Download MBBS Pulmonary Medicine Presentations 9 Tuberculosis Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Pulmonary Medicine 9 Tuberculosis PPT-Powerpoint Presentations and lecture notes

TUBERCULOSIS(Part 2)

MCQ & Revision of Part 1
OBJECTIVES
? What are complications of tuberculosis?

? What are various presentations of EPTB?

? Drug resistant tuberculosis

? DOTS & RNTCP

COMPLICATIONS
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


EPTB

? Common sites:LN,PE

? Any site

? Diagnosis:more difficult

LN TB

?LN-site

?painless enlargement

,systemic symptoms<50%

?Matting

?Sinus/fistula

?FNAC/Bx/NAAT/smear/cultur

e


Pleural Effusion

? Pain/dyspnea/cough

? Fever/dec appetite

? Radiology

? Pleural fluid analysis

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

MANAGEMENT
Principles of chemotherapy

? Variable bacilli population:rapid growers,slow growers,dormant

? Longer duration

? 2 phases of treatment

? Need for multiple drugs to treat(spontaneous resistance)

TREATMENT REGIMENS

Type of TB case

Intensive Phase

Continuation Phase

New(CAT 1)

2RHEZ

4RHE

Retreatment(CAT 2) 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
? New case:CAT 1

? Smear positive

? Smear negative

? EPTB

? Retreatment:CAT 2

? Relapse

? Defaulter

? failure

? 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
Drug Resistance:Magnitude

? 3% Primary

? 12% Acquired

? XDR 4-20% of MDR

Dx in drug resistant Tb

? MDR-TB:

? Rapid Molecular Test ( LPA/ CB-NAAT)


? Liquid Culture & DST

? Solid Culture & DST

? XDR-TB:

? Liquid Culture & DST


? Solid Culture & DST

? LPA(Genotypic methods)
Changed to

daily
OLD

Grouping of antiTb drugs(2017 ,RNTCP

guidelines)

FQ

Levo/moxi/gati

Injectable agents

K/A/C

Other second line drugs

Etio/prothio/cycloserine/linezolid

Add on drugs

D1:Z/E/H high dose,D2:Bedaquiline/delaminid

D3:PAS,Amoxy-clav,Meropenem,imipenem

cilastatin


RNTCP 2017
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
Newer ATT

? Bedaquiline

? Delaminid

? protaminid

MCQ

? A pt on ATT C/O burning soles

? A pt on ATT C/O loss of appetite & vomittings

? A pt on ATT C/O dec vision


DOTS & RNTCP

Advantages

? Directly observed

? Standardised treatment

? Free of cost
TB & HIV

? Increased chances of reactivation/relapse

? Atypical presentations

? Higher ADR/drug interactions

? Priorty to treat Tb first and then ART

TB & DM

? Higher risk

? Glycemic control must for cure

? Higher chances of ADR