CASE REPORT

PULMONARY TUBERCULOSIS
By Dwi Widyasti 04043100054 Zikanovelia 04043100055

Advisor: Prof.dr.H.Eddy Mart Salim

INTRODUCTION
Pulmonary tuberculosis (Tb) is a contagious bacterial infection that mainly involves the lungs, but may spread to other organs. It caused by bacteria called Mycobacterium tuberculosis. Pulmonary Tb spread by person to person through droplets in the air. When people with Tb in their lungs or throat cough, laugh, sneeze, sing even talk, the germs that cause Tb may be spread in to the air.

Although the effective treatment of pulmonary Tb is available, pulmonary Tb still being problem of world healthy. World Health Organization estimates 30 million persons will die 10 years later because of pulmonary tuberculosis. WHO estimates 400 person in Indonesia will die everyday. The total number of new cases (positive and negative BTA) Tb in Indonesia more than 600 millions people each year. The incidence of positive BTA cases (contagious) in 2005 is estimated 107 new cases per 100 millions population.

Pulmonary Tb should be overcame with quickly and exactly diagnosis and treatment. Knowing symptoms, physical examination, supporting examination and treatment is the early step for overcome pulmonary Tb. This case want to be discussed because it has high mortality rate. May this case report can be usefull for all.

CASE REPORT
IDENTIFICATION
Name Age Sex Address Status Occupation Education Hospitalized : Mrs.DS : 28 years old : female : bukit kecil palembang : married : housewife : elementary school : 27 agustus 2008

ANAMNESIS
Chief of complain
Breathing difficulty since 3 hours before admitted

History Of Illness

6 months before addmition patient complained having a

cough. First, cough without phlegm, a few days later cough accompanied by a bit white pleghm, blood (-), breathing difficulty (-), chest pain (-). Cough recovered by itself, no take medications.Frequently cough about 1 week after. Patient also complained sometimes fever at night, chill (-), night sweat (+), no problem with her appetite, urination and defecation.

History of illness cont-1

3 months admittion, patient complained cough more often with a bit of white pleghm, blood (-), dyspnoe (+) no depend on activity and position, wheezing (-), chest pain (-), fever at night, chill (-), night sweat (+), loss of appetite, loss of weight, nausea (-), vomiting (-), fatigue (+). she wasnt take any drug. She had no problem in urination and defecation 1 week before addmition, patient complained cough more often with green- yellow , blood (-), hoarsenees, chest pain (-). She also complained breathing difficulty no depend on activity, weather, and not accompanied by soriumound. Beside that, fever at nigt, night sweat (+), loss of appetite and decreassed of her weight. She had no problem in urination and defecation.

History of ilness cont-2

3 hours before admittion, patient complained dificulty of her breath becoming severer. Its not influence by temperature or emotion. Cough with green-yellow pleghm, hoarseness, chest pain (-), fever (+), chills (+). She had no problem with urination and defecation.

History of past illness

Diabetic melitus is dinied No history of consuming anti tuberculoid drugs No history of consuming alcohol or smoking

History of familys diseases

There are no patients family who have the same complain

PHISYCAL EXAMINATION
General condition General condition Sicness condition : Conciousness : Nutrient : Dehydration : Blood preassure : Pulse rate : Respiration rate : Temperature : Body weight : Body lenght :

: sick moderate sickness compos mentis unadequat (-) 120/80 98x/minute 30x/minute 38,80C 36 kg 160 cm

Ph

Spesific condition Skin The skin is black brown. Efllourecention and scar (-), abnormal pigmentation (-), icteric (-). Lymph Glands There are no enlargment of the lymph node on submandibular, neck, axilaries, and inguinal Head Oval, symmetrical, puffy face (-), deformity (-), malar rash (-) Nose Epistaxis (-), normal nasal septum, normal mucous layer.

 Eyes Exopthalmus (+/+), edematous palpebra superior (-/-), pale of conjungtiva palpebra (-/-), icteric sclera (-/-). Good light response on both of eyes, symmetrical eyes movement. Ear Normal both of meatus accusticus externus Neck Jugularvein preassure (5-2) cmH2O, lymph nodes enlargment (-), tyroid gland enlargment (-), hypertrophy sternocleidomastoideus (-), siffness (-)

 Lung I : Symetrical of static and dynamic right and left are equal, hoarseness P : stemfremitus immeasurable P : stony-dull in all area of lung A : vesikuler increassed, rales moist (+) all lung area, wheezing (-)

 Cor I : ictus cordis is not seen P : ictus cordis is not palpable P : immeasureable A : HR=98x/minute, murmur (-), gallop (-) Abdomen I : flat P : soft, liver and spleen are not palpable, preasure pain (-). P : tympani A : bowel sound (+) normal

 Genital Not examinated Upper extremity Paint on joint (-), pale on finger (-), erythema of palmar (-), pitting edema (-) Lower extremity Pain on joint (-), varices (-), pale on foot (-), pitting edema (-)

Laboratory finding Sputum BTA I (+3) BTA II (+3) BTA III (+2) Hematology Hemoglobin : 10,4 g/dl (14-18, 12-16 g/dl) Leucocyte : 7100/mm3 (5000-10.000/mm3) LED : 90 (<10mm/jam, <15) Hitung Jenis Basofil : 0% (0-1%) Eosinofil : 1% (1-3%) Batang : 1% (2-6%) Segmen : 86% (50-70%) Limfosit : 10% (20-40%) Monosit : 2% (2-8%)

 Clinical Chemistry BSS : 132 mg/dl Total cholesterol : 203 mg/dl HDL-cholesterol : 17 mg/dl LDL-cholesterol : 112 mg/dl Triglyceride : 369 mg/dl Uric acid : 4,9 mg/dl Ureum : 35 mg/dl Creatinin : 0,7 mg/dl Natrium : 135 mmol/L Kalium : 3,9 mmol/L

(<200 mg/dl) (>55 mg/dl) (<130 mg dl) (<150 mg/dl) (3,5-7,1/2,6-6,0mg/dl) (15-39 mg/dl) (0,9-1,3 mg/dl) (135-150 mmol/L) (3,5-5 mmol/L)

Rontgen PA thorax

symetric thorax well-marked trachea good condition of bone widening of intercostal space infiltrat in all area of lung

RESUME
A 28 years old women, hospitalized since 27 agust 2008 with difficulty breathing since 3 hours before hospitalized. 6 months before hospitalized patient complained having a cough. First, cough without phlegm, a few days later cough accompanied by a bit white pleghm, blood (), breathing difficulty (-), chest pain (-). Cough recovered by itself, no take medications.Frequently cough about 1 week after. Patient also complained sometimes fever at night, chill (-), night sweat (+). 3 months before hospitalized, patient complained cough more often with a bit of white pleghm, blood (-), dyspnoe (+) no depend on activity and position, wheezing (-), chest pain (-), fever at night, chill (-), night sweat (+), loss of appetite, loss of weight, fatigue (+). She didnt take any drugs.

Resume cont 1

1 week before hospitalized, patient complained cough more often with green- yellow , blood (-), hoarsenees, chest pain (-). Beside that, fever at nigt, night sweat (+), loos of appetite and decreassed of her weight. 3 hours before hospitalized, patient complained dificulty of her breath becoming severer. Its not influence by temperature, emotion. Cough with greenyellow pleghm, hoarseness, chest pain (-), fever (+), chills (+). She had no problem with urination and defecation

RESUME CONt 2

No history of comsumpting antituberculosis drugs. From the phisical examination, we found patient in moderate sickness condition and compos mentis conciousness. Blood preasure 120/80, pulse rate 35x/menit, jugular vein preasure (5-2) cmH20. In lung examination we found increase of vesikuler, stony-dull in all area of lung, moderate moist rales (+) in all area of lung. In heart examination we found HR= 98x/menit.