Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pulmonary Medicine 7 Tuberculosis Integrated PPT-Powerpoint Presentations and lecture notes
Clinical Manifestations &
Overview of Management of
Pulmonary Tuberculosis
Dept of Pulmonary Medicine
Learning Objectives
? When to suspect Pulmonary Tuberculosis?
? How to diagnose?
? How to manage a case of drug susceptible Tuberculosis?
When to suspect?(Pulmonary)
? TB suspect Presumptive Tb
? > 2weeks cough
? fever>2 wks,
Dyspnea
? significant wt loss
Chest pain
? Haemoptysis
? abnormal CXR
Signs
? General
? Emaciated
? Pal or
? Cyanosis
? Clubbing
? Edema
? LNpathy
? Respiratory
? Any
? Consolidation
? Fibrosis
? Cavity
? Pleural inv
? Miliary
Signs
? Bronchial
? Dec/Absent BS
? Normal
? Added sounds
Diagnostic tools
Diagnostics
? CXR: ? Sensitivity & poor specificity
? Complementary tool
? Microscopy:
? Serology:Banned
? Gold standard:culture
? LJ media
? Rapid :Bactec
? MGIT
? Bac T
Diagnosis
? Microscopy
? ZN stain
Phenotypic methods
Phenotypic methods
? Flourescent
? Culture
? solid (6-8 wks)
? liquid (42 days)
? Rapid
Genotypic methods
? CBNAAT
? LPA
OLD
RNTCP 2017
Management
? Medical:
? long duration
? IP & CP
? Surgery:complications
? Haemoptysis
? Aspergilloma
? Pleural diseases
TREATMENT REGIMENS
Type of TB case
Intensive Phase
Continuation Phase
New
2RHEZ
4RHE
Retreatment
2SIH
nt REZ
ermi /
tt1R
en H
t EZ
regimens 5RHE
are being changed to
daily regimens under
RNTCP in India
R;rifampicin,H:isoniazid,E:ethambutal,Z:pyrazinamide,S:streptomyci
n
? CAT 1 & 2
? CAT 4 :MDR
? CAT 5:XDR
? Definitions
? MDR:R and H
? XDR:R and H,any FQ,any injectables(kanamycin,amikacin,capreomycin)
? Primary & acquired resistance
? Mono/poly drug resistance:DRTB
DR TB:Principles of Treatment
? MDR:4 second line drugs /not used
? XDR:7 drugs
? Duration:24(MDR),36(XDR)
DOTS plus previously
Second line drugs
? Treatment longer
? Toxic
? Expensive
more
? Stress:emergence rather than treatment of DRTb
Infection Vs Disease
? What `s the difference
? For Infection
? Mantoux/PPD
? Interferon gamma release Assay
? TB Gold/Elispot
COMPLICATIONS
? Local-?ARDS/respiratory failure
? Bronchiectasis/PTOAD
? aspergilloma
? haemoptysis (symp )
? Pleural -Empyema/pneumo
? Extensive lung destruction
? Rt middle lobe syndrome
? Scar ca
? Systemic-
? shock
? amyloidosis
? disseminated tb-(laryngeal tb)
? Cor-pulmonale
THANK YOU
This post was last modified on 08 April 2022