Curriculum Vitae

Dr. dr. PRAYUDI SANTOSO, SpPD-KP, M.Kes, FCCP, FINASIM

E-mail: prayudimartha@yahoo.com prayudi@unpad.ac.id

Education : Occupation :
MD FK Universitas Padjadjaran Bandung Staf of Respirology & Critical Ill, Departement of Internal
Internist FK Universitas Padjadjaran Bandung Medicine, Faculty of Medicine, Universitas Padjajaran / Hasan
Consultant KIPD Sadikin General Hospital, Bandung – Indonesia
MSc FK Universitas Padjadjaran Bandung Coordinator of MDR TB Hasan Sadikin General Hospital
PhD FK Universitas Padjadjaran Bandung Member of Coach TB Nasional
Member of Working Group of National MDR-TB Indonesia
Member of COVID-19 Hasan Sadikin General Hospital
National TB Coach

Organization :
West Java Society of Internal Medicine (PAPDI Jabar)
Indonesian Society of Respirology (PERPARI)
Fellow American College of Chest Physcian (ACCP)
Member European Respiratory Society (ERS)
TUBERKULOSIS EKSTRA
PARU
Dr. dr. Prayudi Santoso, Sp.PD-KP, M.Kes, FCCP,FINASIM
Respirology and Critical Care Division
Internal Medicine Department
Padjadjaran Medical Faculty / Hasan Sadikin General Hospital
Bandung-2022
prayudi@unpad.ac.id
Definition TB
• Tuberculosis : systemic infection caused by Mycobacterium
tuberculosis
• Extrapulmonary TB accounts for 20-30% of all active TB cases
• The diagnosis and treatment of extrapulmonary TB are challenging
EPTB in Immunocompromised persons
1. HIV / AIDS
2. Immunocompromised individual (other than HIV / AIDS)
• Solid organ and stem cell transplants
• Tumor-necrosis factor (TNF-α) blocking medication
• Renal failure
• Corticosteroid medication
• Neoplasia / malignancy
• Diabetes
• Silicosis
• Gastro-intestinal surgery
• Aging
Baykan et al. Insights into Imaging (2022) 13:39
Case Definition of EPTB
Case Definition
Presumptive A patient with symptoms and signs of EPTB who needs to be
investigated.
Bacteriologically confirmed case A patient who has a microbiological diagnosis of EPTB based on
positive microscopy, culture or a validated PCR-based tests.
Clinically diagnosed case A patient with negative microbiological tests for TB (microscopy,
culture, and validated PCR-based tests), but with strong clinical
suspicion and other evidence of EPTB, such as compatible imaging
findings, histological findings, ancillary diagnostic tests or response
to anti-TB treatment

TB: tuberculosis; EPTB: extra-pulmonary tuberculosis; PCR: polymerase chain reaction

SK Sharma et al. Expert review of respiratory medicine. 2021. 15(7):931-48

Extrapulmonary TB, diagnosis
The general symptoms of TB disease, pulmonary or extrapulmonary
• Weight loss
• Fatique
• Malaise
• Fever
• Night sweats
Extrapulmonary TB, diagnosis
The symptoms of extrapulmonary TB disease depend on site of
disease
For example:
• TB on spine may cause pain in the back;
• TB on kidney may cause blood in the urine;
All of these symptoms may cause by other disease, but they should
prompt the clinical to suspect TB disease.
Extrapulmonary TB, diagnosis
Previous TB infection or TB disease

The medical history

Simultaneous Pulmonary TB
• 33% of EPTB cases Chest X-ray

Nonspecific changes in blood test biochemistry

Clinical Clues to Promt Suspicion of
Extrapulmonary Tuberculosis
• HIV infection
• Joint inflammation (monoarticular) with negative bacterial cultures
• Persistent sterile pyuria
• Tuberculosis-endemic country of origin
• Unxeplained pericardial effusion, constrictive pericarditis, or
pericardial calcification
• Vertebral osteomyelitis involving the thoracic spine

Golden MP, Vikram HR. American Family Physician, 2005;72:1761-8

Clinical Suspicion of EPTB
Summary of EPTB Disease
Summary of EPTB Disease
Sensitivity and Specificity
Sensitivity and Specificity
Treatment
• The basic principles that underline the treatment of pulmonary TB,
also apply to EPTB
• Usually 6-9 month regimen (2 + 4 – 7 months)
• TB meningitis 9 – 12 months (some authors – up to 2 years)

Some patients being treated for TB meningitis develop tuberculomas

during therapy, perhaps as a form of paradoxal reaction.
This does not necessarily indicated treatment failure.

Am J Respir Crit Care Med, 2003;167:603-22

Summary of WHO Guidelines
Summary of WHO Guidelines