Respir Case Rep. 2019; 8(3): 86-93 | DOI: 10.5505/respircase.2019.09825

Ýmmünkompetent Bir Hastada Masif Yaygýn Tüberküloz: Endemik Bir Ülke Endonezya'dan Erken Taný ve Ampirik Tedavi Yaklaþýmý (Olgu Sunumu ve Literatür Deðerlendirmesi)

Allen Widysanto¹, Audrey Suryani Soetjipto², Nata Pratama Lugito^3
1Siloam Lippo Village Karawaci, Pelita Harapan Üniversitesi, Göðüs Hastalýklarý Bölümü, Tangerang, Endonezya
²Pelita Harapan Üniversitesi, Pratisyen Hekim, Tangerang, Endonezya
³Siloam Lippo Village Karawaci, Pelita Harapan Üniversitesi, Ýç Hastalýklarý Kliniði, Tangerang, Endonezya

Tüberküloz (TB), yüzyýllardýr bu hastalýðý yenmek için verilen çabalara raðmen hala yaygýndýr. Endonezya, saðlýk hizmetlerine; özellikle de yüksek derecede duyarlý ve spesifik moleküler araþtýrmaya eriþime eþit olmayan bir daðýlýmýyla, dünyadaki toplam TB yükünün en yüksek olduðu üçüncü ülkedir. Enfeksiyonun kontrol altýna alýnmasý için hýzlý ve doðru TB tanýsý çok önemlidir. ARB smear testi (balgam yayma), kolayca eriþilebilir ve uygun maliyetli bir testtir. Ancak, bazý eksiklikleri vardýr. Akciðer, perikardiyal, peritoneal, utero-over, genitoüriner ve dalak tutulumu ile ikinci basamak bir saðlýk tesisine baþvuran, öncesinde saðlýklý 23 yaþýndaki Endonezyalý bir kadýnda, ARB yayma negatif dissemine tüberküloz (TB) saptadýðýmýz olguyu sunuyoruz. Klinisyen, hastanýn kliniði ve hastalýðýn endemik epidemiyolojisini göz önüne alarak, pozitif mikrobiyoloji ve tanýsal biyopsi sonucu olmadan anti-tüberküloz tedavisine baþlamayý tercih etti. Anti-tüberküloz tedavinin baþlanmasýndan 2 ay sonra ortaya çýkan pozitif mikobakteriyel kültür ile taný doðrulandý. Ayrýca, diðer ülkelerden bildirilen 20 adet immünokompetan dissemine tüberkülozularý da inceledik.

Anahtar Kelimeler: yaygýn tüberküloz, taný, endemik, immünkompetent

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Massive Disseminated Tuberculosis in an Immunocompetent Patient: Early Diagnostic and Empiric Treatment Approach from an Endemic Country: Indonesia (A Case Report and Literature Review)

Allen Widysanto¹, Audrey Suryani Soetjipto², Nata Pratama Lugito^3
1Department Of Pulmonary And Respiratory Medicine, Siloam Lippo Village Karawaci, Pelita Harapan University, Tangerang, Indonesia
²General Practitioner, Pelita Harapan University, Tangerang, Indonesia
³Department Of Internal Medicine, Siloam Lippo Village Karawaci, Pelita Harapan University, Tangerang, Indonesia

Tuberculosis is still rampant, despite the centuries of efforts to conquer it. Indonesia is host to the third highest TB burden in the world, with an uneven distribution of health care access, and especially to highly sensitive and specific molecular investigations. Rapid and accurate TB diagnosis is crucial for the control of the infection. An AFB smear test is easily accessed and is cost-effective, although there are a number of shortcomings with the approach. We report here on a case of negative acid-fast bacilli (AFB) smear disseminated tuberculosis (TB) in a previously healthy 23-year-old Indonesian female who presented to a secondary care facility with pulmonary, pericardial, peritoneal, utero-ovarian, genitourinary and splenic involvement. The clinician chose to start anti-tuberculosis therapy without a positive microbiology and biopsy for bacterial load containment purposes, considering also the patient’s clinical and endemic epidemiology. The diagnosis was confirmed with a positive mycobacterial culture after the initiation of anti-tuberculosis therapy. In the present study, we also review the diagnosis of 20 other cases of disseminated tuberculosis reported in other countries.

Keywords: Disseminated TB, diagnosis, endemic, immunocompetent

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ATIF KOPYALA