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2. Profile of Tuberculosis with HIV patients in Saiful Anwar General Hospital, Malang Name : Daniel Raj Arumugam NIM : 0910714002

3. Tuberculosis • Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. • tuberculosis doesn’t only infect the lungs but also the other parts of the body named extrapulmonary tuberculosis • is an airborne disease – cough, sneeze contributes to disease transmission.

4. Tuberculosis with Human Immunodeficiency Virus Infection (HIV) • Tuberculosis takes advantage of a weakened immune system more easily • It is said to be 10 times more likely to develop active tuberculosis than someone without HIV.

5. Problem • How is the profile of tuberculosis with HIV patients hospitalized at the Saiful Anwar General Hospital, Malang in the year 2010 and 2011? Has there been increase in the number of patients and deaths of tuberculosis with HIV patients over the period of years?

6. Primary Objective • To obtain and analyze a research profile of tuberculosis with HIV patients hospitalized at the Saiful Anwar General Hospital, Malang of the year 2010 and 2011.

7. To identify the number of tuberculosis with HIV patients using Specific Objective Gender Educational Level Age Job Classification Daily Habits Mortality Classification Type of Discharge Chief Complaint

8. Benefits • As a base for further studies related to tuberculosis HIV coinfection • Can provide input to enhance service to tuberculosis patients • As a base to perform steps in particular to health promotion measures on tuberculosis.

9. Etiology • Caused by Mycobacterium complex; Mycobacterium tuberculosis, Mycobacterium bovis, Mycobacterium africanum, Mycobacterium microti and Mycobacterium canetti. • Mycobacterium tuberculosis is an acid fast bacillus

10. Patophysiology • Tuberculosis transmission occurs exclusively from human to human. • Tuberculosis is spread by airborne droplet nuclei. • They can be inhaled and subsequently entrapped in the distal airways and alveoli. • Bacilli are ingested by macrophages, transported to the lymphatic. • Development of an immune response  delayed type hypersensitivity reaction  leads decrease in bacilli

11. Some of them remain viable, or dormant, for many years latent tuberculosis infection @ asymptomatic (only under the tuberculin skin test detects infection) •  latent infection will progress to overt, active tuberculous disease

12. Diagnosis • Laboratory Test • Ziehl-neelsonstain identifies 50 – 80% of culture positive tuberculosis • Radiology Test • Tuberculin Test putting a small amount of tuberculosis protein under the top layer of skin on inner forearm.

13. Treatment • With tuberculosis, you must take antibiotics for at least six to nine months • people with latent tuberculosis infection have tuberculosis bacteria in their bodies, but THEY ARE NOT SICK because the bacteria are not active. • Latent tuberculosis may need just one type of tuberculosis drug meanwhile active tuberculosis, particularly if it's a drug-resistant strain, will require several drugs at once. • The most common medications used to treat tuberculosis include Rifampicin, Isoniazid, Ethambutol, and Pyrazinamide

14. Drug-resistant tuberculosis is caused by tuberculosis bacteria that are resistant to at least one first-line anti- tuberculosis drug • Multidrug-resistant tuberculosis (MDR TB) is resistant to more than one anti- tuberculosis drug and at least isoniazid (INH) and rifampin (RIF) • The treatment of HIV-related tuberculosis requires close monitoring because of frequent drug toxicities, possible drug-drug interactions,

15. DOT (Directly Observed Treatment) • DOT means that a trained health care worker or other designated individual (excluding a family member) provides the prescribed tuberculosis drugs and watches the patient swallow every dose.

16. Surgical Therapy • Surgery has a high success rate, but it also has a risk of complications, which may include infections other than tuberculosis or shortness of breath after surgery. • Surgery sometimes may be needed to remove or repair organs damaged by tuberculosis in parts of the body other than the lungs (extrapulmonarytuberculosis)

17. Prevention • The only type of tuberculosis that is contagious is the active variety • Best method in making sure tuberculosis doesn’t transmit is by staying at home. • A proper ventilation of the room is essential as tuberculosis germs spread more easily in small closed spaces where air doesn't move. • Patients are also advised to cover their mouth by using a tissue or a handkerchief or wearing a mask.

19. Hypothesis • There is no significant difference of profile variables in tuberculosis patients with HIV in Saiful Anwar General Hospital between the year 2010 and 2011.

20. Method Design • This research is constructed with a descriptive with analytic approach research method on the Profile of Tuberculosis with HIV Patients at Saiful Anwar General Hospital of the year 2010 and 2011.

21. Research Results ;Age Interval

22. Gender

23. Educational Level

24. Job classification

25. Daily habits

26. Chief complaints

28. Type of discharge

29. Mortality classification

31. Discussion • Total number of patients: 2010 = 86 2011 = 83 2002 = 132 • This shows a steep reduction in the number of tuberculosis patients over the past 9 years.

32. Total number of patients based on age intervals 2010  0 – 35 = 72.1% ; >35 = 27.9% 2011  0 – 35 = 80.7% ; >35 = 19.3% Shows a slight increase in number of patients classified under the age interval 0 – 35 years.

33. Total number of cases based on gender 2010  Men = 64 ; Female = 22 2011  Men = 53 ; Female = 30 Most men suffer from tuberculosis than women Could be due to the greater amount of involvement of men than women in many issues – socially, jobs and etc.

34. Total number of cases based on educational level 2010  SLTP = 45.5% ; SLTA = 54.5% 2011  SLTP = 45.8% ; SLTA = 54.2% • Shows almost no difference from 2010 to 2011

35. Highest number of cases classified under job classification 2010  Private sector = 45.3% ; Jobless = 9.3% ; Government sector = 7.0% 2011  Private sector = 56.7% ; Jobless = 7.2% ; Student = 4.8% • Most patient admitted are from the private sector

36. Most frequent daily habit amongst patients = cigarette smoking 2010  50% 2011  71.8% • Smoking damages the lungs and can make smokers more susceptible to tuberculosis infection

37. Most number of cases based on chief complaint 2010  weakness of body = 24.4% ; shortness of breath = 22.1% 2011  coughing = 26.6% ; shortness of breath = 19.3% • HIV positive patients with tuberculosis may have the classic symptoms of tuberculosis.

38. Total number of cases based on mortality rate 2010  30.2% 2011  34.9% 2002  7.58% • This shows a steep increase in the number of death amongst tuberculosis with HIV patients over the past 9 years.

39. Cause of death amongst tuberculosis with HIV patients which records to be the highest  sepsis 2010  40% 2011  34.7% • Serious medical condition where chemicals released into the blood to fight infection, trigger widespread inflammation may result in organ damage

40. Conclusion • The number of cases admitted in the year 2010 and 2011 are 86 and 83 respectively. This shows a great reduction in the number of patients since the year 2002 which had 132 cases recorded. • The highest total number of tuberculosis patients based on the age group between the ages of 0 – 35 years. Nonetheless, the incidence of the tuberculosis disease in males is higher compared to females. • Most patients had acquired SLTA education level. • Most patients work under the private sector with a percentage of 45.3% and 56.7% in the year 2010 and 2011 respectively.

41. The number of patients smoke cigarettes are the highest in the year 2010 and 2011. • In the year 2010, most patients admitted with main complaint of weakness of the body with a percentage of 24.4% meanwhile in the year 2011, the most number of patients admitted complaint of coughing with a percentage of 26.6%. • The number of patients who died had increased slightly in about 4.7%. • In the year 2010 and 2011, the highest number of patients had died of sepsis with a percentage of 53.9% and 41.6% respectively.

42. Recommendations • People classified under productive group age should start considering on gaining knowledge regarding the disease as they have to prevent themselves from getting infected. • People with low levels of education should receive more attention in tuberculosis eradication programs and counseling while not forgetting the people with higher education levels. • The hospital is expected to further improve patient care in the treatment of tuberculosis and more attention in preventing the occurrence of various causes of death of patients, which could help reduce tuberculosis mortality.

43. The hospital management with the evidence of the data provided from this study should conduct awareness program in schools, community centers and also in the rural places to help provide valuable information about the tuberculosis disease to the public. • Staff nurses, physicians, or young doctors are expected to state inputs more accurately and complete in charge of data in medical records in particular data on education level, job classification, daily habits, and chief complaints,

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