Lepra Refarat

8/17/2019 Lepra Refarat

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BAGIAN ILMU KESEHATAN KULIT DAN KELAMIN REFERAT

FAKULTAS KEDOKTERAN MARET 2016

UNIVERSITAS HASANUDDIN

KUSTA

DISUSUN OLEH:

Amir Farid Bin Aminuddin 111 12 !06

A"#ira Nur$ida#u Bin%i A"$ri 111 12 !0&

Hanna Ami'ra Bin%i A(du) Ra*a+ Bur+' 111 12 !0!

Nuru) Sa,ia$ Hami*a$ Bin%i Su$aimi 111 12 !0-

.EMBIMBING:

Dr/ D#a$ .ra%ii

DIBAAKAN DALAM RANGKA TUGAS KE.ANITERAAN KLINIK

.ADA BAGIAN ILMU KESEHATAN KULIT DAN KELAMIN

FAKULTAS KEDOKTERAN UNIVERSITAS HASANUDDIN

MAKASSAR

2016



PENDAHULUAN

End'mi+ di India dan Timur au$ "'3a+ *aman +un4 5 +u"%a ada)a$

diim4r +' Er4a ada a(ad +'785 mun9+in d'n9an a"u+an A)'and'r/ a(a$ ini

m'n;aai un;a+n#a ada a(ad +' 1< di 'r4a$ 5 )a)u 'r)a$an7)a$an m'n9$i)an9/

Ba$+an "'%')a$ 'n'muan dari a9'n 5 M/ )'ra' 5 4)'$ Armau'r Han"'n di

N4r'9ia ada 1!&< =(a"i) 'r%ama di+ai%+an d'n9an 'n#a+i% manu"ia>5 #an9

('r"i,a% m'nu)ar +u"%a %ida+ muda$ di%'rima/ M'r'+a m'm'r;a#ai 'n#a+i% +u"%a

diari"i 4)'$ +')uar9a dan +'#a+inan ini5 dan +'%a+u%an a+an +';a;a%an #an9

di"'(a(+an 4)'$ +u"%a 5 %')a$ m'm('ri +4n%ri(u"i ada "%i9ma dan dia"in9+an

#an9 m'n3adi "i+a %'r$ada '"a+i% +u"%a/ .andan9an ma"#ara+a% %'%a m'n3adi

$am(a%an u%ama un%u+ 'n9'nda)ian +u"%a5m'"+iun +'ma3uan da)am

(a+%'ri4)49i5 +'m4%'rai dan 'id'mi4)49i/?2@

Ma"a)a$ 'id'mi4)49i ma"i$ (')um %'r';a$+an5 ;ara 'nu)aran (')um

di+'%a$ui a"%i $an#a ('rda"ar+an an99aan +)a"i+ #ai%u m')a)ui +4n%a+ )an9"un9

an%ar+u)i% #an9 )ama dan 'ra%/ An99aan +'dua ia)a$ "';ara in$a)a"i5 "'(a(

M.leprae ma"i$ daa% $idu ('('raa $ari da)am dr4)'%/ =2>

Ku"%a di+'na) 3u9a d'n9an nama Leprosy a%au M4r(u" Han"'n =MH>/

Ku"%a %'rma"u+ 'n#a+i% %'r%ua/ Ka%a +u"%a ('ra"a) dari (a$a"a India +u"%$a5

di+'na) "'3a+ 1800 %a$un "'(')um Ma"'$i/ Ka%a +u"%a da)am +i%a( in3i)5

%'r3'ma$an dari (a$a"a H'(r' *araa%$5 #an9 "'('narn#a m'n;a+u ('('raa

'n#a+i% +u)i% )ainn#a/ T'rn#a%a (a$a (')(a9ai d'"+ri"i m'n9'nai 'n#a+i% ini

"an9a% +a(ur5 aa(i)a di(andin9+an d'n9an +u"%a #an9 +i%a +'na) "'+aran9/ Ku"%a

m'rua+an 'n#a+i% in,'+"i #an9 +r4ni+5 dan 'n#'(a(n#a ia)a$ Mycobacterium



leprae (M. leprae) #an9 ('r"i,a% in%ra"')u)'r 4()i9a%/ Sara, 'ri,'r "'(a9ai a,ini%a"

'r%ama5 )a)u +u)i% dan mu+4"a %ra+%u" r'"ira%4riu" (a9ian a%a"5 +'mudian daa%

+' 4r9an )ain +';ua)i "u"unan "ara, u"a%/ Kuman 'n#'(a( ada)a$

Mycobacterium leprae #an9 di%'mu+an 4)'$ G/A/Han"'n ada %a$un 1!&8 di

N4r'9ia5 #an9 "amai "'+aran9 (')um 3u9a daa% di(ia++an da)am m'dia

ar%i,i"ia)/ Dia9n4"i" 'n#a+i% +u"%a dida"ar+an 9am(aran +)ini"5 (a+%'ri4"+4i"5

dan $i"%4a%4)49i"/?1@

4na "'+%rum +u"%a di+)a"i,i+a"i #ai%u m'nuru% Rid)'# dan 4)in95

Madrid5 HO dan .u+'"ma"/ Rid)'# dan 4)in9 m'm'r+'na)+an i"%i)a$

"'+%rum d'%'rmina%' ada 'n#a+i% +u"%a #an9 %'rdiri a%a" ('r(a9ai %i' a%au

('n%u+5 #ai%u tuberculoid (TT), borderline tuberculoid (BT), borderline (BB),

borderline lepromatous (BL) and lepromatous (LL).?2@ B'n%u+ %i' +)ini"

('r9an%un9 ada "i"%'m imuni%a" "')u)'r =SIS>/ SIS (ai+ a+an %ama+ 9am(aran

+)ini" +'ara$ %u('r+u)4id5 "'(a)i+n#a SIS r'nda$ a+an m'm('ri+an 9am(aran

)'r4ma%4"a/ Un%u+ 'nan9anan r'a+"i +u"%a di)a+u+an ('rda"ar+an %i' r'a+"i

dan ('ra% rin9ann#a r'a+"i #an9 dia)ami/ Aa(i)a da)am a+%u 2 "amai < %a$un

(a+%'ri4"+4i+ (')um n'9a%i, ma+a 'n94(a%an di)an3u%+an $in99a (a+%'ri4"+4i+

n'9a%i,/ ?1@

Tu3uan dari 'nu)i"an r','ra% ini ada)a$ un%u+ m'n9'%a$ui d',ini"i dari

+u"%a5 '%i4)49in#a5 9'3a)a dan %anda #an9 mun;u)5 ;ara m'n'9a++an dia9n4"an#a5

"'r%a 'na%a)a+"aann#a #an9 %'a%/



DISKUSI

DEFINISI

Ku"%a m'rua+an 'n#a+i% in,'+"i #an9 +r4ni+5 dan 'n#'(a(n#a ada)a$

M.leprae #an9 ('r"i,a% in%ra"')u)'r 4()i9a%/ Sara, 'ri,'r "'(a9ai a,ini%a" 'r%ama/

La)u +u)i% +'mudian mu+4"a %ra+%u" r'"ira%4riu" (a9ian a%a"5 +'mudian daa% +'

4r9an )ain +';ua)i "u"unan "ara, u"a%/ =15<518>

ETIOLOGI

Kuman 'n#'(a( ada)a$ Mycobacterium leprae #an9 di%'mu+an 4)'$

G/A/Han"'n ada %a$un 1!&8 di N4r'9ia5 #an9 "amai "'+aran9 (')um 3u9a

daa% di(ia++an da)am m'dia ar%i,i"ia)/ Mycobacterium leprae ('r('n%u+ (a"i)

d'n9an u+uran <7! Um 05 Um5 %a$an a"am dan a)+4$4)/ =1> Mycobacterium

leprae daa% $idu ada "u$u <07<<4 #ai%u di(aa$ "u$u %u(u$ dan m'mun#ai

ma"a $idu #an9 )ama 12718 $ari/

=25>

Mycobacterium leprae 3u9a ('r"i,a% n4nm4%i)5 n4n "4ra5 dan m'rua+an 9ram74"i%i, #an9 ('r"i,a% )'ma$/ Mi+4(a+%'ri

ini m'rua+an %urunan A;%in4m#;'%a)'"5 #an9 m'nun3u++an 'r"amaan d'n9an

(a+%'ri "''r%i Corynebacterium5 Nocardia5 dan Rhodococcus/ Ba+%'ri ini 3u9a

m'n9$a"i)+an a"am mi+4)i+ #an9 m'main+an 'ran 'n%in9 da)am "%ru+%ur dan

,un9"i dindin9 "')/=651051> Mycobacterium leprae5 ia)a$ %i' (a+%'ri in%ra"')u)'r

4()i9a% #an9 m'n9in,'+"i "')7"') S;$ann "'(a9ai %ar9'% u%ama/ Ba9ian #an9

%'rin,'+"i a+an m'nu3u++an ma+r4,a9 #an9 a9a+ ('r(u"a #an9 di+'na)i "'(9ai

‘foamy machrophae! #an9 di'nu$i d'n9an )iid7)iid dr4)'% #an9 di"'(a(+an

4)'$ M. leprae/ Ini m'nun3u++an "i,a% M. leprae #an9 m'm'r)u+an )'ma+ un%u+

%um('"aran di da)am ma+r4,a9/ =11>



EPIDEMIOLOGI

Ma"a)a$ 'id'mi4)49i ma"i$ (')um %'r';a$+an5 ;ara 'nu)aran (')um

di+'%a$ui a"%i $an#a ('rda"ar+an an99aan +)a"i+ #ai%u m')a)ui +4n%a+ )an9"un9

an%ar+u)i% #an9 )ama dan 'ra%/ An99aan +'dua ia)a$ "';ara in$a)a"i5 "'(a(

M.leprae ma"i$ daa% $idu ('('raa $ari da)am dr4)'%/ =1> 4r)d H'a)%$

Or9ani*a%i4n =HO> %')a$ m')'%a++an 'n#a+i% +u"%a "'(a9ai ma"a)a$ 9)4(a)

"'$in99a ian#a $aru" di'ridi+a"i "';ara %4%a) dan ariurna di n'9ara7n'9ara

dimana an9+a r'C')an"in#a %in99i/ .'n#a+i% +u"%a ini di)a4r+an 'nd'mi+ di

('('raa (ua$ n'9ara #ai%u Bra*i)5 Ind4n'"ia dan India #ai%u "'(an#a+ !0

dariada %4%a) +a"u" #an9 di;a%a+an/ =>

Di Ind4n'"ia 'nd'ri%a ana+7ana+ di (aa$ umur 18 %a$un didaa%+an

+uran9 )'(i$ 115<- 5 %'%ai ana+ di (aa$ umur 1 %a$un 3aran9 "'+a)i/ Saa% ini

u"a$a 'n;a%a%an 'nd'ri%a di (aa$ u"ia 1 %a$un 'n%in9 di)a+u+an un%u+ di;ari

+'mun9+inan ada %ida+n#a +u"%a +4n9'ni%a)/ Fr'+u'n"i %'r%in99i %'rdaa%

ada+')4m4+ umur an%ara 2 7< %a$un/=1>

S')ama 'ri4d' 200!7201<5 an9+a 'n'muan +a"u" (aru +u"%a ada %a$un

201< m'rua+an #an9 %'r'nda$ #ai%u "'('"ar 65&- 'r 100/000 'ndudu+/

S'dan9+an an9+a r'Ca)'n"i +u"%a ('r+i"ar an%ara 05&- $in99a 05-6 'r 10/000

=&5- $in99a -56 'r 100/000 'ndudu+> dan %')a$ m'n;aai %ar9'% 1 'r 10/000

'ndudu+ = 10 'r 100/000 'ndudu+>/ .ada %a$un 201< di)a4r+an 16/!6 +a"u"

(aru +u"%a5 )'(i$ r'nda$ di(andin9+an %a$un 2012 #an9 "'('"ar 1!/--8 +a"u"/

S'('"ar !<58 +a"u" di an%aran#a m'rua+an %i' Mu)%i Ba"i)'r/ S'dan9+an

m'nuru% 3'ni" +')amin5 <5& 'nd'ri%a ('r3'ni" +')amin 'r'muan/ M'nuru%

r4Cin"i5 Ka)iman%an S')a%an5 DKI a+ar%a5 dan Riau m'rua+an %i9a r4Cin"i

d'n9an r44r"i +u"%a MB %'r%in99i ada %a$un 201< #ai%u ma"in97ma"in9 "'('"ar

-<5&-5 -25-<5 dan -25-/ .r4Cin"i d'n9an r44r"i +u"%a ada ana+ %'r%in99i

#ai%u Nu"a T'n99ara Timur =8<580>5 .aua Bara% =<051>5 dan Suma%'ra U%ara

=2!5&>/ =12>



PATOGENESIS

M. leprae m'mun#ai a%49'ni%a" dan da#a inCa"i #an9 r'nda$5 "'(a(

'nd'ri%a #an9 m'n9andun9 +uman )'(i$ (an#a+ (')um %'n%u m'm('ri+an 9'3a)a

#an9 )'(i$ ('ra%5 (a$+an daa% "'(a)i+n#a/ K'%ida+ "'im(an9an an%ara d'ra3a%

in,'+"i d'n9an d'ra3a% 'n#a+i%5 %ida+ )ain di"'(a(+an 4)'$ r'"4n" imun #an9

('r('da =1<>5 #an9 m'n99u9a$ %im(u)n#a r'a+"i 9ranu)4ma "'%'ma% a%au

m'n#')uru$ #an9 daa% "'m(u$ "'ndiri a%au r49r'"i,/ O)'$ +ar'na i%u5 'n#a+i%

ini daa% di"'(u% "'(a9ai 'n#a+i% imun4)49i+/ G'3a)a +)ini"n#a )'(i$ "'(andin9

d'n9an %in9+a% r'a+"i "')u)arn#a dariada in%'n"i%a" in,'+"in#a/ =1>

.a%49'n'"i"

'n#a+i% +u"%a di+ai%+an d'n9an port of entry #ai%u ;ara ma"u+n#a (a+%'ri

M.leprae +'da)am %u(u$/ .'r%ama ia)a$ 'nu)aran m')a)ui +4n%a+ #ai%u +4n%a+

+u)i% d'n9an +u)i% "';ara )an9"un9 #an9 'ra%5 )ama dan ('ru)an9/ M.leprae

%'ru%ama m'ma"u+i %u(u$ manu"ia m')a)ui )'"i +u)i% a%au "'%')a$ %rauma5

a)auun di+a%a+an (a$a 'nu)aran m')a)ui +u)i% #an9 in%a+ 3u9a mun9+in

%'%ai )'(i$ "u)i%/ an9 +'dua ia)a$ 'nu)aran m')a)ui in$a)a"i d'n9an m')a)ui

"a)uran 'rnaa"an #ai%u 'r;i+an )uda$5 di mana M.leprae %ida+ m'n9a+i(a%+an)'"i ada aru7aru +ar'na "u$u ada aru7aru #an9 %in99i %'%ai )an9"un9 ma"u+

+' a)iran dara$/ Dari a)iran dara$ M.leprae +'mudian daa% m'n;aai "ara, %'i

dan di,a94"i% "') ";$ann dan ('rmu)%i)i+a"i di da)amn#a/ Ti' 'nu)aran #an9

+'%i9a ia)a$ m')a)ui in9'"%i"a)uran 'n;'rnaan/ Ti' ini +$u"un#a m'ru3u+

+'ada i(u m'n#u"u +ar'na air "u"u i(u #an9 m'nd'ri%a +u"%a )'r4ma%4"a

m'n9andun9 "an9a% (an#a+ (a+%'ri #an9 $idu5 namun in"id'n +u"%a ada (a#i

#an9 minum "u"u dari i(u #an9 m'nd'ri%a +u"%a )'r4ma%4"a $an#a "'%'n9a$ (i)a

di(andin9+an d'n9an (a#i #an9 minum "u"u (4%4)/ Ha) ini m'nun3u++an (a$a

'nu)aran m')a)ui air "u"u ma"i$ di'r%an#a+an/ =6>

GEJALA KLINIS

B'n%u+ %i' +)ini" ('r9an%un9 ada "i"%'m imuni%a" "')u)'r =SIS>/ SIS (ai+

a+an %ama+ 9am(aran +)ini" +'ara$ %u('r+u)4id5 "'(a)i+n#a SIS r'nda$ a+an

m'm('ri+an 9am(aran )'r4ma%4"a/ Ti' I a%au indeterminate %ida+ %'rma"u+

da)am "'+%rum/ TT ada)a$ %i' %u('r+u)4id 4)ar5 #a+ni %u('r+u)4id 1005



m'rua+an %i' #an9 "%a(i) "'$in99a %ida+ mun9+in ('ru(a$ %i'/ B'9i%u 3u9a LL

ada)a$ %i' )'r4ma%4"a 4)ar m'rua+an )'r4ma%4"a 100 #an9 "%a(i)/

S'dan9+an %i' an%ara Li dan Ti di"'(u% %i' borderline a%au ;amuran5 ;amuran

an%ara %u('r+u)4id dan )'r4ma%4"a/ BB ada)a$ %i' ;amuran #an9 %'rdiri dari

0 %u('r+u)4id dan 0 )'r4ma%4"a/ BT dan Ti )'(i$ (an#a+ %u('r+u)4idn#a5

"'dan9+an BL dan Li )'(i$ (an#a+ )'r4ma%4"an#a/ Ti'7%i' ini m'rua+an %i'

#an9 )a(i)5 "'$in99a (i"a ('(a" ('ra)i$ %i' +'ara$ TT a%au LL/ 4na "'+%rum

+u"%a m'nuru% ('r(a9ai +)a"i,i+a"i daa% di)i$a% ada %a()' di(aa$ ini/ =15251<>

K)a"i,i+a"i 4na "'+%rum +u"%a

Rid)'# 4)in9 TT5 Ti5 BT5 BB5 BL5 Li5 LL

Madrid Tu('r+u)4id5 B4rd'r)in'5 L'r4ma%4"a

HO .au"i(a"i)ar5 Mu)%i(a"i)ar

.u"+'"ma" .au"i(a"i)ar5 Mu)%i(a"i)ar

Ta(') 1/ 4na S'+%rum Ku"%a

Kara+%'ri"%i+ .B =.au"i(a"i)ar> MB =Mu)%i(a"i)ar>

L'"i Ku)i% =Ma;u)a #an9

da%ar5 au) #an9 m'nin99i5

in,i)%ra%5 )a+ 'ri%'m5 n4du">

17 L'"i

Hi4i9m'n%a"i Eri%'ma

Di"%ri(u"i %ida+ "im'%ri"

L'"i

Di"%ri(u"i )'(i$ "im'%ri"

K'ru"a+an "ara, =$i)an9n#a

"'n"a"i+')'ma$an 4%4% #an9

di'r"ara,i 4)'$ "ara, #an9

%'r+'na>

Hi)an9n#a "'n"a"i #an9

$')a"

Han#a "a%u ;a(an9 "ara,

Hi)an9n#a "'n"a"i +uran9

3')a"

Ban#a+ ;a(an9 "ara,

BTA N'9a%i, .4"i%i,

Ti' Ind'%'rmina%' =I>5

Tu('r+u)4id =T>5 B4rd'r)in'Tu('r+u4id =BT>

L'r4ma%4"a =LL>5

B4rd'r)in' )'r4ma%4u"=BL>5 Mid (4rd'r)in' =BB>

Ta(') 2/ .'r(andin9an M4r(u"7Han"'n .B =.)au"i(a"i)ar> dan MB =Mu)%i(a"i)ar>

Kara+%'ri"i%i+ Tu('r+u)4id B4rd'r)in'

Tu('r+u)4id

Ind'%'rmina%'

L'"i

Ti' Ma;u)a a%au ma;u)a Ma;u)a di(a%a"i Ma;u)a



di(a%a"i in,i)%ra% in,i)%ra%

um)a$ Sa%u a%au ('('raa Sa%u d'n9an )'"i

"a%')i%

Sa%u a%au ('('raa

Di"%ri(u"i T'r)4+a"i dan

a"im'%ri"

A"im'%ri" B'rCaria"i

.'rmu+aan K'rin95 S+uama K'rin95 S+uama Daa% $a)u" a9a+

('r+i)a%

S'n"i(i)i%a" Hi)an9 Hi)an9 A9a+ %'r9an99u

BTA

.ada )'"i +u)i% N'9a%i, N'9a%i,5 a%au J1 Bia"an#a n'9a%iC'

T'" L'r4min .4"i%i, Kua% =J<> .4"i%i, =J2> M'ra9u+an

Ta(') </ G'3a)a +)ini+ M4r(u"7Han"'n .au"i(a"i)ar

T'" L'r4min =Mi%"uda> un%u+ m'm(an%u 'n'n%uan %i'5 $a"i)n#a (aru daa% di+'%a$ui

"'%')a$ < min99u/

Kara+%'ri"i%i+ L'r4ma%4"a B4rd'r)in'

L'r4ma%4"a

Mid7(4rd'r)in'

L'"i

Ti' Ma;u)a5 in,i)%ra%

di,u"5 au)5 n4du"

Ma;u)a5 )a+5 au) .)a+5 )'"i ('n%u+

+u(a$5 )'"i un;$'d

4u%um)a$ Ban#a+ di"%ri(u"i

)ua"5 ra+%i" %ida+

ada +u)i% "'$a%

Ban#a+ %ai +u)i%

"'$a% ma"i$ ada

B'('raa5 +u)i%

"'$a%=J>

Di"%ri(u"i Sim'%ri" 'nd'run9 Sim'%ri" A"im'%ri"

.'rmu+aan Ha)u" dan ('r+i)a Ha)u" dan ('r+i)a S'di+i% ('r+i)a5

('('raa )'"i

+'rin9

S'n"i(i)i%a" Tida+ %'r9an99u S'di+i% ('r+uran9 B'r+uran9

BTA

.ada )'"i +u)i% Ban#a+ Ban#a+ A9a+ Ban#a+

.ada $'m(u"an$idun9

Ban#a+ Bia"an#a %ida+ ada Tida+ ada

T'" L'r4min N'9a%i, N'9a%i, Bia"an#a N'9a%i,

Ta(') 8/ G'3a)a +)ini+ M4r(u"7Han"'n Mu)%i(a"i)ar

PEMERIKSAAN PENUNJANG

1/ .'m'ri+"aan (a+%'ri4"+4i+

.'m'ri+"aan (a+%'ri4"+4i+ di9una+an un%u+ m'm(an%u m'n'9a++an

dia9n4"i" dan 'n9ama%an 'n94(a%an/ S'diaan di(ua% dari +'r4+an 3arin9an +u)i%



a%au u"aan dan +'r4+an mu+4"a $idun9 #an9 diarnai d'n9an 'arnaan

%'r$ada (a"i) %a$an a"am5 an%ara )ain d'n9an 'arnaan i'$)7N'')"'n/ um)a$

%'ma% #an9 diam(i) un%u+ 'm'ri+"aan rui%n "'(ai+n#a minima) 876 %'ma%5

#ai%u +'dua ;uin9 %')in9a (a9ian (aa$ dan 278 )'"i )ain #an9 a)in9 a+%i, =#an9

a)in9 'ri%'ma%4"a dan in,i)%ra%i,>/

ara 'n9am(i)an (a$an d'n9an m'n99una+an "+a') "%'ri)/ S'%')a$ )'"i

%'r"'(u% did'"in,'+"i +'mudian di3'i% an%ara i(u 3ari dan 3ari %')un3u+ a9ar

m'n3adi i"+'mi+5 "'$in99a +'r4+an 3arin9an m'n9andun9 "'di+i% mun9+in dara$/

Iri"an #an9 di(ua% $aru" "amai di d'rmi"5 m')amaui subepidermal clear "one

a9ar m'n;aai 3arin9an #an9 di$ara+an (an#a+ m'n9andun9 "') Vir;$4 ="')

)'ra> #an9 di da)amn#a m'n9andun9 (a"i) M.leprae/ K'r4+an 3arin9an i%u

di4)'"+an di 9')a" a)a"5 di,i+"a"i di a%a" ai5 +'mudian diarnai d'n9an 'arnaan

i'$)7N'')"'n/

M/ )'ra' %'r94)4n9 (a"i) %a$an a"am =BTA> a+an %ama+ m'ra$ ada

"'diaan/ Di('da+an ('n%u+ (a%an9 u%u$ ="4)id>5 (a%an9 %'ru%u" =,ra9m'n%'d>5 dan

(u%iran =9ranu)ar>/ B'n%u+ "4)id ada)a$ (a"i) $idu5 "'dan9+an ,ra9m'n%'d dan

9ranu)ar m'rua+an ('n%u+ ma%i/ K'ada%an BTA %ana m'm('da+an "4)id dan

n4n"4)id ada "'(ua$ "'diaan din#a%a+an d'n9an ind'+" (a+%'ri =IB> d'n9an ni)ai

dari 0 "amai 6J m'nuru% Rid)'#/ 0 (i)a %ida+ ada BTA da)am 100 )aan9 andan9

=L.>5 1J (i)a 1710 BTA da)am 100 L.5 2J (i)a 1710 BTA da)am 10 L.5 <J (i)a 17

10 BTA ra%a7ra%a da)am 1 L.5 8J (i)a 117100 BTA ra%a7ra%a da)am 1 L.5 J (i)a

10171000 BTA ra%a7ra%a da)am 1 L.5 6J (i)a 1000 BTA ra%a7ra%a da)am 1 L./

.'m'ri+"aan d'n9an m'n99una+an mi+r4"+4 ;a$a#a d'n9an min#a+ 'm'r"i

ada 'm('"aran )'n"a 4(#'+%i, 100/ IB "'"'4ran9 ada)a$ IB ra%a7ra%a "'mua )'"i

#an9 di(ua% "'diaan/=1>

2/ .'m'ri+"aan $i"%4a%4)49i+

Adan#a ma""a 'i%')4id #an9 ('r)'(i$an di+'))in9i 4)'$ )im,4"i% #an9

di"'(u% %u('r+') a+an m'n3adi 'n#'(a( u%ama +'ru"a+an 3arin9an dan ;a;a%/ .ada

'nd'ri%a d'n9an "i"%'m imuni%a" "')u)ar r'nda$ a%au )umu$5 $i"%i4"i% %ida+ daa%



m'n9$an;ur+an M. leprae #an9 "uda$ ada di da)amn#a5 (a$+an di3adi+an %'ma%

('r+'m(an9 (ia+ dan di"'(u% "') Vir;$4 a%au "') )'ra a%au "') (u"a/

Granu)4ma ada)a$ a+umu)a"i ma+r4,a9 dan a%au d'riCa%7d'riCa%n#a/

Gam(aran $i"%4a%4)49i+ %i' %u('r+u)4id ada)a$ %u('r+') dan +'ru"a+an "ara,

#an9 )'(i$ n#a%a5 %ida+ ada (a"i) a%au $an#a "'di+i% dan n4n"4)id/ .ada %i'

)'r4ma%4"a %'rdaa% +')im "un#i "u('id'rma) = subepidermal clear "one>5 #ai%u

"ua%u da'ra$ )an9"un9 di (aa$ 'id'rmi" #an9 3arina9nn#a %ida+ a%4)49i+/=1>

</ .'m'ri+"aan "'r4)49i+

.'m'ri+"aan "'r4)49i+ +u"%a dida"ar+an a%a" %'r('n%u+n#a an%i(4di ada

%u(u$ "'"'4ran9 #an9 %'rin,'+"i 4)'$ M. leprae/ An%i(4di #an9 %'r('n%u+ daa%

('r"i,a% "'"i,i+ %'r$ada M. leprae5 #ai%u an%i(4di anti phenolic lycolipid#$

=.GL71> dan an%i(4di an%ir4%'in 16 +D "'r%a < +D/ S'dan9+an an%i(4di #an9

%ida+ "'"i,i+ an%ara )ain an%i(4di an%i7)i4ara(in4manan =LAM>5 #am9 3u9a

di$a"i)+an 4)'$ +uman M. tuberculosis/

.'m'ri+"aan "'r4)49i+ ini ia)a$ daa% m'm(an%u dia9n4"i" +u"%a #an9

m'ra9u+an5 +ar'na %anda +)ini" dan (a+%'ri4)49i+ %ida+ 3')a"/ Di "amin9 i%u daa%

m'm(an%u m'n'n%u+an +u"%a "u()ini"5 +ar'na %ida+ didaa%i )'"i +u)i%5 mi"a)n#a

ada nara+4n%a+ "'ruma$/

Ma;am7ma;am 'm'ri+"aan "'r4)49i+ +u"%a ia)a$:

• U3i ML.A = Mycobacterium leprae %article &lutination>

•U3i ELISA = 'n"yme Lined mmunosorbent &ssay)

• ML di"%i;+ = Mycobacterium leprae dipstic >

• ML ,)4 %'"% = Mycobacterium Leprae flo* test)

PENATALAKSANAN

K'm4%'rai +u"%a dimu)ai %a$un 1-8- d'n9an diamin4di,'ni) "u),4n =DDS>

"'(a9ai 4(a% %un99a) =m4n4%'rai DDS>/ DDS $aru" diminum "')ama <7 %a$un

un%u+ .B5 "'dan9+an un%u+ MB 710 %a$un5 (a$+an "'umur $idu/ K'+uran9an

m4n4%'rai DDS ada)a$ %'r3adin#a r'"i"%'n"i5 %im(u)n#a +uman persisters "'r%a



%'r3adin#a a"i'n defaulter / .ada %a$un 1-68 di%'mu+an r'"i"%'n"i %'r$ada DDS/

O)'$ "'(a( i%u ada %a$un 1-!2 HO m'r'+4m'nda"i+an 'n94(a%an +u"%a

d'n9an Mu)%i Dru9 T$'ra# =MDT> un%u+ %i' .B mauun MB/ ?8@ Da"4n5

ri,ami"in5 +)4,a*imin5 4,)4+"a"in dan min4;#;)in' m'rua+an bacbone dari

%'rai MDT/ A9'n +'m4%'rai )ainn#a "''r%i )'C4,)4a;in5 "ar,)4a;in dan

+)ari%r4mi"in 3u9a ','+%i, %'r$ada M. leprae/ ?&@

Tu3uan 'n94(a%an MDT ada)a$ m'n;'9a$ dan m'n94(a%i r'"i"%'n"i5

m'm'r'nd'+ ma"a 'n94(a%an5 m'm'r;'a% 'mu%u"an ma%a ran%ai 'nu)aran5

?1@

m'nin9+a%+an +'%'ra%uran ('r4(a% "'r%a m'n;'9a$ %'r3adin#a ;a;a% a%au

m'n;'9a$ ('r%am(a$n#a ;a;a% #an9 "uda$ ada "'(')um 'n94(a%an/ Bi)a a"i'n

+u"%a %ida+ minum 4(a% "';ara %'ra%ur5 ma+a +uman +u"%a daa% m'n3adi

r'"i"%'n+'(a) %'r$ada MDT5 "'$in99a 9'3a)a 'n#a+i% m'n'%a5 (a$+an

m'm(uru+/ MDT ada)a$ +4m(ina"i dua a%au )'(i$ 4(a% an%i+u"%a5 "a)a$ "a%un#a

ri,ami"in "'(a9ai an%i +u"%a #an9 ('r"i,a% (a+%'ri"ida) +ua% "'dan9+an 4(a% an%i

+u"%a )ain ('r"i,a% (a+%'ri4"%a%i+/ ?8@

R'+4m'nda"i HO (a9i 'nd'ri%a au;i(a"i)ar =%ida+ di%'mu+an (a"i)

dari au"an a%au (i4"# )ima a%au +uran9 )'"i 'nd'ri%a ind'%'rmina%' dan

%u('r+u)4id> ada)a$ 600m9 ri,ami"in (aa$ 'n9aa"an "'+a)i "'(u)an un%u+ 6

(u)an dan 100m9 $ari da"4n "')ama 6 (u)an5 %ana 'n9aa"an5 d'n9an

"')'"ain#a 'n94(a%an da)am a+%u - (u)an/ Ba9i 'nd'ri%a d'n9an "a%u )'"i

'n#a+i% au;i(a"i)'r d4"i" %un99a) 600m9 ri,ami"in5 800m9 4,)4+"a"in5 dan

100m9 min4;#;)in' =ROM>5 "'mua di('ri+an ada "a%u a+%u/ .a"i'n

mu)%i(a"i)'r =BT5 BB5 BL dan LL )'(i$ dari )ima )'"i "'%ia (a"i) %'r)i$a% ada

au"an a%au (i4"i> di('ri+an ri,ami"in 600m9 dan +)4,a*imin <00m9 "'(u)an

"'+a)i di (aa$ 'n9aa"an d'n9an da"4n 100m9$ari5 dan +)4,a*imin

0m9$ari/ .'n94(a%an di('ri+an "')ama 12 (u)an ?5&@/ Ba9i 'nd'ri%a #an9 %ida+

('r%4)'ran"i d'n9an +)4,a*imin5 di('ri+an r'3im'n a)%'rna%i, #ai%u ri,ami"in

600m95 4,)4+"a"in 800m95 dan min4;#;)in' 100m9 "'+a)i da)am "a%u (u)an un%u+

%'m4$ 28 (u)an/ Ba9i 'nd'ri%a #an9 in%4)'ran a%au r'"i"%'n %'r$ada ri,ami"in

a%au da"4n di('ri+an +)4,a*imin 0m95 4,)4+"a"in 800m9 dan min4;#;)in'



100m9 "'%ia $ari un%u+ 6 (u)an dii+u%i d'n9an 1! (u)an +)4,a*imin 0m9 "'%ia

$ari di%am(a$ (ai+ 4,)4+"a"in 800m9$ari5 a%au min4;#;)in' 100m9$ari/ ?@

Tabel 1 MDT un%u+ %i' MB

Sumber: D'rma%4)49# On)in' 4urna) ?&@

Tabel 2 MDT un%u+ %i' .B


Tabel 3 MDT un%u+ %i' SL.B


i/ Ri,ami"in



Ri,ami"in ada)a$ 4(a% #an9 m'n3adi "a)a$ "a%u +4m4n'n

+4m(ina"i DDS d'n9an d4"i" 10m9+9 BB di('ri+an "'%ia $ari a%au

"'%ia (u)an/ Ri,ami"in %ida+ (4)'$ di('ri+an "';ara m4n4%'rai5 4)'$

+ar'na m'm'r('"ar +'mun9+inan %'r3adin#a r'"i"%'n"i5 %'%ai ada

'n94(a%an +4m(ina"i "')a)u dii+u%+an5 %ida+ (4)'$ di('ri+an "'%ia

min99u a%au "'%ia 2 min99u m'n9in9a% ','+ "amin9n#a/ E,'+

"amin9 #an9 $aru" di'r$a%i+an ada)a$ $'a%4%4+"i+5 n',r4%4+"i+5

9'3a)a 9a"%r4in%'"%ina)5 ,)u7)i+' "#ndr4m' dan 'ru"i +u)i%/ ?1@ O(a% ini

di('ri+an da)am d4"i" (u)anan %un99a)5 "'(ua$ r4%4+4) #an9 %ida+ ada

','+ %4+"i+ #an9 "i9ni,i+an %')a$ di)a4r+an/

ii/ K)4,a*imin

D4"i" "'(a9ai an%i+u"%a ia)a$ 0 m9 "'%ia $ari5 a%au 100 m9 "')an9

"'$ari5 a%au <100 m9 "'%ia min99u/ u9a ('r"i,a% an%iin,)ama"i

"'$in99a daa% dia+ai ada 'nan99u)an9an ENL d'n9an d4"i" )'(i$

#ai%u 2007<00 m9$ari namun ai%an +'r3a (aru %im(u) "'%')a$ 27<

min99u/ E,'+ "amin9n#a ia)a$ arna m'ra$ +';4+)a%an ada +u)i%5

dan arna +'+unin9an ada "+)'ra5 "'$in99a miri i;%'ru"5 aa)a9i

ada d4"i" %in99i5 #an9 "'rin9 m'rua+an ma"a)a$ da)am +'%aa%an

('r4(a% 'nd'ri%a/ ?1@

iii/ O,)4+"a"in

O,)4+"a"in m'rua+an %urunan ,)u4r4+uin4)4n #an9 a)in9 a+%i,

%'r$ada Mycobacterium leprae in Ci%r4/ D4"i" 4%ima) $arian ada)a$800 m9/ E,'+ "amin9n#a ada)a$ mua)5 diar'5 dan 9an99uan "a)uran

;'rna )ainn#a5 ('r(a9ai 9an99uan "u"unan "ara, u"a% %'rma"u+

in"4mnia5 n#'ri +'a)a5 di""iness, ner+ousness dan $a)u"ina"i/

a)auun d'mi+ian $a) ini 3aran9 di%'mu+an dan (ia"an#a %ida+

m'm(u%u$+an 'n9$'n%ian 'ma+aian 4(a%/ ?1@

iC/ Min4"i+)in



T'rma"u+ da)am +')4m4+ %'%ra"i+)in/ E,'+ (a+%'ri"ida)n#a )'(i$

%in99i dariada +)ari%r4mi"in5 %'%ai )'(i$ r'nda$ dariada ri,ami"in/

D4"i" "%andar $arian 100 m9/ E,'+ "amin9n#a ada)a$ 'arnaan 9i9i

(a#i dan ana+7ana+5 +adan97+adan9 m'n#'(a(+an $i'ri9m'n%a"i

+u)i% dan m'm(ran' mu+4"a5 ('r(a9ai "im%4m "a)uran ;'rna dan

"u"unan "ara, u"a%5 %'rma"u+ di""iness dan unsteadiness/ O)'$ "'(a(

i%u %ida+ dian3ur+an un%u+ ana+7ana+ a%au "')ama +'$ami)an/ ?1@

C/ .'n;'9a$an ;a;a%

.'nd'ri%a +u"%a #an9 %'r)am(a% didia9n4"i" dan %ida+ m'ndaa%

MDT m'mun#ai ri"i+4 %in99i un%u+ %'r3adin#a +'ru"a+an "ara,/

K'ru"a+an "ara, %'ru%ama ('r('n%u+ n#'ri "ara,5 $i)an9n#a

"'n"i%i(i)i%a" dan ('r+uran9n#a +'+ua%an 4%4%/ ara %'r(ai+ un%u+

m')a+u+an 'n;'9a$an ;a;a% a%au r'C'n%i4n 4, di"a(i)i%i'" =.OD>

ada)a$ d'n9an m')a+"ana+an dia9n4"i" dini +u"%a5 'm('rian

'n94(a%an MDT #an9 ;'a% dan %'a%/ S')an3u%n#a d'n9an m'n9'na)i

9'3a)a dan %anda r'a+"i +u"%a #an9 di"'r%ai 9an99uan "ara, "'r%a

m'mu)ai 'n94(a%an d'n9an +4r%i+4"%'r4id "'"'9'ra mun9+in/ Bi)a

%'r3adi 9an99uan "'n"i(i)i%a"5 'nd'ri%a di('ri '%un3u+ "'d'r$ana

mi"a)n#a m'ma+ai "'a%u un%u+ m')indun9i +a+i #an9 %')a$ %'r+'na5

m'ma+ai "arun9 %an9an (i)a ('+'r3a d'n9an ('nda #an9 %a3am a%au

ana"5 dan m'ma+ai +a;ama%a un%u+ m')indun9i ma%a/ S')ain i%u

dia3ar+an u)a ;ara 'raa%an +u)i% "'$ari7$ari/ Ha) ini dimu)ai d'n9an

m'm'ri+"a ada %ida+n#a m'mar5 )u+a5 a%au u)+u"/ ?1@

Ci/ R'$a(i)i%a"i

U"a$a r'$a(i)i%a"i m'di" #an9 daa% di)a+u+an un%u+ ;a;a% %u(u$

ia)a$ an%ara )ain d'n9an 3a)an 4'ra"i dan ,i"i4%'rai/ M'"+iun

$a"i)n#a %ida+ "'murna +'m(a)i +' a"a)5 %'%ai ,un9"in#a dan "';ara

+4"m'%i+ daa% di'r(ai+i/ ara )ain ia)a$ "';ara +'+ar#aan5 #ai%u

m'm('ri )aan9an '+'r3aan #an9 "'"uai ;a;a% %u(u$n#a5 "'$in99a



daa% ('rr'"%a"i dan daa% m'nin9+a%+an ra"a 'r;a#a diri5 "')ain i%u

daa% di)a+u+an %'rai "i+4)49i+/ ?1@

Cii/ .'n94(a%an ENL

O(a% #an9 a)in9 "'rin9 dia+ai ia)a$ %a()'% +4r%i+4"%'r4id5 an%ara

)ain r'dni"4n/ D4"i"n#a ('r9an%un9 ada ('ra% rin9ann#a r'a+"i5

(ia"an#a r'dni"4n 17<0 m9 "'$ari5 +adan97+adan9 )'(i$/ D4"i"n#a

di%urun+an ('r%a$a "'+iran#a ada 'r(ai+an dari r'+a"i "amai

('r$'n%i "ama "'+a)i/ Ada +'mun9+inan %im(u) +'%'r9an%un9an

%'r$ada +4r%i+4"%'r4id5 "'$in99a 'nd'ri%a $aru" m'ndaa%+an

+4r%i+4"%'r4id %'ru" m'n'ru"/ ?1@

K)4,a*imin 3u9a daa% dia+ai "'(a9ai an%i7r'a+"i ENL5 %'%ai

d4"i"n#a )'(i$ %in99i/ Ma+in ('ra% r'a+"i5 ma+in %in99i d4"i"n#a5

(ia"an#a an%ara 2007<00 m9 "'$ari/ K$a"ia%n#a )'(i$ )am(a% dariada

+4r%i+4"%'r4id/ u9a d4"i"n#a di%urun+an ('r%a$a 3i+a ada 'r(ai+an

r'a+"i/ K)4,a*imin daa% dia+ai un%u+ )'a" dari +'%'r9an%un9an

+4r%i+4"%'r4id/ E,'+ "amin9n#a daa% m'n#'(a(+an +u)i% m'n3adi

m'ra$ +';4+)a%an namun ('r"i,a% re+ersible 3i+a 4(a%n#a di$'n%i+an/ ?1@

ENL #an9 ('ra% dan ('r+'an3an9an dan %'rdaa% +'%'r9an%un9an

ada "%'r4id 'r)u di%am(a$+an )amr'n5 un%u+ d'a"a <00 m9$ari

"')ama 27< (u)an/ Bi)a ada 'r(ai+an %urun+an m'n3adi 200 m9$ari

"')ama 27< (u)an/ Bi)a ada 'r(ai+an %urun+an m'n3adi 100 m9$ari

"')ama 27< (u)an5 dan "')an3u%n#a 0 m9$ari (i)a 'nd'ri%a ma"i$

da)am 'n94(a%an MDT5 a%au "%4 (i)a din#a%a+an RFT/ .ada "aa%

"ama d4"i" r'dni"4n di%urun+an "';ara ('r%a$a/ ?1@

Ciii/ .'n94(a%an r'a+"i r'C'r"a)

i+a r'a+"i di"'r%ai d'n9an n'uri%i" a+u%5 4(a% i)i$an 'r%ama ada)a$

+4r%i+4"%'r4id #an9 d4"i"n#a di"'"uai+an d'n9an ('ra% rin9ann#a

n'uri%i"5 (ia"an#a di('ri+an r'dni"4n 80 m9 "'$ari5 +'mudian

di%urun+an 'r)a$an7)a$an/ An994%a 9'ra+ #an9 %'r+'na n'uri%i" a+u%

$aru" dii"%ira$a%+an/ Ana)9'%i+ dan "'da%iCa +a)ua di'r)u+an daa%

di('ri+an/ i+a r'a+"i %ida+ di"'r%ai d'n9an n'uri%i" a+u% ma+a %ida+

'r)u di('ri+an 'n94(a%an %am(a$an/

?1@



Tabel 1 MDT un%u+ r'a+"i )'ra


DIAGNOSIS BANDING

Ban#a+ 'n#a+i% +u)i% )ain #an9 "';ara +)ini" m'n#'ruai +')ainan +u)i% ada

'n#a+i% +u"%a/ Ba$+an ada i"%i)a$ #an9 m'n#'(u%+an 'n#a+i% +u"%a "'(a9ai

'niru %'r$'(a% (the reat imitator) da)am 'n#a+i% +u)i%/ ?8@ B'('raa +')ainan

+u)i% #an9 miri d'n9an 'n#a+i% +u"%a an%ara )ain:

i/ L'"i ma+u)a ?<58@

Tanda )a$ir m'rua+an "a%u )'"i ('ri9m'n %'%ai ada)a$ n4rma)/ .ada

)'"i Ci%i)i945 )'"i #an9 %'r$a"i) ada)a$ )'"i d'i9m'n%a"i dimana i9m'n

+u)i% $i)an9 %4%a) arna +u)i% ama% u%i$ mana+a)a ada )'"i +u"%a %ida+

"')a)un#a d'i9m'n%a"i/ L'"i $i4i9m'n%a"i %'ru%ama #an9 di%'mu+an

ada i%iria"i" a)(a ada ana+7ana+ "u)i% un%u+ di('da+an "ama )'"i dari

ma+u)a )'rama%4"a namun 'rmu+aan ada )'"i i%iria"i" a)(a ('r"i"i+

d'n9an ma+u)a ('n%u+ (undar4Ca) dan ada 'm'ri+"aan a"uan %ida+

m'n9andun9 (a+%'ri %a$an a"am/ .i%iria"i" C'r"i+4)4r %ida+ "')a)u ('r"i"i+5

d'n9an di"%ri(u"i "'n%ra) ada (adan "'r%a ma+u)a7ma+u)a d'n9an u+uran

#an9 +';i) "'r%a "+uama $a)u" dan ('r(a%a" %'9a" ('r('da d'n9an



+ara+%'ri"%i+ ma+u)a dari )'r4ma%4u"/ L'"i ada %in'a +44ri" "an9a% 9a%a)

dan (i"a m'mi)i+i %'i C'"i+u)'r #an9 %ida+ dimi)i+i ada )'"i %u('r+u)4id

dan 'm'ri+"aan +'r4+an (ia"an#a m'nun3u++an adan#a 3amur/

Gam(ar 1/1 Vi%i)i94 Gam(ar 1/2 .i%iria"i" V'r"i+4)4r

Gam(ar 1/< .i%iria"i" a)(a

ii/ .)a+ dan )'"i anu)ar ?<@

Granu)4ma mu)%i,4rm'5 "ar;4id4"i" dan TB +u%i" (i"a

m'n#'ruai +u"%a %u('r+u)4id #ai%u m'mi)i+i da"ar imun4)49i #an9

"ama dan "'rin9 %ida+ (i"a di('da+an m')a)ui 4)a $i"%4)49i"/ Namun5

)'"in#a %ida+ an'"%'"i a%au ma%i ra"a/ .ada 'nd'ri%a "ar;4id4"i"5 "ara,7

"ara, 'ri,'r +adan9 di%'mu+an 'm('"aran/



iii/ N4du) ?<58@

L'i"$mania"i" ;u%an'4u" m'n#'(a(+an n4du) #an9 (ia"an#a

('r+ru"%a dan u)"'ra"i "'%')a$ ('('raa min99u a%au (u)an d'n9an

+uan%i%i #an9 (an#a+ ('r('da d'n9an n4du) ada 'nd'ri%a LL/ Ba9i

m'n'9a++an dia9n4"' )'i"$mania"i" ;u%an'4u" ma+a dian3ur+an

'm'ri+"aan ")i%7"+in "'r%a %'" )'i"$manin/ ?<@ .ada 'nd'ri%a n'ur4

,i(r4ma%4"i" di%'mu+an ('r;a+ ;a, au )ai% #ai%u ('r;a+ ;4+)a% muda

('r(a%a" %'9a" #an9 "'rin9 %im(u) "'3a+ )a$ir5 n4du" dan %um4r

('r%an9+ai ada u"ia #an9 )'(i$ )an3u% %'r"'(ar )ua" %ana ra"a (aa)"'r%a 'm'ri+"aan BTA =7>/ Sar+4ma +a4"i m'mi)i+i n4du" )una+

('rarna (iru +'un9uan5 )4+a)i"a%a %'ru%ama ada +a+i d'n9an

'm'ri+"aan BTA =7>/ .ada 'nd'ri%a C'ru+a Cu)9ari" di%'mu+an au)7

au) d'n9an 'rmu+aan #an9 +a"ar/ ?8@

Gam(ar 1/8 N'ur4 ,i(r4ma%4"i" Gam(ar 1/ Sar+4ma +a4"i



Gam(ar 1/6 V'ru+a Cu)9ari"

iC/ B'r;a+ +'rm'ra$an ?8@

.'nd'ri%a "4ria"i" m'mi)i+i ('r;a+ m'ra$ #an9 ('r(a%a" %'9a"5

d'n9an "i"i+ #an9 ('r)ai"7)ai"/ .ada 'nd'ri%a %in'a ;ir;ina%a ('r;a+

m'ra$ #an9 m'nin99i5 "'rin9 m'radan9 "'r%a m'n9andun9

C'"i+')+ru"%a/ Mana+a)a )'"i ada 'nd'ri%a d'rma%i%i" "'(4r4i+

('rada ada da'ra$ "'(4r' #ai%u da'ra$ #an9 ('rmin#a+ d'n9an "i"i+

+unin9 ('rmin#a+5 9a%a)5 +r4ni"5 r'"idi, "'r%a %ida+ ada ra"a (aa)/ ?8@

Gam(ar 1/& ."4ria"i" Gam(ar 1/! Tin'a ir;ina%a



Gam(ar 1/- D'rma%i%i" "'(4r4i+

Komplia!i

K4m)i+a"i #an9 a)in9 "'rin9 %im(u) a+i(a% )'ra ada)a$ +'ru"a+an "ara,

'ri,'r5 in"u,i"i'n"i C'na "'r%a 3arin9an aru%/ S'+i%ar "''r'ma% a%au "''r%i9a

dari 'nd'ri%a #an9 (aru didia9n4"a d'n9an +u"%a m'mi)i+i5 a%au a+an nan%i

m'mi)i+i 'n#a+i% +r4ni" m'rua+an a+i(a% dari +'ru"a+an "ara, #an9 ir'C'r"i(')

%'ru%ama m'n9'nai +''ma% %un9+ai "'r%a +'%'r)i(a%an ada ma%a/ Han;urn#a

"'%um na"i ada %i' LL ada)a$ a+i(a% 'm('n%u+an 3arin9an "i+a%ri+"#an9

m'n99an%i %u)an9 dan +ar%i)a94/ K'ra%i%i" mun9+in (i"a %im(u) a+i(a% ('('raa

,a+%4r #ai%u ma%a #an9 %'r)a)u +'rin95 in"'n"i%iCi%a" +4rn'a "'r%a )a94,%a)mu"/

K'ra%i%i" dan )'"i ada (i)i+ ma%a d'an daa% m'n9a+i(a%+an +'(u%aan/

In"u,i"i'n"i C'na #an9 m')i(a%+an C'na7C'na da)am (i"a m'n9a+i(a%+an

d'rma%i%i" "%a"i" "'r%a u)+u" ada %un9+ai/ .'ru"a+an "'ndi =;$ar;4% 34in%">mun9+in %'r3adi +ar'na $i)an9n#a "'n"a"i n#'ri #an9 ('r,un9"i "'(a9ai ')indun9/

K'%'r)i(a%an "ara, "ima%i+ m'n9a+i(a%+an 'nurunan $idr4"i" #an9 m'n#'(a(+an

+'rin9n#a %')aa+ %an9an "'r%a +a+i/ K4m(ina"i +4m)i+a"i ini di"'r%ai ;'d'ra

+u)i% #an9 ('ru)an9 di"'(a(+an n#'ri ')indun9 #an9 ('r+uran9 m'n9a+i(a%+an

$i'r+'ra%4"i"5 'r%am(a$an ,i""ura "'r%a in,'+"i (a+%'ri #an9 "'ma+in m'nin9+a%/

?2@



K'ru"a+an "ara, m'n9a+i(a%+an $i)an9n#a 'r"ara,an 4%4% #an9 a+$irn#a

m'n#'(a(+an +')'ma$an/ 'd'ra dan in,'+"i dari ('+%'ri da)am "i+)u" #an9

('ru)an9 m'rua+an "um('r dari +'ru"a+an 3arin9an #an9 ara$ ada 'nd'ri%a

+u"%a/ K4n%ra+%ur5 +')'ma$an 4%4% "'+und'r "'r%a 'm('n%u+an ('+a" )u+a daa%

m'n9$a"i)+an d',4rma%i%a" ada ,a"a #an9 )'(i$ )an3u%/ ?2@

i/ R'a+"i +u"%a

R'a+"i +u"%a ada)a$ in%'ru"i d'n9an 'i"4d' a+u% ada 'r3a)anan

'n#a+i% #an9 "'('narn#a "an9a% +r4ni+/ Namun a%4,i"i4)49i (')um

3')a" ('%u)5 %'rmin4)49i dan +)a"i,i+a"i ma"i$ ('rma;am7ma;am/ R'+"i

+u"%a di(a$a9i+an +'ada dua #ai%u ENL ='ri%'ma n4du"um )'r4"um>

dan r'a+"i re+ersal =r'a+"i upradin >/ ENL ada)a$ r'a+"i d'n9an

n4du" "'$in99a di"'(u% r'a+"i )'ra n4du)ar mana+a)a r'C'r"a) %ana

n4du" di"'(u% r'a+"i n4n7n4du)ar/ ?1@

Eri%'ma n4d4"um )'r4"um ada)a$ i"%i)a$ #an9 m'n99am(ar+an

"ua%u r4"'" Ca";u)i%i" immun4+4m)'+" #an9 m')i(a%+an d'rmi"

'nd'ri%a d'n9an +u"%a %i' LL/?!@

ENL %im(u) ada %i' )'r4ma%4"a 4)ar dan daa% u)a ada BL5 ('rar%i main %in99i %in9+a%

mu)%i(a"i)arn#a ma+in ('"ar +'mn9+inan %im(u) ENL/ S';ara

imun4a%4)49i"5 ENL %'rma"u+ r'"4n" imun $um4ra) #an9 ('rua

,'n4m'na +4m)'+" imun a+i(a% r'a+"i an%ara an%i9'n M.leprae J

an%i(4d# =I9M5 I9G> J +4m)'m'n m'n3adi +4m)'+" imun/ D'n9an

%'r('n%u+n#a +4m)'+" imun ini5 ma+a ENL %'rma"u+ da)am 94)4n9an

'n#a+i% +4m)'+" imun5 4)'$ +'rana "a)a$ "a%u r4%'in M.leprae

('r"i,a% an%i9'ni+5 ma+a an%i(4di daa% %'r('n%u+/ T'rn#a%a +adar

immun49)4(u)in 'nd'ri%a +u"%a )'r4ma%4"a )'(i$ %in99i dariada %i'

%u('r+u)4id/ Ha) ini +'rana ada %i' )'rama%4"a 3um)a$ +uman 3au$

)'(i$ (an#a+ dariada %i' %u('r+u)4id/ Ha) ini daa% %'r3adi +'rana

ada 'n94(a%an5 (an#a+ +uman +u"%a #an9 ma%i dan $an;ur5 ('ar%i

(an#a+ an%i9'n #an9 di)'a"+an dan ('r'a+"i d'n9an an%i(4di "'r%a

m'n9a+%i,+an "i"%'m +4m)'m'n/ G'3a)a +)ini" #an9 %im(u) (a9i r'a+"i



ENL ada)a$ ('rua n4du" 'ri%'ma dan n#'ri d'n9an %'ma% r'di)'+"i

di )'n9an dan %un9+ai/ .ada ENL %ida+ %'r3adi 'ru(a$an %i'/ ?@ ENL

di%andai d'n9an n4du) 'ri%'ma%4"a "u(+u%an #an9 mun;u) (i)a%'ra)

"';ara "im'%ri" ada a3a$ dan '+"%r'mi%a" 'nd'ri%a LL dan

(4rd'r)in'/ S'+i%ar 0 'nd'ri%a LL dan 2 'nd'ri%a BL

m'n9a)ami r'a+"i ENL/ Fa+%4r 'mi;u un%u+ ENL %'rma"u+

'm('da$an5 +'$ami)an5 ni,a"5 m'n#u"ui5 m'n"%rua"i5 %rauma5 in,'+"i

'n#'r%a5 Ca+"ina"i5 "%r'"" ,i"i+5 "%r'"" m'n%a) dan MDT/ ?-@

R'a+"i r'C'r"a) daa% %'r3adi ada %i' (4rd'r)in' =Li5 BL5 BB5 BT5Ti>/ M'"+iun ,a+%4r 'n;'%u"n#a (')um di+'%a$ui namun di'r+ira+an

ada $u(un9ann#a d'n9an r'a+"i $i'r"'n"i%iCi%a" %i' )am(a%/ R'a+"i

'radan9an daa% %'r3adi daa% %'r3adi ada %'ma%7%'ma% +uman

M.leprae ('rada #ai%u ada "ara, dan +u)i%5 umumn#a %'r3adi ada

'n94(a%an 6 (u)an 'r%ama/ Ti' +u"%a #an9 %'rma"u+ (4rd'r)in' ini

daa% ('r9'ra+ ('(a" +'ara$ TT dan LL d'n9an m'n9i+u%i nai+

%urunn#a SIS5 "'(a( "'%ia 'ru(a$an %i' "')a)u di"'r%ai 'ru(a$an

SIS u)a/ G'3a)a +)ini" r'a+"i r'C'r"a) ada)a$ umumn#a "'(a9ian a%au

"')uru$ )'"i #an9 %')a$ ada ('r%am(a$ a+%i, dan a%au %im(u) )'"i (aru

da)am a+%u #an9 r')a%i, "in9+a%/ Ar%in#a )'"i $#4i9m'n%a"i m'n3adi

'ri%'ma5 )'"i 'ri%'ma m'n3adi ma+in 'ri%'ma%4"a5 )'"i ma+u)a m'n3adi

in,i)%ra%5 )'"i in,i)%ra% ma+in in,i)%ra% dan )'"i )ama m'n3adi ('r%am(a$

)ua"/ ?1@

P"o#$o!i! ?25<@

.'n94(a%an an%i(a+%'ri un%u+ +u"%a "an9a% ','+%i,5 d'n9an %in9+a% +am(u$

#an9 r'nda$ %'%ai 'r)u diam(i) "')ama ('r(u)an7(u)an %ana u%u" 4(a%/

.'nd'ri%a (4rd'r)in' ('ri"i+4 un%u+ ('r+4m)i+a"i m'n3adi r'a+"i %i' 15 #an9

mun9+in m'n9a+i(a%+an +'ru"a+an "ara, #an9 "an9a% ('ra%/ K'(an#a+an

'nd'ri%a da%an9 d'n9an +'ru"a+an "ara, #an9 %ida+ (i"a diu)i$+an/ .'n94(a%an

n'uri%i" ada "aa% ini %ida+ ('9i%u m'mua"+an "'$in99a ada ('('raa 'nd'ri%a



m'n9a)ami +'ru"a+an "ara, #an9 'rman'n mauun di4(a%i d'n9an

+4r%i+4"%'r4id/ K'ru"a+an "ara, dan +4m)i+a"in#a mun9+in "an9a% m')umu$+an

%'ru%ama +'%i+a "'mua 'ma% %un9+ai dan +'dua ma%a %'r)i(a%/ ?<@ 'nd'ri%a )'ra

d'n9an %i' TT a%au 'nd'ri%a BT #an9 "uda$ "'m(u$ m'n3adi TT (i"a

di"'m(u$+an "'ndiri %ana 'n94(a%an/ Namun 'nd'ri%a %i' )ain a+an m'n3adi

)'(i$ (uru+ d'n9an %in9+a% m4r(idi%a" #an9 %in99i a+i(a% +'ru"a+an "ara, dan

superimposed reactional states/ ?2@

Ke!imp%la$

Ku"%a ada)a$ 'n#a+i% +r4ni" #an9 di"'(a(+an 4)'$ (a+%'ri

Mycobacterium leprae #an9 ('r"i,a% in%ra"')u)'r 4()i9a% dan m'n#'ran9 +u)i% "'r%a

"ara, %'i/ Mani,'"%a"i +)ini" dari 'n#a+i% ini "an9a% ('rCaria"i d'n9an "'+%rum

#an9 ('rada dian%ara dua ('n%u+ +)ini" dari )'ra #ai%u ('n%u+ )'r4ma%4"a dan

%u('r+u)4id/Dia9n4"a ada +u"%a dida"ar+an ada dia9n4"%i+ "';ara +)ini" dimana

%'rdaa% %i9a %anda +ardina) #an9 +$a" #ai%u )'"i +u)i% #an9 ma%i ra"a

=$i4i9m'n%a"i a%au 'ri%'ma #an9 ma%i ra"a a%au an'"%'"i>5 'n'(a)an "ara, 'ri,'r

dan di%'mu+an M.leprae =(a+%'ri4)49i" 4"i%i,>/ Mycobacterium leprae ma"u+

+'da)am %u(u$ manu"ia5 3i+a 4ran9 %'r"'(u% m'mi)i+i r'"4n imuni%a" #an9 %in99i

ma+a +u"%a a+an )'(i$ m'n9ara$ ada %u('r+u)4id5 namun 3i+a r'"4n imuni%a"

dari %u(u$ 4ran9 %'r"'(u% r'nda$ ma+a +u"%a a+an )'(i$ m'n9ara$ ada

)'r4ma%4"a/ .'m'ri+"aan 'nun3an9 d'n9an 'm'ri+"aan BTA dan m'n'n%u+an

ind'+" (a+%'ri m'm(an%u m'm('da+an 3'ni" +u"%a #an9 did'ri%a/

.'n94(a%an )'ra di"aran+an m'ma+ai r49ram Mu)%i Dru9" T$'ra# =MDT>5

#an9 dir'+4m'nda"i+an 4)'$ HO "'3a+ 1-!1/ Tu3uan dari r49ram MDT ada)a$

m'n9a%a"i r'"i"%'n"i da"4n #an9 "'ma+in m'nin9+a%5 m'nurun+an an9+a u%u"

4(a% =dr474u% ra%'> dan +'%ida+%aa%an 'nd'ri%a/ K4m)i+a"i u%ama #an9

di%a+u%+an ada)a$ +';a;a%an (a9ian %u(u$ a+i(a% $i)an9n#a "'n"i%i,i%a" %'ru%ama

ada +u)i%/ .r49n4"i" 'n#a+i% ini d'n9an adan#a 4(a%74(a% +4m(ina"i5 m'n3adi

)'(i$ (ai+5 dan 'n94(a%ann#a m'n3adi )'(i$ "'d'r$ana/



DAFTAR PUSTAKA

1/ i"nu IM/ Ku"%a/ In: M'na)di SL5 'di%4r/ I)mu .'n#a+i% Ku)i% dan

K')amin/ & 'd/ a+ar%a: Badan .'n'r(i% FKUI 201/ / !&7102/

2/ L'' D/ L'r4"#/ In: 4),, K5 'di%4r/ it"patric-s ermatoloy in /eneral

medicine/ ! 'd/ N' 4r+: M; Gra Hi))74mani'" 2012/

</ Burn" T5 Br'a%$na;$ S5 4 N5 Gri,,i%$" / Roo!s Te0tboo of

ermatoloy/ !%$ 'd/ Au"%ra)ia: B)a;+"$')) .u()i"$in9 4man# 2010/ .9/

<2/125 <2/18



8/ Ad$#a%ma5 A/R/ Laian5 '%/ a)/ .'d4man Na"i4na) .r49ram .'n9'nda)ian

.'n#a+i% Ku"%a/ K'm'n%'rian K'"'$a%an RI Dir'+%4ra% 'nd'ra)

.'n9'nda)ian .'n#a+i% dan .'n#'$a%an Lin9+un9an5 2012/ .9/ 6!7&15 --/

/ am'" D5 B'r9'r TG5 E)"%4n DM/ &ndre*!s isease of the 1in2 Clinical

ermatoloy/ 11%$ 'd/ anada: Saund'r" E)"'Ci'r 2011/ .9/ <<15 <8-7<0/

6/ Amiruddin MD/ I)mu .'n#a+i% Ku"%a/ Ma+a""ar: Ha"anuddun UniC'r"i%#

.r'"" 2012

&/ I"$ii5 N4ri$i"a MD .$D/ =200<>/ R';'n% adCan;'" in %$' %r'a%m'n% 4,

)'r4"#/ D'rma%4)49# On)in' 4urna)5 -=2>/ R'%ri'C'd ,r4m:

$%%:'";$4)ar"$i/4r9u;i%'m1%d13&,%

!/ R'u'na5 Lui" R'u'na5 ')ia/ =2002>/ Er#%$'ma n4d4"um/

D'rma%4)49# On)in' 4urna)5 !=1>/ R'%ri'C'd ,r4m:

$%%:'";$4)ar"$i/4r9u;i%'m8!2-%6rn

-/ M'$%a5 Vandana Ba)a;$andran5 / =2006>/ Er#%$'ma n4d4"um

)'r4"um: A r'"'n%in9 mani,'"%a%i4n 4, )'r4ma%4u" )'r4"#/

D'rma%4)49# On)in' 4urna)5 12=&>/ R'%ri'C'd ,r4m:

$%%:'";$4)ar"$i/4r9u;i%'m&d&8r-+

10/ K/ Sa+am4%45 D'ar%m'n% 4, .a%$4)49#5 4))'9' 4, V'%'rinar# M'di;in'5

UniC'r"i%# 4, G'4r9ia5 01 D/ / Br44+" Dr5 A%$'n"5 GA <06027&<!!

11/ A#""ar A/ E)amin5 Ma%%$ia" S%'$r5 and Ma$aCir Sin9$5 Liid Dr4)'%"

and M#;4(a;%'rium )'ra' In,';%i4n5P4urna) 4, .a%$49'n"5 C4)/ 20125

Ar%i;)' ID <61<&85 10 a9'"5 2012/ d4i:10/112012<61<&8

http://escholarship.org/uc/item/1td1j7ft

http://escholarship.org/uc/item/4829t6rn

http://escholarship.org/uc/item/7d74r9k5

http://escholarship.org/uc/item/1td1j7ft

http://escholarship.org/uc/item/4829t6rn

http://escholarship.org/uc/item/7d74r9k5



12/ .r4,i) K'"'$a%an Ind4n'"ia 201<5 mu+a "ura% 180718< K'm'n%'rian

K'"'$a%an R'u()i+ Ind4n'"ia/

1</ Ei;$')mann5 K/5 G4n*Q)'*5 S/G/5 Sa)a"7A)ani"5 // and O;am47andiani5 /5

201</ L'r4"#/ An uda%': d',ini%i4n5 a%$49'n'"i"5 ;)a""i,i;a%i4n5 dia9n4"i"5 and

%r'a%m'n%/ A;%a" D'rm47Si,i)i49rQ,i;a" =En9)i"$ Edi%i4n>5 108=&>5 /876</

18/ 'an LB5 4"'$ L5 R4na)d .R5 D'rma%4)49#5 2nd Edi%i4n5 USA5 E)"'Ci'r5

200! a9' 110&

1/ 4') L5 Mari)da Aar';ida Mi)an'* M4r9ad4 d' A(r'u5 20185 L'r4"#:

r'Ci' 4, %$' 'id'mi4)49i;a)5 ;)ini;a)5 and '%i4a%$49'ni; a"';%" 7 .ar% 15

An Bra" D'rma%4) =En9)i"$ Edi%i4n>5 !-=2>: 2021!/

https://www.ncbi.nlm.nih.gov/pubmed/?term=Last%26%23x000f3%3Bria%20JC%5Bauth%5D

https://www.ncbi.nlm.nih.gov/pubmed/?term=de%20Abreu%20MA%5Bauth%5D

https://www.ncbi.nlm.nih.gov/pubmed/?term=Last%26%23x000f3%3Bria%20JC%5Bauth%5D

https://www.ncbi.nlm.nih.gov/pubmed/?term=de%20Abreu%20MA%5Bauth%5D

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