Dr. Erlina - Rev1 Difficult Cases EB17
Dr. Erlina - Rev1 Difficult Cases EB17
Dr. Erlina - Rev1 Difficult Cases EB17
cases MDR TB
Dr. dr Erlina Burhan MSc. Sp.P (K)
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine,
University of Indonesia / Persahabatan Hospital
erlina_burhan@yahoo.com
Introduction
• Difficult cases of drug resistant (DR) TB often found in many sites
• Should be managed immediately to prevent patient’s drop out/loss
to follow up
• Involve other/related diseases or comorbidity discussed together
as a team with other related medical doctor or specialist
• Not only the disease but also sosio-economic problem or managerial
problem
1
Difficult in taking ATA history
• Most of DR-TB patient had ≥ 1 medical history of TB treatment
• Not all those patient know about ATA drug history
• The treating doctor does not inform the patient about the ATA drug in details
• The patient forgot about the drug information
• The patient underestimate about the drug information
• One of requirement of Shorter regiment history of FQ treatment
less than 1 month ???
2
3
Difficult in Diagnosis
• Diagnosis with rapid molecular test
• Rapid molecular test only in Provincial Hospital
• M. Tb culture and DST only in 13 hospital (already QA)
• Discrepancy between rapid molecular test and DST
• Xpert: Resistance rifampicin ; DST Resistance sensitive
4
Current distribution of 504 Xpert machines (March 2017)
10
19
3
18 404 63
Labs Hospitals PHCs
8 2
6 15
4
8 8
6 3
3
6 6 3
5 5 4
12 4 4 8
7
13
34
13
9 10
11 7
29203
Pengobatan Ulang)
30000 • 8.5% dari estimasi insiden TB RR/MDR (2.731 dari 32,000
kasus)
25000 • 27% dari estimasi kasus TB RR/MDR dari yang semua kasus
15523
TB yang dilaporkan (2.731 dari 10,000 kasus)
20000
9703
15000
10000
3833
2731
2441
1935
1896
1656
1581
1299
1255
1094
819
696
550
5000 460
441
296
216
155
148
66
34
0
2009 2010 2011 2012 2013 2014 2015 2016
8
Laporan Kasus Poli MDR
Nama : Tn. D
Usia : 52 tahun
9
Riwayat Perjalanan Penyakit
Sept 2017-
2015 2016-2017
sekarang
• Gagal • Gagal • Regimen
Kategori I regimen MDR Bedaquilin
20 bulan
REGIMEN
Regimen BB Z E S Km Cm Lfx Eto Cs PAS B6 Bdq
Tgl
10/11/15 53 kg 1500 750 750 750 750 150
29/6/16 56 kg 1500 stop 750 750 750 150
18/6/17 52kg 1500 stop 750 750 750 150
12/9/17 52kg 1500 750 750 750 8 150 400
11
Hasil pemeriksaan sputum
TgL BTA BIAKAN
10/10/15 1+ NEGATIF
11/1/16 NEGATIF NEGATIF
11/2/16 NEGATIF NEGATIF
15/3/16 NEGATIF NEGATIF
15/4/16 NEGATIF NEGATIF
15/5/16 NEGATIF NEGATIF
16/6/16 NEGATIF NEGATIF
15/8/16 NEGATIF NEGATIF
16/11/16 NEGATIF POSITIF
17/2/17 1+ POSITIF
14/3/17 1+ POSITIF
18/5/17 1+ POSITIF
18/6/17 2+ POSITIF
12
Foto TORAX 31 Agustus 2017
13
Laporan Kasus Poli MDR
Nama : Ny. N
Usia : 36 tahun
14
Riwayat Perjalanan Penyakit
Hasil
Juni 2017
tes cepat (5/6/17)
• Pengobatan TB • Rifampisin
Kategori I dalam resisten
bulan ke-1
15
DST
TgL H R Z E S Km Cm Lfx Eto S PAS Ofl Amk
20/6/17 S R S S R S
REGIMEN
Regimen BB Z E S Km Cm Lfx Eto Cs PAS B6 Bdq
Tgl
5/9/17 35 kg 750 750 500 500 4 100 400
16
Foto TORAX 31 Agustus 2017
17