TB prevalence surveys conducted in six provinces in the years 1983-1993 showed that the prevalence of TB in Indonesia ranges between 0.2 - 0.65%. Meanwhile, according to the Global Tuberculosis Control report released by WHO in 2004, TB incidence rate in 2002 reached 555 000 cases (256 kasus/100.000 population), and 46% of the estimated new cases.
Causes of TB Disease
Tuberculosis is an infectious disease caused by bacteria Mikobakterium tuberculosis. These rod-shaped bacteria and is resistant to acid, also known as Trunk Hold acid (BTA). This bacterium was first discovered by Robert Koch on March 24, 1882, to commemorate his services so that the bacteria are given the name of Koch bacillus. In fact, tuberculosis of the lungs is sometimes referred to as the Koch Pulmonum (KP).
Mode of transmission of TB disease
TB disease is usually transmitted through contaminated air with Mikobakterium tuberculosis bacteria are released at the time of TB patient coughs, and in children the source of infection is generally derived from adult TB patients. These bacteria often enter and when accumulated in the lungs will breed a lot (especially in people with low immunity), and can be spread through blood vessels or lymph nodes. That is why TB infection can infect almost all organs such as lungs, brain, kidney, gastrointestinal tract, bone, lymph nodes, etc., though the organs most often affected are the lungs.
When Mikobakterium tuberculosis successfully infect the lungs, it soon will grow colonies of bacteria that form globular (rounded). Usually through a series of immunological reactions would seek TB bacteria is inhibited by forming a wall around the bacteria by lung cells. Mechanism of formation of the wall surrounding tissue to create scar tissue and the TB bacteria will become dormant (resting). Dormant forms is what is actually seen as a tubercle on the x-ray examination.
In some people with good immune system, this form will remain dormant throughout their lives. Whereas in those with poor immune systems, bacteria will have breeding tubercles grow so much. That many of these tubercles form a space in the lungs. Space is what will be the source of production of sputum (phlegm). Someone who has been producing sputum can be estimated is experiencing positive growth and excess tubercles infected with tuberculosis.
Increased transmission of infection have been reported at this time, many linked to several conditions, including worsening socio-economic conditions, not optimal health care facilities, increasing the number of people who have no shelter and the epidemic of HIV infection. Besides the immune system is weak / declining, and the number of bacteria is a virulence factor that plays an important role in the occurrence of TB infection.
Symptoms of TB Disease
Symptoms of TB disease can be divided into general symptoms and specific symptoms that arise according to the organ involved. Clinical picture is not very typical, especially in new cases, making it quite difficult to diagnose clinically.
Symptoms of systemic / general:
* Fever is not too high that lasts a long time, usually felt at night with night sweats. Sometimes an attack of influenza-like fever and intermittent nature.
Decreased appetite and weight.
* Cough-cough for over 3 weeks (may be accompanied by blood).
* Uncomfortable feeling (malaise), weakness.
Specific symptoms:
* Depending on which organs are affected, if there is partial blockage of bronchi (the tubes leading to the lungs) due to pressure of enlarged lymph nodes, make noise "wheezing" noise accompanied by shortness of breath weakened.
* If there is fluid dirongga pleural (lung packing), can be accompanied by chest pains.
* If the bone, there will be symptoms such as bone infection at some point to form channels and lead to the overlying skin, in this estuary will discharge pus.
* In children, can affect the brain (brain wrapping layer) and is referred to as meningitis (inflammation of the lining of the brain), the symptoms are high fever, a decrease in consciousness and convulsions.
In pediatric patients that do not cause symptoms, TB can be detected if there are known contacts with adult TB patients. Approximately 30-50% of children in contact with adult pulmonary TB patient gives a positive tuberculin test results. In children aged 3 months - 5 years who live with adult pulmonary TB patients with smear-positive, 30% reported being infected by serology / blood.
Enforcement of Diagnosis
If a person is suspected of contracting tuberculosis, then a few things to be done to establish the diagnosis are:
* Anamnesa both to patients and their families.
* Physical examination.
* Laboratory tests (blood, sputum, cerebrospinal fluid).
* Examination of anatomic pathology (PA).
* X-ray chest (thorax photo).
* Tuberculin test.
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