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Pulmonary tuberculosis (tb)

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Pulmonary tuberculosis (tb)

  1. 1. PULMONARY TUBERCULOSIS (TB) Presented by ASER MOHAMED KAMAL
  2. 2. Pulmonary tuberculosis (TB)  DEF:Tuberculosis is the infectious disease primarily affecting lung parenchyma is most often caused by mycobacterium tuberculosis.it may spread to any part of the body including meninges,kidney,bones and lymphnodes.  It’s the one of the most prevalent infections of human beings and cotnributes considerably to illness and death around the world . It is spread by inhealing tiny droplets of salaiva from the coughs or sneezes of an infected person . It is slowly spreading ,chronic , granulomatus bacterial infection charactarized by gradual wieght loss
  3. 3. MYCOBACTERIUM TUBERCULI
  4. 4. TYPES  PULMONARY TUBERCULOSIS  AVIAN TUBERCULOSIS( MICROBACTERIUM AVIUM ;OF BIRDS)  BOVINE TUBERCULOSIS(MYCOBACTERIUM BOVIS ;OF CATTLE)  MILIARY TUBERCULOSIS / DISSEMINATED TUBERCULOSIS
  5. 5. CLASSIFICATION  Class I (TB exposure)  (+) exposure  (-) Mantoux tuberculin test  (-) signs and symptoms suggestive of TB  (-) chest radiograph
  6. 6. CLASSIFICATION  Class II (TB infection)  (±) exposure  (+) Mantoux tuberculin test  (-) signs and symptoms suggestive of TB  (-) chest radiograph
  7. 7. CLASSIFICATION  Class III (TB disease)  Has three or more of the ff. criteria  (+) history of exposure to an adult/adolescent with active TB disease  (+) Mantoux tuberculin test  (+) signs and symptoms suggestive of TB  Cough/wheezing > 2 weeks; fever > 2 weeks  Painless cervical and/or other lymphadenopathy  Poor weight gain; failure to make a quick return to normal after an infection (measles, tonsillitis, whooping cough) or failure to respond to approriate antibiotic therapy (pneumonia, otitis media)  Abnormal Chest radiograph  Laboratory findings suggestive of TB (histological, cytological, biochemical, immunological or molecular)
  8. 8. CLASSIFICATION  Class IV (TB inactive)  A child/adolescent with or without history of previous TB and any of the ff:  (±) previous chemotherapy  (+) radiographic evidence of healed/calcified TB  (+) Mantoux tuberculin test  (-) signs and symptoms suggestive of TB  (-) smear/culture for M. tuberculosis
  9. 9. INCIDENCE  With the increased incidence of AIDS, TB has become more a problem in the U.S., and the world.  It is currently estimated that 1/2 of the world's population (3.1 billion) is infected with Mycobacterium tuberculosis  Global Emergency Tuberculosis kills 5,000 people a day  2.3 million die each year
  10. 10. ETIOLOGY  Mycobacterium tuberculosis  Droplet nuclei(coughing,sneezing,laughing)  Exposure to TB
  11. 11. Risk Factors 1. Age: infants and adolescents are at highest risk of disease 2. Close contact with an untreated sputum positive patient 3. Impaired host defenses: immunodeficiency states, particularly that associated with HIV infection; immunosuppression related to accompanying viral infection, or drug induced; malnutrition. 4. Other disease staes: Hodgkin’s lymphomas, diabetes mellitus, leukemia, malignancy (head and neck) severe kidney disease, silicosis, prolonged treatment with corticosteroids
  12. 12. Risk Factors 5. Persons whose tuberculin skin test results converted to (+) In the past 1-2 years. 6. Persons who have CXR suggestive of old TB. 7. IMMUNO COMPROMISED STATUS (ELDERLY,CANCER). 8. DRUG ABUSE AND ALCOHOLISM. 9. PEOPLE LACKING ADEQUATE HEALTH CARE. 10. IMMIGRANTS FROM COUNTRIES WITH HIGHER INCIDENCE OF TB. 11. INSTITUTIONALISATION(LONG TERM CARE FACILITIES).
  13. 13. PATHOPHYSIOLOGY  (INITIAL INFECTION OR PRIMARY INFECTION)  ENTRY OF MICRO ORGANISM THROUGH DROPLET NUCLEI  BACTERIA IS TRANSMITTED TO ALVEOLI THROUGH AIRWAYS  DEPOSITION AND MULTIPLICATION OF BACTERIA  BACILLI ARE ALSO TRANSPORTED TO OTHER PARTS OF THE BODY THROUGH BLOOD STREAM AND LYMPHNODE INFLAMMATION
  14. 14. PATHOPHYSIOLOGY  PHAGOCYTOSIS BY NEUTROPHILS AND MACROPHAGES  ACCUMULATION OF EXUDATE IN ALVEOLI  BRONCHO PNEMONIA  NEW TISSUE MASSES OF LIVE AND DEAD BACILLI ARE SURROUNDED BY MACROPHAGES WHICH FORM A PROTECTIVE MASS AROUND GRANULOMAS  GRANULOMAS THEN TRANSFORMS TO FIBROUS TISSUE MASS AND CENTRAL PORTION OF WHICH IS CALLED GHON TUBERCLE
  15. 15. PATHOPHYSIOLOGY  THE MATERIAL (BACTERIA AND MACROPHAGES BECOMES NECROTIC FORMING CHEESY MASS  MASS BECOMES CALCIFIED AND BECOMES COLAGENOUS SCAR  BACTERIA BECOME DORMANT AND NO FURTHER PROGRESSION OF ACTIVE DISEASE  (ACTIVE DISEASE OR RE INFECTION)  INADEQUATE IMMUNE RESPONSE  ACTIVATION OF DORMANT BACTERIA
  16. 16. PATHOPHYSIOLOGY  GHON TUBERCLE ULCERATES AND RELEASING CHEESY MATERIAL INTO BRONCHI  BACTERIA THEN BECOME AIRBORNE RESULTING IN FURTHER SPREAD OF INFECTION  ULCERATED TUBERCLE HEALS AND BECOMES SCAR TISSUE  INFECTED LUNG BECOME INFLAMMED  FURTHER DEVOLOPMENT OF PNEUMONIA AND TUBERCLE FORMATION  UNLESS THE PROCESS IS ARRESTED IT SPREADS DOWNWARDS TO THE HILUM OF LUNGS AND LATER EXTENDS TO ADJASCENT LOBES
  17. 17. CLINICAL MANIFESTATIONS CONSTITUTIONAL SYMPTOMS  Anorexia  Low grade fever  Night sweats  Fatique  Weight loss PULMONARY SYMPTOMS  Dyspnea  Non resolving bronchopneumonia  Chest tightness  Non productive cough  Mucopurulent sputum with hemoptpysis  Chest pain EXTRA PULMONARY SYMPTOMS  Pain  Inflammation
  18. 18. ASSESSMENT AND DIAGNOSTIC FINDINGS  HISTORY COLLECTION  PHYSICAL EXAMINATION  Clubbing of the fingers or toes (in people with advanced disease)  Swollen or tender lymph nodes in the neck or other areas  Fluid around a lung (pleural effusion)  Unusual breath sounds (crackles)  IF MILIARY TB;  A physical exam may show:  Swollen liver  Swollen lymph nodes  Swollen spleen
  19. 19. ASSESSMENT AND DIAGNOSTIC FINDINGS Tests may include:  Biopsy of the affected tissue (rare)  Bronchoscopy  Chest CT scan  Chest x-ray  Interferon-gamma release blood test such as the QFT-Gold test to test for TB infection  Sputum examination and cultures  Thoracentesis  Tuberculin skin test (also called a PPD test)
  20. 20. QUANTIFERON GOLD TEST  QFT-Gold test measures interferon-gamma in the testee's blood after incubating the blood with specific antigens from M. Tuberculosis proteins
  21. 21. COMPLICATIONS  Bones. Spinal pain and joint destruction may result from TB that infects your bones(TB spine or potss spine)  Brain(meningitis)  Liver or kidneys  Heart(cardiac tamponade)  Pleural effusion  Tb pneumonia  Serious reactions to drug therapy(hepato toxicity;hypersentivity)
  22. 22. MEDICAL MANAGEMENT  PULMONARY TB is treated primarily with antituberculosis agents for 6 to 12 months.  Pharmacological management  Streptomycin 15mg/kg  Isoniazid or INH(Nydrazid) 5 mg/kg(300 mg max perday)  Rifampin 10 mg/kg  Pyrazinamide 15 – 30 mg/kg  Ethambutol(Myambutol) 15 -25 mg/kg daily for 8 weeks and continuing for up to 4 to 7 months
  23. 23. MEDICAL MANAGEMENT  Capreomycin 12 -15 mg/kg  Ethionamide 15mg/kg  Paraaminosalycilate sodium 200 -300 mg/kg  Cycloserine 15 mg/kg  Vitamin b(pyridoxine) usually adminstered with INH 
  24. 24.  Other drugs that may be useful, but are not on the WHO list of SLDs:  Rifabutin  Macrolides:e.g.,clarithromycin (CLR)  Linezolid(LZD)  Thioacetazone(T)  Thioridazine  Arginine
  25. 25. MULTIDRUG THERAPY  Multiple-drug therapy to treat TB means taking several different antitubercular drugs at the same time.  The standard treatment is to take isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months. Treatment is then continued for at least 4months with fewer medicines
  26. 26. Prevention  ISOLATION  Ventilate the room  Cover the mouth  Wear mask  Finish entire course of medication  vaccinations
  27. 27. CONCLUSION

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