Tesis

Terapi Nutrisi pada Pasien Meningitis Tuberkulosis dengan Tuberkulosis Paru = Nutritional Therapy in Patients Tuberculous Meningitis with Pulmonary Tuberculous.

Latar Belakang: Mycobacterium tuberculosis merupakan penyebab tuberkulosis pada paru dan organ lain, seperti meningen (meningitis tuberkulosis). Meningitis tuberkulosis dapat merupakan komplikasi tuberkulosis primer, yang bersifat laten/asimptomatik, namun risiko reaktivasi meningkat pada penurunan sistem imun/malnutrisi. Disfagia, defisit kognitif, hemiparese, dan ketidakmampuan makan mandiri juga dapat menyebabkan malnutrisi, sehingga akan meningkatkan lama rawat dan mengganggu perbaikan kapasitas fungsional. Tatalaksana nutrisi diperlukan untuk meminimalisasi kehilangan berat badan, mendapatkan imbang nitrogen positif, dan menyediakan nutrisi untuk membangun system imun. Pada pelaksanaannya, pemberian nutrisi harus memperhatikan kondisi klinis serta komplikasi berupa peningkatan tekanan intrakranial dan defisit neurologi yang terjadi. Metode: Laporan serial kasus ini menguraikan empat kasus meningitis tuberkulosis dengan tuberkulosis paru. Semua pasien datang dengan penurunan kesadaran dan telah terdiagnosis tuberkulosis paru sebelumnya, namun pasien minum obat tidak sesuai dengan anjuran dokter. Status gizi keempat pasien adalah malnutrisi ringan dan berat, obes 1 dan normal. Selama dirawat, tatalaksana nutrisi diberikan sesuai pedoman terapi nutrisi untuk penderita tuberkulosis. Asupan makronutrien diberikan meningkat bertahap sesuai kondisi klinis dan toleransi pasien. Suplementasi mikronutrien juga diberikan. Pemantauan meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, keseimbangan cairan, dan kapasitas fungsional. Hasil: Dua orang pasien menunjukkan perbaikan klinis, kapasitas fungsional, hasil laboratorium, toleransi asupan, dan outcome, sedangkan dua orang lainnya mengalami perburukan dan meninggal pada hari perawatan ke-44 dan ke-24. Kesimpulan: Dukungan nutrisi infeksi tuberkulosis pada paru dan susunan saraf, dapat memberikan manfaat untuk pemulihan pasien.
Kata Kunci: meningitis tuberkulosis, tuberkulosis paru, malnutrisi, terapi nutrisi, outcome klinis.


Objective: Mycobacterium tuberculosis is the cause of tuberculous in the lung and other organs, such as the meninges (tuberculous meningitis). Tuberculous meningitis can be a complication of primary tuberculous, latent/asymptomatic, but the risk of reactivation increases to a decrease in the immune system/malnutrition. Dysphagia, defisit kognitif, hemiparese, and inability to eat independently can also cause malnutrition, thereby increasing the length of stay and interfere with the functional capacity improvement. Management of nutrients needed to minimize the lose weight, get a positive nitrogen balance, and provide nutrients for building the immune system. In practice, the nutrition must consider the clinical condition and the complications in the form of increased intracranial pressure and neurological deficits that occur. Methods: This case series report outlines four cases of tuberculous meningitis with pulmonary tuberculous. All patients present with loss of consciousness and have been diagnosed with pulmonary tuberculous before, but patients taking the medicine does not comply with doctor's advice. Nutritional status of the four patients was mild and severe malnutrition, obese and normal one. During the treatment, management of nutrition was given according to the guidelines of nutrition therapy for patients with tuberculosis. Macronutrient intake increased gradually given appropriate clinical condition and patient tolerance. Micronutrient supplementation are also given. Monitoring included subjective complaints, hemodynamic, analysis and tolerance intake, laboratory tests, anthropometric, fluid balance, and functional capacity. Results: Two patients showed clinical improvement, functional capacity, laboratory results, tolerance intake, and outcome, while two other people suffered deterioration and died on the 44 th and 24 th day of treatment. Conclusion: Nutritional support tuberkulosis infection in the lungs and nervous system, can provide benefit to the patient's recovery.
Key Word: tuberculous meningitis, pulmonary tuberculous, malnutrition, nutrition therapy, clinical outcome.