1 Tuberculosis (TB)

DEFINITIONS
Tuberculosis is a contagious infection and can be fatal, caused by Mycobacterium tuberculosis, Mycobacterium bovis or Mycobacterium africanum.

Tuberculosis showed that the disease most often caused by Mycobacterium tuberculosis, but sometimes caused by M.bovis or M.africanum.
Other bacteria that cause diseases like tuberculosis, but not contagious and most provide a poor response to drugs very effective treatment for tuberculosis.

Tuberculosis is spread through contaminated air by the bacterium M. tuberculosis.
Udar contaminated by bacteria due to active tuberculosis bacteria through coughing and release the bacteria can survive in air for several hours.
Fetus can be infected from their mothers before or during the delivery process by inhaling or swallowing of contaminated amniotic fluid. Babies can be infected by inhaling air containing the bacteria.
In developing countries, children infected by other mikobakterium that causes tuberculosis. This organism called M. bovis, which can be spread through milk is not sterilized.

Immune system of someone who is infected by tuberculosis bacteria are usually destroyed or held at the site of infection. Sometimes the bacteria are not destroyed but remains in the form of inactive (dormant) inside macrophages (a type of white blood cells) for many years.
Approximately 80% of tuberculosis infections caused by bacteria that dormant back. Bacteria that live in the scar tissue caused by previous infection (usually on top of one or both of the lungs) begin breeding. Pengaktivan these dormant bacteria can occur if the patient's immune system is declining (eg because of AIDS, use of corticosteroids or elderly).

Usually someone who is infected with tuberculosis has a 5% chance to experience an active infection within 1-2 years.
-The development of tuberculosis in each person varies, depending on various factors: Ethnic: tuberculosis developed more rapidly in blacks and Native Americans
- The immune system: an active infection more often and more quickly occur in people with AIDS. People with AIDS have a 50% chance of suffering utnuk active infection within 2 months. If bacteria become resistant to antibiotics, the possibility of death in patients with AIDS and tuberculosis within two months amounted to 50%.

Active tuberculosis usually begins in the lungs (pulmonary tuberculosis).
Tuberculosis which attacks parts of the body (extrapulmonary TB) usually originates from pulmonary tuberculosis that has spread through blood. Infection may not cause disease, but the bacteria remain dormant life in the small scar tissue.

Tuberculosis milier
Tuberculosis can be fatal can happen if a large number of bacteria spreads throughout the body via the bloodstream. This is called TB infection milier, because it causes the formation of millions of small-sized wounds millet (bird food).
Milier tuberculosis symptoms can be very vague and difficult to recognize, namely in the form of weight loss, fever, chills, weak, unwell and respiratory disorders.
If the attack bone marrow, severe anemia can occur and other blood disorders, resembling leukemia.
The release of bacteria at any time into the bloodstream from a hidden injury can cause fever, loss arose, accompanied by a gradual weight loss.

CAUSE
Mycobacterium tuberculosis, Mycobacterium bovis or Mycobacterium africanum.

SYMPTOMS
Initially only patients feeling unwell or coughing.
In the morning, cough can be accompanied by a little green or yellow sputum. Number of sputum usually be increased, in line with the development of disease. In the end, will be colored red with sputum containing blood.

One of the most common symptom is night sweats. Patients are often awakened at night because his body drenched in sweat so that clothing or even sepreinya must be replaced.

Shortness of breath is a sign of air (pneumothorax or fluid (pleural effusion) in the pleural cavity.
About a third of infections found in the form of pleural effusion.

In a new tuberculosis infection, bacteria move from the wound in the lungs to the lymph nodes originating from the lungs. If the body's natural defense system can control the infection, the infection will not continue and the bacteria become dormant.
In children, the lymph nodes become large and pressing the bronchial tubes and cause coughing or even may cause lung contraction. Sometimes the bacteria got into the channel and formed a group of lymph nodes in the neck. Infection in the lymph nodes can penetrate skin and produce pus.

Tuberculosis can attack organs besides the lungs and a condition termed extrapulmonary tuberculosis.
Parts of the body most often affected are the kidneys and bones.
Renal tuberculosis can only produce few symptoms, but the infection can destroy part of the kidney. Then tuberculosis can spread to the bladder.


In men, infection can also spread to the prostate, seminal vesicles and epididymis, causing the formation of lumps in the penis sac.
In women, tuberculosis can attack the ovaries and the channels, resulting in sterility. From the ovary, the infection can spread to the lining of the abdominal cavity and cause peritonitis, tuberculosis, with symptoms such as fatigue, abdominal pain, tenderness accompanied by mild to severe pain resembling appendicitis.

Infection can spread to joints, causing arthritis, tuberculosis.
Inflamed and painful joints. The most commonly affected are the hip and knee joints, but can also attack the wrist bones, hands and elbows.

Tuberculosis can infect the skin, intestines and adrenal glands.
Infection of the aortic wall (main artery) caused aortic rupture.
Infection of the pericardium causes tuberculosis pericarditis, where perikardiuim stretched by the fluid. This fluid can interfere with the ability of the heart in pumping blood. Symptoms include fever, neck vein dilation and shortness of breath.

Infection at the base of the brain called tuberculosis meningitis.
Symptoms include fever, persistent headache, nausea and decreased awareness. Very stiff neck so your chin can not be brought closer to the chest.
Sometimes after meningitisnya improved, will form a mass in the brain, called tuberkuloma. Tuberkuloma can cause muscle weakness (as happens in a stroke) and must be removed surgically.

In children, the bacteria can infect the spine and the tip of the long bones of the arm and leg.
If these conditions are not addressed, could have happened to collapse at one or two back bones that can lead to paralysis.

In developing countries, tuberculosis bacteria can be spread through contaminated milk and live in the lymph nodes in the neck or in the small intestine.
Mucous membranes of the digestive tract are resistant to bacteria, because it was new infections occur when bacteria are in a very large quantity or if there is disruption of the immune system.
Intestinal tuberculosis may not cause symptoms, but causes abnormal tissue growth in the infected area, which could be misinterpreted as cancer.

DIAGNOSIS
Which is often a preliminary indication of tuberculosis is the chest x-rays. This disease appears as white areas of irregular shape with a black background.
X-rays can also show pleural effusion or enlargement of the heart (pericarditis).

Diagnostic tests for tuberculosis are:

1. Tuberculin skin test, injecting small amounts of protein derived from TB bacteria into the
layers of skin (usually in the arm). 2 days later were observed in the injection area, if there's
redness pembengkakand, then the result is positive.
2. Examination of sputum, body fluids or infected tissue. With a needle, a liquid sample taken
from the chest, abdomen, joints or about the heart. Biopsy may be necessary to obtain
samples of infected tissue.

To confirm the diagnosis of tuberculosis meningitis, polymerase chain reaction examination (PCR) to liquid serebrospinalis.
To ensure renal tuberculosis, PCR can be performed on urine, x-ray examination of the patient or with a special dye to describe any abnormal masses or cavities caused by tuberculosis. Sometimes it is necessary that the mass sampling to differentiate between cancer and tuberculosis.

To confirm the diagnosis of tuberculosis in the female reproductive organs, pelvic examination was performed through laparoscopy.
In certain cases the necessary examination of liver tissue samples, lymph nodes or bone marrow.

TREATMENT
There are five types that can be used antibotik.
An active pulmonary tuberculosis infections often contain a billion or more bacteria, thus providing a kind of drugs would leave thousands of organisms that really resistant to the drug. Therefore, at least, given two different drugs having different mechanism of action and both drugs together this will destroy all bacteria.

Once patients completely recovered, treatment should be continued, because it takes a long time to destroy all bacteria and to reduce the possibility of recurrence.

Antibiotics are most often used are isoniazid, rifampicin, pyrazinamide, streptomycin and ethambutol.

Isoniazid, rifampicin and pyrazinamide can be combined in one capsule, thus reducing the number of pills that must be swallowed by the patient.
All three of these drugs can cause nausea and vomiting due to its effect on the liver. If nausea and vomiting occur, hence the use of drugs should be discontinued until liver function tests.
If the liver function tests showed a reaction to one of the three drugs, the drugs in question are usually replaced with another drug.

Ethambutol giving begins with a relatively high dose to help reduce the number of bacteria immediately. After two months, the dose is decreased to avoid side effects harmful to the eyes.
Streptomycin is the first drug effective against tuberculosis, but must be given in the form of injections. If given in high doses or continued use until more than three months, streptomycin can cause loss of hearing and balance.

If people actually follow the treatment regularly, so no need for surgery to remove part of lung.
Sometimes surgery to remove pus or correct spinal deformity due to tuberculosis.

PREVENTION
-There are several ways to prevent tuberculosis: eradication of bacteria ultraviolet rays, can be used in places where a group of people with various diseases have to sit together for several hours (eg in hospital, the emergency waiting room). This light can kill bacteria present in the air.
- Isoniazid is very effective when given to people with high risk of tuberculosis, such as health care workers with positive tuberculin test results, but the X rays did not show any disease. Isoniazid taken daily for 6-9 months.

Pulmonary tuberculosis patients who are undergoing treatment need not isolated more than a few days because the medicine works quickly so reduce the likelihood of transmission. But patients who experienced coughing and did not undergo treatment on a regular basis, need longer isolated because of contagious disease
Patients are usually no longer can transmit the disease After undergoing treatment for 10-14 days.