Download MBBS Pulmonary Medicine Presentations 8 Tuberculosis Part 2 Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pulmonary Medicine 8 Tuberculosis Part 2 PPT-Powerpoint Presentations and lecture notes


TUBERCULOSIS(Part 2)

SITES

? Virtually anywhere

? Lungs

? Pleura

? Lymph node


PULM

PU O

L N

MOA

NR

A Y

RY-

CLINICAL SCENARIO

SYMPTOMS(Pulmonary)

? Cough+ exp (>2 weeks)

? Fever

? Appetite/weight loss

? Chest pain

? Haemoptysis

? Dyspnea
SIGNS

? General

? Emaciated
? Anaemic
? Clubbing
? Cyanosis
? LN
? Edema

PRESENTATION(signs)

? Respiratory

? consolidation
? fibro-cavitatory disease
? Collapse
? Effusions
? Pneumothorax
? hydro-pneumothorax

? Wide variety of clinical findings


PRESENTATION(Pulmonary)





EPTB-PRESENTATION

LN TB

?LN-site

?painless enlargement

,systemic symptoms<50%

?Matting

?Sinus/fistula

?FNAC/Bx/NAAT/smear/cultur

e


SKELETAL TB

?Site

?Pain/joint swelling/dec

range of motion.

?Draining sinuses and

abscesses

?Systemic symptoms

?Radiographic changes

m/b nonspecific

CNS TB

? Tuberculous meningitis(MC), intracranial

tuberculomas, , cranial nerve palsies and

communicating hydrocephalus , cranial

vasculitis may lead to focal neurologic deficits.

? Malaise, headache, fever, or personality

change,A/S,seizures/focal defects

? CSF ?lymphocytic,increased protein,ADA,CB

NAAT


Koch's abdomen

?Site-gut/peritoneum/LN

?pain,nausea/vomitting

?altered bowel habbits

?Distension

?Diagnosis:ascetic fluid

analysis/LN

sampling/radiology

Miliary

? Fever/dec appetite/wt loss/vague-elderly

? Haematogenous

? Fulminant disease -septic shock, ARDS,MOF

? CXR/Liver/spleen BX/BM

? Haematological-anaemia(NCNC),hyponatremia
PRESENTATION(Extra-Pulmonary)

? Genitourinary-infertility, urinary difficulties

? CVS-pericarditis(pain/dyspnea)

CLINICAL CLUES-EPTB

? Ascites -lymphocyte predominance and negative bacterial cultures

? Chronic lymphadenopathy (especially cervical)

? CSF -lymphocytic pleocytosis / elevated protein /low glucose

? Pleural effusion -Exudative / lymphocyte predominance/negative

bacterial cultures

? Joint inflammation (monoarticular) with negative bacterial cultures

? Persistent sterile pyuria

? Unexplained pericardial effusion, constrictive pericarditis, or

pericardial calcification/Vertebral osteomyelitis involving the thoracic

spine
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
INVESTIGATIONS

? Active infection

? Latent Infection

? Drug resistance

TESTS FOR ACTIVE TUBERCULOSIS


ACTIVE TUBERCULOSIS

? Radiology-X-ray

? Microbiological-smear /culture

? NAAT-gene expert

CXR

? Abnormalities often seen in

apical or posterior segments

of upper lobe or superior

segments of lower lobe

? May have unusual

appearance in HIV-positive

persons

? Cannot confirm diagnosis of

TB!!

? Sensitive,specificity is low
? No chest X-ray pattern is absolutely typical of

TB

? 10-15% of culture-positive TB patients not

diagnosed by X-ray

? 40% of patients diagnosed as having TB on the

basis of x-ray alone do not have active TB

Proportion of patients with pulmonary

TB who have positive AFB smears
SPUTUM SMEAR

? Rapid , results within hours

? Inexpensive

? simple, relatively easy to perform

? Reliable(40-64%sensitive,90%specificity)

AFB - Ziehl-Nielson stain


CULTURE

? Gold standard for TB diagnosis(100 bacil i)

? Culture al specimens, even if smear negative

? Conventional(LJ-6-8wks)

? Rapid ?liquid culture-Bactec/MGIT

? Al ows DST Vs smear
Colony Morphology ? LJ Slant

IMMUNOLOGICAL TESTS

? BANNED
? Antigen/antibody detection method(ELISA )

? Not specific, rapid, expensive

? Cannot differentiate active/past infection.

TESTS FOR LTBI

WHAT is LTBI?

1.PPD-

infection with M tuberculosis produces a Delayed Type

Hypersensitivity (DTH) to certain antigenic components

2.Interferon gamma release assays ?Quantiferon gold/Elispot

test

? single patient visit

? assesses responses to multiple antigens

? does not boost anamnestic immune responses

? Less reader bias/reading

? moderate concordance between TST and QFT


Mantoux test
Limitations

? Active Vs inactive disease

? Old Vs new

? BCG /MOTT(though IGRA are less affected)

TESTS FOR DRUG RESISTANCE
DRUG RESISTANCE

? Conventional/rapid culture & DST

? GOLD standard

? NAAT-gene xpert LPA

MANAGEMENT
Principles of chemotherapy

? Variable bacil i population:rapid growers,slow

growers,dormant

? Longer duration

? 2 phases of treatment

? Need for multiple drugs to treat(spontaneous

resistance)

This post was last modified on 08 April 2022