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7/17/2019 Meningitis Tuberkulosis
http://slidepdf.com/reader/full/meningitis-tuberkulosis-5691484af193b 1/21
N A D Y A M O N G A N
1 0 2 0 1 1 1 0 6
MENINGITIS TUBERCULOSIS
7/17/2019 Meningitis Tuberkulosis
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SKENARIO
Seorang anak laki laki berusia 6 tahun dibawa ibunyRS karena kejang kaku di seluruh tubuhnya dan beru
1 hari yang lalu.
7/17/2019 Meningitis Tuberkulosis
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ANALISIS MASALAH
RM (meningitist!e"#$%sis&
An'mnesis
eme"i)s''n*si)
+%")ing,i'gn%si
s
eme"i)s-enn.'
eti%$%gi
e-i,emi%$%gi
-'t%*si%$i
en't'$')s'n''n)%m-$i)'si
7/17/2019 Meningitis Tuberkulosis
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HIOTESIS
•
'sien men,e"it' meningitis t!e"#$%sis
7/17/2019 Meningitis Tuberkulosis
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ANAMNESIS
• I,entit's
• Ke$/'n t'm' Ke.'ng 3 se$'m' 45menit
• Ke$/'n -ene"t'
se"ing ti,"
77 !! 2 )g
• RS• RD
• Ri8''t -en')it ,'$'m )e$'"g' nene) !'t) !e",'"'/ !
• Ri8''t -"i!',i ,'n s%si'$
• Ri8''t %!'t
7/17/2019 Meningitis Tuberkulosis
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EMERIKSAAN 9ISIK
•
Tanda2 kesadaran = GCS E3M6V3 = 12• TTV = TD 110:;0< n',i =03:menit<
n'>'s 203: menit< s/ ;?@ C
• Tanda rangsang eningeal =
)') ),)
•
Sara! kranialis• "otorik
• Sensorik
• #oordinasi
• Status ental
7/17/2019 Meningitis Tuberkulosis
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EMERIKSAAN ENUNANG
• D'"'/ "tin• Lm!'$ -ngsi
• e8'"n''n BTA
• K$t" ,'"'/
• U.i t!e")$in
• eme"i)s''n "',i%$%gi
7/17/2019 Meningitis Tuberkulosis
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DIAGNOSIS KERA DAN BANDING
7/17/2019 Meningitis Tuberkulosis
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ANATOMI
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MENINGES
• Terdiri atas 3 lapisan:
• - duramater: (lpsn perieostale dan meningeale)• - arachnoid (spt jaringan)
• - piamater
7/17/2019 Meningitis Tuberkulosis
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MENINGITIS BACTERIALIS
•
Te",i"i ,'"i-',' ti-e- A#te -"$ent
- Ase-ti) meningitis
- C/"%ni# meningitis
7/17/2019 Meningitis Tuberkulosis
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ETIOLOGI
• B't'ng -$e%m%"*) g"'m
• U)"'n 0<@
• T'/'n 's'm
• D'-'t /i,- !e"minggmingg ,'$'m )e',''n )e"ing
• L'm!'t !e"m$ti-$i)'si
7/17/2019 Meningitis Tuberkulosis
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EIDEMIOLOGI
• Insi,en meningitis TB se!'n,ing ,eng'n TB -"ime"< m!e"g'ntng -',' st'ts s%si%e)%n%mi< /igiene m's'"'st'ts gii ,'n >')t%" geneti)
• Mene"'ng sem' si'< te"t'm' 'n') si' 5 t'/n
7/17/2019 Meningitis Tuberkulosis
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ATO9ISIOLOGI
BTA m's) t!/
F
Te"se"ing me$'$i in/'$'si
'"'ng -',' )$it< s'$"'n #e"n'
F
M$ti-$i)'si
F
In>e)si -'" : >%#s in>e)si $'in
F
ene!'"'n /em't%gen
F
Meningens
F
Mem!ent) t!e")e$
F
BTA ti,') ')ti> : ,%"m'in
Bi$' ,'' t'/'n t!/ men"n
F
R-t"e t!e")e$ meningen
F
e$e-'s'n BTA )e "'ng s!'"'#/n%i,
F
MENINGITIS
7/17/2019 Meningitis Tuberkulosis
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MANI9ESTASI KLINIS
/'se 1
N%n s-e#i*# sm-t%m
>ee"
$et/'"g
/'se 2
C%n>si%n
C"'ni'$ ne"e -'"esis
Meningism's#$itis
/'
C%
7/17/2019 Meningitis Tuberkulosis
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• St',im 1 (st',im inisi'$:n%n s-esi*): -"%,"%m'$&
• Ge.'$' ,'n t'n,' n%n s-esi*)
•
Be$m ',' )e$'in'n ne"%$%gis• Ti,') ',' -en"n'n )es','"'n
• St',im 2 (t"'nsisi%n'$:meningiti)&
• Ti,') s','"
• Ke$'in'n ne"%$%gis
• I"it'si meningen
• T'n,' meninge'$
• S'"'> %t') te")en' III< I< I< II
• St',im ()%m':-'"'$iti)&
• K%m'< --i$ ti,') !e"e')si
• e"n'-'s'n ti,') te"'t"< ,em'm tinggi
• S-'sme -',' e)st"emit's
7/17/2019 Meningitis Tuberkulosis
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ENATALAKSANAAN
• 9'"m')%$%giDosis (/kgbb/hr) Dosis maksimal
(/hari)Efek samping
Is%ni'i, 515 mg 00 mg He-'t%t%)si) ,'nne"itis -e"i>e"
-i"i,%)sin 250 mg 13 1 /'
Ri>'m-isin 1020 mg 600 mg e"!'/'n 8'"n'</e-'t%t%)si)
i"'in'mi, 150 mg 2 g"'m /e-'t%t%)si)<'n%"e)si'< i"it'sis'$"'n #e"n'</i-e""isemi'
St"e-t%mi#in 1 g":/'"i IM T$i -e"m'nen
Et'm!t%$ 1520 mg 1<25 g"'m Ne"itis %-ti)< !t'
8'"n' me"'/ /i.'
7/17/2019 Meningitis Tuberkulosis
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Se$'in it .g' ,'-'t ,i!e"i)'n ,e)s'met's%n nt) menge,em' se"e!"i?• Mingg 1 0<@ mg:)g:/'"i
• Mingg 2 0< mg:)g:/'"i
• Mingg 0<2 mg:)g:/'"i
• Mingg @ 0<1 mg:)g:/'"i< ,i$'n.t)'n ,eng'n te"'-i ,e)s'met's%n %"'$ mingg< ,im$'i ,eng'n ,%sis @ mg:/'"i ,'n )em,i'n ,it"n)'n 1 mg
N%n >'"m')%$%gis • Men.'g' ,'' t'/'n t!/
• e"i$') /i,- se/'t
7/17/2019 Meningitis Tuberkulosis
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ROGNOSIS DAN ENCEGAHAN
• "%gn%sis
M')in ,ini -en')it ini ,i,i'gn%sis ,'n ,i%!'ti< m')' m'))emng)in'n -'sien sem!/ t'n-' )e"s')'n se"is 'ng
• en#eg'/'n
"ime"• Imnis'si< -e"s%n'$ /igiene
Se)n,e"• Di'gn%sis ,ini ,'n te"'-i
Te"sie"• 9isi%te"'-i ,'n "e/'!i$it'si
7/17/2019 Meningitis Tuberkulosis
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KESIMULAN
• Meningitis t!e")$%sis me"-')'n -e"','ng'n -',' se'ng ,ise!'!)'n %$e/ !')te"i Mycobacterium tuberkulos-ene!'"'nn' me$'$i /em't%gen 't' $im>%gen? Ge.'$'','$'/ ','n' t'n,' "'ngs'ng meninge'$ 'ng -%siti>? -eng%!'t'n sege"' nt) men#eg'/ -"%gn%sis 'ng !" .g' ,eng'n .'ng)' 8')t 'ng $'m' )'"en' in>e)si TB<gst'n,'", -eme"i)s''n CS9<)$t" !')te"i<,i!e,')'n ,eng-"$ent ,'n i"s )e)e"/'n CS9
7/17/2019 Meningitis Tuberkulosis
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T / ' n ) Y
%
T HA N K
Y O U T / ' n ) 6 %
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