Morbus Hansenfk Ukrida Olivia Cs Des07
Transcript of Morbus Hansenfk Ukrida Olivia Cs Des07
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
1/30
LEPROSY
Pembimbing:dr. Maria Dwikarya, SpKK
Disusun oleh:Olivia KhatharinaDeni Apriyanda
MulyantiEmilia
Kepaniteraan Peny Kulit FK Ukrida di RS HUSADA
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
2/30
Secara nasional pada th 2000 Indonesiadiharapkan sdh eliminasi kustaGAGAL
Mengapa ?Case Finding < intensif,
Terapi < efektif (DO ok Reaksi Kusta)
Perlunya peningkatan pengetahuan DOKTER
utk menegakkan Diagnosis dini, Konseling
dan mengatasi Reaksi Kusta
Pengobatan dengan Rejimen Alternatif.
PENDAHULUAN
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
3/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
4/30
Patogenesis M. leprae
makrofagSel Schwann(sarung myelin saraf)
M. Leprae
mukosa
Sel Virchow
(sel busa)
deMyelinisasi
Regenerasi Kerusakan progresif
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
5/30
Perbedaan tipe PB dan MBmenurut klasifikasi WHO:
Pausi Basiler Multi Basiler
Lesi kulit 1-5
Hipopigmentasi >
Eritema +1
Asimetris
>5
Infiltrat >
Eritema +2
Simetris
Kerusakan
saraf
Anestesi st. awal
unilateral(5A + = anestesi, atrofi,anhidrosis,alopesia,akromia)
Anestesi st. akhir
Bilateral (gloves)
Cat : Semua pasien dgn BTA (2+), apapun klasifikasi klinisnya diobati
dgn MDT-MB
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
6/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
7/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
8/30
Kelainan Saraf Tepi
N. fasialis : lagoftalmus,mulut mencong
N. trigeminus : anestesikornea, kulit wajah,konjungtiva
N. radialis : wrist drop,anestesi dorsum manus,ekstensi jari (-)
N. ulnaris : Clawing J4-5,atrofi hipotenar
N. medianus : Clawing J1-
3, kontraktur J1, atrofitenar N. poplitea lateralis : foot
drop N. tibialis post : claw toes
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
9/30
Penunjangdiagnosis
Prx. Bakterioskopik:
Lokasi : lesi plg aktif, hindari wajah
dan selaput lendir hidungBiasa pada : cuping telinga,lengan, punggung, bokong, paha
Indikasi : ps yang dicurigai,
ps baru dgn terdiagnosa klinis,
relaps & resistensi obat,
ps. MB tiap 1th.
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
10/30
Penunjang diagnosis
Prx. Histopatologis :
ditemukan selVirchow/ sel lepra/ sel
busa Prx. Serologis :
Uji MLPA
Uji ELISA
Uji FLA-ABS
Uji ML dipstick
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
11/30
Tipe I (REVERSAL):Hipersensitivitas tipe IV
Lesi lama berubah jadi > merah
menjadi infiltrat
Peningkatan Imunitas SelularHsl Rx : upgrading / reversal ( TT)
Tipe II (ENL):Hipersensitivitas tipe III
Pembentukan komplek Ag-Ab
Hasil Rx : nodus, eritem, nyeri
Gejala Konstitusi: demam, nyeri,
tidak gatalpd tipe BL
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
12/30
Obat dan Dosis rejimen MDT-PB
Dapson Rifampisin
(di-klinik), (ac)
Dewasa
Anak-anak10-14 th*
100 mg/hr(Hb >10)
50 mg/hr
600 mg/bln
450 mg/bln
*Cat : Sesuaikan dosis bagi anak-anak < 10 th
Terapi
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
13/30
Obat dan Dosis rejimen MDT-MB
Dapson Rifampisin(di-klinik), (ac)
Klofazimin
Dewasa
Anak-anak
10-14 th*
100 mg/hr
50 mg/hr
600 mg/bln
450 mg/bln
300 mg/bl (klnk) +50 mg/hr
150 mg/bl (klnk) +50 mg selang sehari
*Cat : Sesuaikan dosis bagi anak-anak < 10 th
Terapi
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
14/30
Rifampisin (ac) Ofloksasin (pc) Minoksiklin (pc)
Dewasa
(PB) 6 bln
(MB) 24 bln
Anak-anak
5-14 th
(PB) 6 bln
600 mg
600 mg
300 mg
400 mg
400 mg
200 mg
100 mg
100 mg
50 mg
Terapi Alternatif
(dalam uji klinis)
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
15/30
Rejimen untuk penderita yang tidak dapat makan Rifampisin
Lama pengobatan Jenis Obat Dosis
6 bln
Diikuti dg 18 bl
KlofaziminOfloksasin
Minosiklin
Klofazimin denganOfloksasinATAU
Minosiklin
50 mg/hr400 mg/hr
100 mg/hr
50 mg/hr400 mg/hr
100 mg/hr
Terapi
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
16/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
17/30
Penanganan Rx Lepra
Prinsip pengobatan
Pemberian obat anti RxIstirahat atau imobilisasi
Analgetik, sedatif
untuk atasi nyeri
Obat anti kusta tetap
Reaksi ringanAspirin 600-1200 mg/4 jam
Kloroquin 3 x 150 mg/hr
Reaksi beratRujuk RS
Tipe IKSTipe IIKlofazimin, KS
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
18/30
Cara pemberian KS :
Dimulai dg dosis tinggi /sedang
Gunakan Prednison/prednisolone
Dosis tunggal pd pagi hari
Dosis turun stlh respons max
Dosis steroid Prednison
dimulai 30-80 mg /hari/ pc
dan turun 5-10 mg per 2 mgg.
Penanganan Reaksi Lepra
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
19/30
LEPRO
SYImpairments:
-Facial disfigurement
-Nerve damage
-Eye damage
-Personality disorder
Secondary impairment:
-Cracks and wounds
-Ulcers
-Septic hand or foot
-Joint stiffness or contractures
-Shortening of fingers or toes
-Mutilation of the hand or foot
-Disorganization of the foot or wrist
Disabilities
Inability to carry out
certain activities
Handicaps:
Unemployment
Economic dependence
Physical dependence
Social integration
Dehabilitation
Social disadvantages
Loosening
of social
ties
Destitution Totalisolation
from society
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
20/30
NERVEINVOLVEMENT
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
21/30
Preventing Damage To Insensitive Hands
1. Thenar eminence, about 1.0
1.5cm from the crease at the base of
the thumb, along a line extending
from the midline of the thumb.
2. Pulp of the thumb
3. Pulp of the index finger
4. Pulp of the little finger5. Palm, about 3-4 cm from the
crease at the base of the little
finger, along a line extending from
the midline of the finger.
Sites for testing sensibility
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
22/30
Sample current
impairment statusrecord for the hand
1. Stiffness: Yes, ring finger
2. Swelling: No3. Muscle wasting: Yes, Hypothenar
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
23/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
24/30
Hand Deformity
DEFORMITY
Claw fingers
Claw thumb
Drop wrist
SITE OF STIFFNESS
Middle joint of fingers
Tip of thumb
Wrist, joints of fingers and thumbs
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
25/30
Preventing Damage To Insensitive Feet
1. Pad of the big toe2. Ball of the foot, about 3-4 cm from
the crease at the base of the big
toe, along a line extending from
the midline of the toe.
3. Ball of the foot, about 1.0-1.5 cm
from the crease at the base of thelittle toe, along a line extending
from the midline of the toe.
4. Instep.
5. Center of the heel.
Sites for testing sensibility
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
26/30
Samplecurrent
impairmentstatus recordfor the foot
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
27/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
28/30
MUSCLE
WEAKNESS
Patients with leg muscleweakness may need, inaddition to anti-leprosydrugs and prednisolone: Splinting of knee Stretching of calf muscles Foot-raising device
Splinting the knee
A Foot-raising device
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
29/30
-
8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07
30/30
Deni Mulyanti Zr Emilia - Olivia
FK UKRIDA RS HUSADA DESEMBER 2007