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CHAPTER I

INTRODUCTION

1.1. Background

Tuberculosis (TB) is a chronic bacterial infection caused by Mycobacterium tuberculosis, an


air-resistant acid-resistant bacillus (Asih, 2004). This disease is characterized by granuloma
formation in infected tissue. Complications. Pulmonary TB disease if not treated properly will
cause complications such as pleurisy, pleural effusion, empyema, laryngitis and intestinal TB.

Tuberculosis sufferers in the Asian region continue to grow. So far, Asia is one of the regions
with the highest spread of tuberculosis (TB) in the world. Every 30 seconds, one patient in Asia
dies from this disease. Eleven of the 22 countries with the highest TB cases are in Asia,
including Bangladesh, China, India, Indonesia and Pakistan. Four out of five TB sufferers in
Asia include the productive age group (Kompas, 2007). In Indonesia, the mortality rate due to
TB reaches 140,000 people per year or 8 percent of deaths worldwide. Every year, there are
more than 500,000 new cases of TB, and 75 percent of sufferers belong to the productive age
group. The number of TB sufferers in Indonesia is the third largest in the world after India and
China.

1.2. Problem
1. What is the Definition of TB?
2. Why can someone get Pulmonary TB?
3. What are the signs and symptoms of pulmonary TB?

1.3. Purpose
1. To explain the definition of pulmonary tuberculosis
2. To explain the causes of pulmonary TB disease, the signs and symptoms and the
pathophysiology in the body.

1.4. Benefit
1. To find out the definition of pulmonary TB.
2. To find out the causes of pulmonary TB disease, the signs and symptoms and the
pathophysiology in the body.
CHAPTER II
EXPLAINING

2.1. Definition

Tuberculosis is a chronic lung bacterial infection caused by Mycobacterium tuberculosis,


which is an air-borne acid-resistant bacteria characterized by granuloma formation in infected
tissue. Mycobacterium tuberculosis is an aerobic germ that can live mainly in the lungs /
various other body organs with high partial pressure. Tuberculosis usually attacks the lungs but
can spread to almost all parts of the body including meninges, kidneys, bones, lymph nodes.
Initial infection usually occurs 2-10 weeks after exposure. Individuals can then experience
active disease due to disruption or ineffectiveness of the immune response.

Pulmonary TB is caused by Mycobacterium tuberculosis which is an acid-resistant aerobic


stem that grows slowly and is sensitive to heat and UV light. Bacteria that are rarely a cause,
but have happened are M. Bovistt and M. Avium.

2.2. Signs
a. Weight loss
b. Anorexia
c. Dispneu
d. Sputum Purulent/green, mucoid/yellow.

2.3. Symptoms
a) Fever
Usually resembles influenza fever. This situation is strongly influenced by the body's
resistance to the severity of infection of the incoming TB germs.
b) Cough
Occurs because of an infection in the bronchi. The nature of cough starts from a dry
cough then after inflammation develops into a productive cough (produces sputum). In
a state of advanced form coughing up blood because there are broken blood vessels.
Most coughing up blood on bronchial wall ulcers.
c) Out of breath.
Shortness of breath will be found in advanced disease where the infiltration is half the
lung
d) Chest pain
Arises when inflammation infiltration has reached the pleura (causing pleurisy)
e) Malaise
Can be anorexia, no appetite, weight loss, headaches, chills, muscle aches, night sweats

2.4. Pathophysiology

In tuberculosis, tuberculosis bacilli cause a strange tissue reaction in the lungs including:
invasion of the infected area by macrophages, formation of a wall around the lesion by fibrous
tissue to form what is called a tubercle. The large number of fibrosis areas causes increased
respiratory muscle effort for pulmonary ventilation and therefore decreases vital capacity,
decreases the total surface area of the respiratory membrane which causes a progressive
decrease in pulmonary diffusion capacity, and an abnormal ventilation-perfusion ratio in the
lungs can reduce blood oxygenation.

2.5. Supporting Investigation


In children, tuberculin test is the most useful examination to show moderate / had been infected
with tuberculous mycobacterium and is often used in "TB screening". Effectiveness in finding
TB infection with tuberculin test is more than 90%. Tuberculin reading is done after 48 - 72
hours; with positive results if there is an induration of more than 10 mm in diameter, doubting
if 5-9 mm. Tuberculin test can be repeated after 1-2 weeks. In children who have received
BCG, the induration diameter of 15 mm and above is only positive, whereas in contracted
children closely with active TB patients, the induration diameter ≥ 5 mm must be considered
positive. Allergies are caused by severe infections, immunosuppression, malignancy
(leukemia), can also be caused by malnutrition, morbilli, varicella and other infectious diseases.

2.6. Epidemiology and Transmission of TB


In the transmission of Mycobacterium tuberculosis infection the things that need to be
considered are:
1. Reservation, source and transmission
Humans are the most common reservoir, respiratory tract secretions from people with open
active lesions move the infection directly through droplets.
2. Incubation period
That is, from the time of entry until the onset of the primary lesion generally takes four to
six weeks, interfering between primary infection and reinfection can be several years.
3. Period can be contagious
As long as the person concerned issues a Turbekel report, especially those who are
coughed or bred.
4. Immunity
Children under three years are most vulnerable, because from birth to one month babies
are given BCG vaccinations that increase the body against tuberculosis.

2.7. Complications
Complications of pulmonary TB disease if not treated properly will cause complications such
as: pleurisy, pleural effusion, empyema, laryngitis, intestinal TB. According to Dep. Kes
(2003) complications that often occur in patients with advanced pulmonary TB: 1) Severe
hemoptysis (bleeding from the lower respiratory tract) which can result in death due to
hypovolemic shock or airway obstruction. 2) Collapses from the lobes due to bronchial
retraction. 3) Bronchiectasis and fribosis in the Lungs. 4) Spontaneous pneumothorax:
spontaneous collapse due to damage to Lung tissue. 5) The spread of infection to other organs
such as the brain, bones, joints, kidneys and so on. 6) Cardio Pulmonary Insufficiency.

2.8. Handling
a. Promotive
1. Counseling to the community what is TB
2. Good notification through banners / advertisements about the dangers of tuberculosis,
modes of transmission, ways of prevention, risk factors
3. Socializing BCG programs in the community.

b. Preventive
1. BCG vaccination
2. Using isoniazid (INH)
3. Clean the environment from a dirty and humid place.
4. If there are TB symptoms immediately to the health center / hospital, so they can be known
early.
c. Curative
Treatment of tuberculosis, especially in the long term administration of antimicrobial drugs.
Medications can also be used to prevent the onset of clinical disease in someone who has
contracted the infection. Patients with tuberculosis with clinical symptoms should receive two
drugs to prevent the emergence of drug-resistant strains.
The combination of selected drugs is isoniazid (isonicyckotic acid hydrazide = INH) with
ethambutol (EMB) or rifamsipin (RIF). The usual dose of INH for adults is usually 5-10 mg /
kg or about 300 mg / day, EMB, 25 mg / kg for 60 days, then 15 mg / kg, RIF 600 mg once
daily. Ethambutol side effects are retrobulbar neuritis with a decrease in visual acuity. A visual
acuity test is recommended every month for this to be known. Severe INH side effects are rare.
The most severe complication is hepatitis. The risk of hepatitis is very low in patients under
the age of 20 years and reaches its peak at the age of 60 years and over. Liver dysfunction, as
evidenced by an increase in serum aminotransferase activity, was found in 10-20% who
received INH. Minimum time of combination therapy 18 months after conversion of sputum
culture to negative. After that, therapy with INH should only be recommended for one year.

Recently the CDC and American Thoracis Societty (ATS) issued a statement regarding the
recommendations of short-term chemotherapy for tuberculosis patients with a history of 6 or 9
months of pulmonary tuberculosis related to a regimen consisting of INH and RIF (without or
with other drugs), and only given to uncomplicated pulmonary tuberculosis patients, for
example: patients without other diseases such as diabetes, silicosis or cancer are diagnosed
with tuberculosis after coughing up blood, even though they experience stones and sweat about
3 weeks.
CHAPTER III
CONCLUSSION

3.1 Conclusions

a. Tuberculosis is a chronic lung bacterial infection caused by Mycobacterium tuberculosis,


which is airborne acid-resistant bacteria characterized by granuloma formation in
infected tissues.
b. Pulmonary TB is caused by Mycobacterium tuberculosis which is an acid-resistant
aerobic stem that grows slowly and is sensitive to heat and UV light. Bacteria that are
rarely a cause, but have happened are M. Bovis and M. Avium.
c. If TB germs attack the lungs, then the risk also increases in the fetus, such as abortion,
fetal growth retardation, premature birth and the occurrence of transmission of TB from
mother to fetus through aspiration of amniotic fluid (called congenital TB).

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