Spondilitis TB Anak
Spondilitis TB Anak
Spondilitis TB Anak
Spondylitis Tuberculosis
Andriyani (1608437590)
Try Intan Kartini (1608437603)
Wilda Septi Pratiwi (1508434475)
TUBERCULOSIS
Spondylitis TB is
infectious disease
- Acid-fast bacillus
caused by - obligat aerob
M.tuberculosis - Destroyed in boilled
that involve water or ultraviolet
spine.
Primary
Happens within
infection is
the third years
from lung or
after primary
genitoutinary
infection
system.
Pathophysiology
Phagocytosis M. tb by
Inhalation of Alveolus macrophage
M. tb
M. tb breed/replication
Destruction of
M. tb
Macrophage lysis
Resolution
Spread to lymph
Tubercle formation nodes
Calcification
hematogen
Caseous
center
Secondary lesion in
the lung
Lesion in hepar,
kidney, spine,
brain, etc
Diagnosis
6
Diagnosis
Criteria Spondylitis TB
Clinical manifestation
Radiography
- lateral x-rays shows severe kyphosis
with destruction of vertebral bodies
Microbiologic evidence of - lateral x-rays shows widening of
m.tuberculosis prevertebral soft tissue.
(and other test)
Diagnosis
Criteria Spondylitis TB
Clinical manifestation
Radiography
Microbiologic evidence of
m.tuberculosis
(and other test) - Found acid-fast bacilli smear
- Cultures for mycobacteria
- Tuberculin skin test
8
Treatment
Dose Maximum dose
Drug name Side effects
(mg/kg/day) (mg per day)
Hepatitis, neuritis perifer,
Isoniazid (H) 5 15* 300
hipersensitivity
hepatotoxic, artralgia,
Pirazinamid (Z) 15 30 2000
gastrointestinal disorder
Prednisone 12 60
Treatment
Guideline treatment antituberculosis
10
Decubitus ulcer : Pressure ulcer is an area of unrelieved
pressure usually over a bony prominence, resulting in ischemia
and tissue necrosis.
CLASIFICATION
12
Case Report
13
Patient identity
Family history
- Grandmother also cough for a long time and untreated
- No history of cancer
Parents history
Parents occupation: father is an enterpreneur and mather is a housewife
Pregnancy history
Patient was born spontaneusly helped by midwife, aterm, directly crying.
During pregnancy mother wasnt illness and unregular ANC.
Anamnese
Feeding history
0-6 months old : breastfeeding
6 24 months old: breastfeeding +weaning food
24 months now : regular food
Immunization history
Never got immunization
Growth history
Birth weight : 3000 gr Admission weight : 28 kg
Birth height : - Admission height : 145 cm
Nutritional status
Height : 145 cm
Weight : 28 kg
- Inspection :
Kyphosis 100, gibbus (-). Mass at
paravertebrae dextra, the size of
a tennis ball and the color same
as the skin.
Ulcer, hiperemis, the size 5x2
x0,2 cm at vertebra and
10x5x0,5 cm at gluteus, on the
basis of the subcutaneous
tissue with pus and surrounded
by necrotic tissue.
- Palpation :
Mass at paravertebrae dekstra
palpable soft, immobile, firm
boundaries, tenderness (-)
Neurologic Status
Upper Upper
Extremity Extremity
Touch Normal Normal Normal Power 5 5 Normal
Painful Normal Normal Tonus Normal Normal
Temperature Normal Normal Involuntary (-) (-)
Lower Lower
Extremity Hip- Extremity Para
Touch estesia Power 1 1 parese
Painful at level Tonus Spastic Spastic Inferior
Temperature T-VII Involuntary (-) (-)
Neurologic Status
Reflex Right Left Interpretation
Physiologic
Biseps (+) (+) Physiologic reflex
Triseps (+) (+) is increase at
Autonomic system :
KPR (++) (++) lower estremity Miction and defecation
APR (++) (++) are normal
Feces (19/10/2016)
Egg of parasite : Negative
Epitel cell : 0-2/LPB
Cylinder : 0/LPB
Eritrocyte : 0-1/LPB
Leukocyte : 0-3/LPB
Amoeba/cyst : Negative
Laboratory findings
Suggest examination
Mantoux test
Peripheral blood smear
Spinal biopsy
CT scan thorax with contrast
Treatment
1. O2 2 lpm by nasal canule
2. IVFD KAEN 1B 20 gtt/minute makro
3. Paracetamol tab 4 x 500 mg
4. PRC transfusion 3 x 200 cc
5. Rifampisin tab 1 x 450 mg
6. Isoniazid tab 1 x 400 mg
7. Pirazinamid tab 1 x 1000 mg
8. Inj. Streptomisin IM 1 x 500 mg
9. Prednison tab 5 mg 2-2-1
10. Wound care/day
11. High-calorie high-protein dietary
Nutrition :
RDA x BBI = (50-60) x 36 = 1800-2160 kcal
PROGNOSIS:
Quo ad vitam : Dubia ad malam
Quo ad fungsionam : Dubia ad malam
Follow up
Hb / Ht / WBC / PLT Hb / Ht / WBC / PLT
12,3/39,9/15.000/ 927.000 12/38,7/15.850/556.000
Ur / Cr / AST / ALT Prednison tapp. off 2-1-1
12 / 0,01 / 19 / 13
-Anemia, leukocytosis,
trombocytosis, CRP
reactive
-Mantoux test : (+)
-MRI and CT scan
-Spinal biopsy
Diagnosis :
Spondylitis TB + Paraparese inferior + Decubitus ulcer grade II
Treatment If deficit neurologic (+) : operatif
2 RHZS +
10 RH
Prednisone 1-2mg/Kg/day
Steroid 2 - 4 week and tappering off 2 6
month