pathological anatomy of the lesion. For cases that can not be done
then the specimen is required and strong clinical evidence consistent with active
extrapulmonary tuberculosis.

D. Causes

Tuberculosis is caused by bacteria that spread from person to person through

microscopic droplets released into the air. This can happen when someone with the untreated,
active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.

Although tuberculosis is contagious, it's not easy to catch. You're much more likely to
get tuberculosis from someone you live with or work with than from a stranger. Most people
with active TB who've had appropriate drug treatment for at least two weeks are no longer
contagious

1) HIV and TB

Since the 1980s, the number of cases of tuberculosis has increased dramatically
because of the spread of HIV, the virus that causes AIDS. Infection with HIV suppresses
the immune system, making it difficult for the body to control TB bacteria. As a result,
people with HIV are many times more likely to get TB and to progress from latent to
active disease than are people who aren't HIV positive.

2) Drug-resistant TB

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 Another reason tuberculosis remains a major killer is the increase in drug-resistant
strains of the bacterium. Since the first antibiotics were used to fight tuberculosis 60
years ago, some TB germs have developed the ability to survive, and that ability gets
passed on to their descendants.

Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the
bacteria it targets. The surviving bacteria become resistant to that particular drug and
frequently other antibiotics as well. Some TB bacteria have developed resistance to the
most commonly used treatments, such as isoniazid and rifampin.

Some strains of TB have also developed resistance to drugs less commonly used in
TB treatment, such as the antibiotics known as fluoroquinolones, and injectable
medications including amikacin, kanamycin and capreomycin. These medications are
often used to treat infections that are resistant to the more commonly used drugs.

E. Risk factors

Anyone can get tuberculosis, but certain factors can increase your risk of the disease.
These factors include:

1. Weakened immune system

A healthy immune system often successfully fights TB bacteria, but your body can't
mount an effective defense if your resistance is low. A number of diseases and
medications can weaken your immune system, including:

a HIV/AIDS

b Diabetes

c End-stage kidney disease

d Certain cancers

e Cancer treatment, such as chemotherapy

f Drugs to prevent rejection of transplanted organs

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 g Some drugs used to treat rheumatoid arthritis, Crohn's disease and psoriasis

h Malnutrition

i Very young or advanced age

2. Traveling or living in certain areas

The risk of contracting tuberculosis is higher for people who live in or travel to
countries that have high rates of tuberculosis and drug-resistant tuberculosis, such as:

a. Sub-Saharan Africa

b. India

c. China

d. Russia

e. Pakistan

f. Poverty and substance abuse

Lack of medical care. If you receive a low or fixed income, live in a remote area, have
recently immigrated to the United States, or are homeless, you may lack access to the
medical care needed to diagnose and treat TB.

Substance abuse. IV drug use or alcohol abuse weakens your immune system and makes
you more vulnerable to tuberculosis.

Tobacco use. Using tobacco greatly increases the risk of getting TB and dying of it.

Where you work or live

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 Health care work. Regular contact with people who are ill increases your chances of
exposure to TB bacteria. Wearing a mask and frequent hand-washing greatly reduce your
risk.

Living or working in a residential care facility. People who live or work in prisons,
immigration centers or nursing homes are all at a higher risk of tuberculosis. That's because
the risk of the disease is higher anywhere there is overcrowding and poor ventilation.

Living in a refugee camp or shelter. Weakened by poor nutrition and ill health and living in
crowded, unsanitary conditions, refugees are at especially high risk of tuberculosis infection.

F. Treathment and drug

Transmission

When someone is suffering from active pulmonary TB cough, sneeze, speak, sing, or spit,
they're spraying the bead-bead infectious aerosols with a diameter of 0.5 to 5 lm. Sneeze can
release tiny particles of up to 40,000 bead. Each bead can transmit an infectious dose of
tuberculosis because this disease is very low. (Someone who inhale less than 10 bacteria
could be directly infected). The people who make contact in a long time, the frequency
often, or always adjacent to TB patients, high risk become infected, with an estimated
infection rate of about 22%.

Medications are the cornerstone of tuberculosis treatment. But treating TB takes much
longer than treating other types of bacterial infections.

With tuberculosis, you must take antibiotics for at least six to nine months. The exact
drugs and length of treatment depend on your age, overall health, possible drug resistance,
the form of TB (latent or active) and the infection's location in the body.

Recent research suggests that a shorter term of treatment four months instead of nine
with combined medication may be effective in keeping latent TB from becoming active
TB. With the shorter course of treatment, people are more likely to take all their medication
and the risk of side effects is lessened. Studies are ongoing.

Most common TB drugs

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 If you have latent tuberculosis, you may need to take just one type of TB drug. Active
tuberculosis, particularly if it's a drug-resistant strain, will require several drugs at once. The
most common medications used to treat tuberculosis include:

Isoniazid

Rifampin (Rifadin, Rimactane)

Ethambutol (Myambutol)

Pyrazinamide

If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones

and injectable medications, such as amikacin, kanamycin or capreomycin, are generally used
for 20 to 30 months. Some types of TB are developing resistance to these medications as
well.

A number of new drugs are being looked at as add-on therapy to the current drug-resistant
combination treatment including:

Bedaquiline

Delamanid

PA-824

Linezolid

Sutezolid

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 BIBLIOGRAPHY

Buku Saku Petugas Program TBC. Depkes RI Diagram diagnosa TB

http://digilib.unimus.ac.id/files/disk1/131/jtptunimus-gdl-nurhayatij-6516-3-babii.pdf
http://mlengsee.wordpress.com/2010/11/11/klasifikasi-penyakit-dan-tipe-pasien-tuberkulosis-
tb/
http://www.klikpdpi.com/konsensus/tb/tb.html