Morbus Hansenfk Ukrida Olivia Cs Des07

8/12/2019 Morbus Hansenfk Ukrida Olivia Cs Des07

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LEPROSY

Pembimbing:dr. Maria Dwikarya, SpKK

Disusun oleh:Olivia KhatharinaDeni Apriyanda

MulyantiEmilia

Kepaniteraan Peny Kulit FK Ukrida di RS HUSADA


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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


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Patogenesis M. leprae

makrofagSel Schwann(sarung myelin saraf)

M. Leprae

mukosa

Sel Virchow

(sel busa)

deMyelinisasi

Regenerasi Kerusakan progresif


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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


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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


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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.


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Penunjang diagnosis

Prx. Histopatologis :

ditemukan selVirchow/ sel lepra/ sel

busa Prx. Serologis :

Uji MLPA

Uji ELISA

Uji FLA-ABS

Uji ML dipstick


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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


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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


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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


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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)


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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


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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


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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


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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


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NERVEINVOLVEMENT


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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


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Sample current

impairment statusrecord for the hand

1. Stiffness: Yes, ring finger

2. Swelling: No3. Muscle wasting: Yes, Hypothenar


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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


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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


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Samplecurrent

impairmentstatus recordfor the foot


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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


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Deni Mulyanti Zr Emilia - Olivia

FK UKRIDA RS HUSADA DESEMBER 2007

Morbus Hansenfk Ukrida Olivia Cs Des07

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