Kusta (Morbus Hansen)
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![Page 1: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/1.jpg)
K U S T AK U S T A
ABRAHAM ARIMUKOABRAHAM ARIMUKO
DEPARTEMEN I P KULIT & KELAMINDEPARTEMEN I P KULIT & KELAMIN
RSPAD GATOT SOEBROTO JAKARTARSPAD GATOT SOEBROTO JAKARTA
![Page 2: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/2.jpg)
DEFINISI
• Penyakit infeksi kronik• Disebabkan Mycobacterium Leprae, yang
obligat intrasellular.• Saraf perifer sebagai afinitas pertama• Dapat mengenai organ lain kecuali
susunan saraf pusat
Sinonim : Lepra, morbus Hansen
![Page 3: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/3.jpg)
EPIDEMIOLOGI
• Penularan : ?– Kontak langsung kulit lama & erat.– Inhalasi
• Masa tunas : 40 hari - 40 tahun.• Bukan penyakit keturunan.• Penyakit yang ditakuti : krn deformitas• Aspek psokologis, sosial, ekonomi.• Terdapat dimana-mana.
![Page 4: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/4.jpg)
• Etiologi : – M leprae, basil tahan asam & alkohol, positif
gram , belum dapat dibiakkan media artifisial.
• Patogenesis : – Predileksi pada daerah yang relatif dingin.– Gejala klinis : sebanding dengan tingkat reaksi
selularnya.
![Page 5: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/5.jpg)
KONTAK
Infeksi Non-infeksi
Sub Klinis
Inditerminate
Diterminate
Ti BT BB BL LiT T L LI
SEMBUH70%
95%
30%
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KLASIFIKASI
SPEKTRUM KUSTA
Ridley & Jopling
MADRID
W H O
Puskesmas
TT BT BB BL LL
Tuberculoid Borderline Lepromatosa
Pausibasiler ( PB) Multibasiler ( MB)
Pausibasiler ( PB) Multibasiler ( MB)
![Page 7: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/7.jpg)
DIAGNOSIS
• Keluhan & Anamnesis• Gejala Klinis
– Kulit– Penebalan saraf– Otot– Gangguan sensibilitas, anhidrosis.– Deformitas.
• Bakterioskopik• Pemeriksaan Penunjang
– PA, Lepromin, PCR.
![Page 8: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/8.jpg)
Tuberkuloid ( TT )
![Page 9: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/9.jpg)
Borderline ( BB )
![Page 10: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/10.jpg)
Borderline lepromatosa ( BL )
![Page 11: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/11.jpg)
Borderline ( BB )
![Page 12: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/12.jpg)
Lepromatous ( LL )
![Page 13: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/13.jpg)
Lepromatous ( LL )
![Page 14: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/14.jpg)
• Bentuk
• Jumlah
• Distribusi• Permukaan• Batas
• Anastesia
Makula,infiltratPapula, nodus
Tak terhitung
SimetrisHalus berkilatTak jelas
Tak jelas
Plakat, kubahPunched-out
Dapat dihitung
AsimetrisAgak kasarLebih jelas
Lebih jelas
Makula saja
Satu, beberapa
AsimetrisKering bersisikJelas
Jelas
LESI TT BB L L
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• BTA :• Lesi kulit• Mukosa
• Tes Lepromin
Banyak,globusBanyak,globus
Negatif
Agak banyakNegatif
Biasa negatif
NegatifNegatif
Positif kuat
L LBBTT
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Gejala 5 A
• Anestesi
• Akromia
• Atrofi
• Alopesia
• Anhidrosis
![Page 17: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/17.jpg)
DEFORMITAS
• Primer : – Akibat langsung desakan granuloma akibat
reaksi thd M leprae. – Kulit, mukosa, tulang jari.
• Sekunder : – Karena kerusakan saraf
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Kerusakan Saraf
• N. facialis : – lagoftalmus
• N. ulnaris : – Kelingking , jari manis : anestesi & clawing– Atrofi hiopotenar
• N. medianus– Anterior ujung jari I,II,III anestesi & clawing.
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Kerusakan Saraf
• N. radialis– Dorsum manus anestesi– Wrist drop.
• N. poplitea lateralis :– Foot drop
• N.tibialis posterior :– Anestesi telapak kaki.– Claw toes
![Page 20: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/20.jpg)
N. auricularis magnus
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Claw - hand
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Pemeriksaan Sensibilitas
• Suhu : Air panas / dingin dalam tabung reaksi
• Nyeri : Jarum
• Raba : Kapas
Pemeriksaan anhidrosis : test Gunawan.
![Page 23: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/23.jpg)
Bakterioskopik
• Sediaan kerokan : – Lesi, cuping teling, mukosa hidung.
• Pewarnaan :– ZIEHL NEELSEN
• Basil terlihat:– Solid ( hidup )– Non Solid ( Fragmented & Granular )– Bentuk globus
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Bakterioskopik
• Index Bakteri ( IB )– Kepadatan BTA, Solid + non solid.– 0 s/d 6 +
• Indeks Morfologi ( IM )– Prosentase bentuk solid dibandingkan seluruh
jumlah bakteri.– Dalam bentuk prosen
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M. leprae
![Page 26: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/26.jpg)
REAKSI KUSTA• Adalah reaksi imun patologik, akut, dapat menimbulkan
kerusakan organ.
• Macam– Eritema nodusum leprosum ( ENL )
• Pada bentuk LL, BL
• Klinis : Nodus, eritema, nyeri, neuritis, artritis, orkitis, limfadenitis, nefritis
– Reversal• Pada bentuk BB
• Klinis : Lesi lama tampak lebih aktif, neuritis.
![Page 27: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/27.jpg)
PENGOBATAN Multi Drug Therapy
• MDT-L ( LL, BL, BB )– Rifampisin : 600 mg / bulan– Klofazimin : 300 mg / bulan + 50 mg / hari– DDS : 100 mg / hari12 bulan ( selesai < 18 bulan )
• MDT – T ( TT, BT )– Rifampisin : 600 mg / bulan– DDS : 100 mg / hari6 bulan ( Selesai < 9 bulan )
![Page 28: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/28.jpg)
Pengobatan Reaksi Kusta
Untuk mencegah kerusakan organ lebih lanjut.
• Kortikosteroid : prednison 15 – 30 mg/hari
• Anti piretik / analgetik, sedativa.
• Klofasimin ( untuk ENL )
• Thalidomid ( untuk ENL )
![Page 29: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/29.jpg)
Mencegah cacat
• Diagnosa dini
• Pengobatan MDT cepat tepat.
• Penanganan reaksi kusta.
• Petunjuk ke pasien :– Pakai alas kaki, sarung tangan, kaca mata,– Perawatan kulit agar tidak terlalu kering.
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Rehabilitasi
• Cacat : – Operasi– Fisioterapi
• Psikologis.
• Sosial ekonomi.
![Page 31: Kusta (Morbus Hansen)](https://reader035.fdokumen.com/reader035/viewer/2022081506/55cf9984550346d0339dc46b/html5/thumbnails/31.jpg)
TerimakasihTerimakasih