Dept of Pulmonary Medicine
Learning Objectives
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? When to suspect Pulmonary Tuberculosis?
? How to diagnose?
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? How to manage a case of drug susceptible Tuberculosis?When to suspect?(Pulmonary)
? TB suspect Presumptive Tb
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? > 2weeks cough? fever>2 wks,
Dyspnea
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? significant wt loss
Chest pain
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? Haemoptysis? abnormal CXR
Signs
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? General
? Emaciated
? Pal or
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? Cyanosis
? Clubbing
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? Edema? LNpathy
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? Respiratory
? Any
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? Consolidation
? Fibrosis
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? Cavity? Pleural inv
? Miliary
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Signs
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? Bronchial? Dec/Absent BS
? Normal
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? Added sounds
Diagnostic tools
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Diagnostics
? CXR: ? Sensitivity & poor specificity
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? Complementary tool? Microscopy:
? Serology:Banned
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? Gold standard:culture
? LJ media
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? Rapid :Bactec? MGIT
? Bac T
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Diagnosis
? Microscopy
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? ZN stain
Phenotypic methods
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Phenotypic methods? Flourescent
? Culture
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? solid (6-8 wks)
? liquid (42 days)
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? RapidGenotypic methods
? CBNAAT
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? LPA
OLD
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RNTCP 2017Management
? Medical:
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? long duration
? IP & CP
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? Surgery:complications? Haemoptysis
? Aspergilloma
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? Pleural diseases
TREATMENT REGIMENS
Type of TB case
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Intensive Phase
Continuation Phase
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New2RHEZ
4RHE
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Retreatment
2SIH
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nt REZermi /
tt1R
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en H
t EZ
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regimens 5RHEare being changed to
daily regimens under
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RNTCP in India
R;rifampicin,H:isoniazid,E:ethambutal,Z:pyrazinamide,S:streptomyci
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n? CAT 1 & 2
? CAT 4 :MDR
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? CAT 5:XDR
? Definitions
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? MDR:R and H? XDR:R and H,any FQ,any injectables(kanamycin,amikacin,capreomycin)
? Primary & acquired resistance
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? Mono/poly drug resistance:DRTB
DR TB:Principles of Treatment
? MDR:4 second line drugs /not used
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? XDR:7 drugs
? Duration:24(MDR),36(XDR)
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DOTS plus previously
Second line drugs
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? Treatment longer
? Toxic
? Expensive
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more? Stress:emergence rather than treatment of DRTb
Infection Vs Disease
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? What `s the difference? For Infection
? Mantoux/PPD
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? Interferon gamma release Assay
? TB Gold/Elispot
COMPLICATIONS
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? Local-?ARDS/respiratory failure
? Bronchiectasis/PTOAD
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? aspergilloma? haemoptysis (symp )
? Pleural -Empyema/pneumo
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? Extensive lung destruction
? Rt middle lobe syndrome
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? Scar ca? Systemic-
? shock
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? amyloidosis
? disseminated tb-(laryngeal tb)
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? Cor-pulmonaleTHANK YOU