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