PEADIATRIC TB 2022 SLIDES

1. M W E B A Z A
VICTOR.J
MBchB 5th Yr Africa Ugandan
mwebazavictor1997@gmail.com
Kampala international university
western campus Uganda under
the care of Jinja Regional Referral
Hospital Children hospital
(Naluffenya)
T U B E R C U L O S I
S I N C H I L D R E N
PRESENTATION
Supervised by DR. TAGOOLA

2. INTRODUCTION
HISTORICAL BACKGROUND
Writing in The Lancet in 1867, W i l l i a m
B u d d
stated that it was well known that Negroes
were
" peculiarly liable to phthisis ".

3. Skeletal remains show some prehistoric
humans (4000 BC) had TB, and
researchers have found tubercular decay
in the spines of Egyptian mummies dating
from 3000 to 2400 BC. Genetic studies
suggest the presence of TB in the
Americas from about 100 AD.
Although Richard Morton established
the pulmonary form associated with
tubercles as a pathology in 1689,

4. R o b e r t K o c h identified and described
the bacillus causing tuberculosis, M.
tuberculosis,
on 24th March 1882. He received the Nobel
Prize in physiology or medicine in 1905 for
this discovery.

5. Albert Calmette and Camille Guérin
achieved the first genuine success in
immunization against tuberculosis in 1906,
using attenuated bovine-strain
tuberculosis. It was called bacille
Calmette–Guérin (BCG). The BCG
vaccine was first used on humans in 1921
in France, but achieved widespread
acceptance in the US, Great Britain, and
Germany only after World War II.

6. Phthis is , phthis is pulmonalis ,
Tuberculosis
Tuberculosis (TB) is an infectious
disease usually caused by Mycobacterium
tuberculosis (MTB) bacteria. Tuberculosis
generally affects the lungs, but can also
affect other parts of the body.
Typically the center of tubercular
granulomas
undergo caseous Necrosis

7. UGANDA TUBERCULOSIS
ROADMAP OVERVIEW, FISCAL
YEAR 2021
According to USAID’ . In 2019, an estimated 88,000
people fell ill with TB in Uganda, and an estimated
15,600 people died.
World Health Organization. Global Tuberculosis
Report, 2020.
While men make up the majority of TB cases (56
percent) in the country, children account for 13
percent .
In 2019, 65,897 TB cases were diagnosed and

8. Furthermore, in 2019, of the estimated 1,500
drug-resistant TB (DR-TB) cases, only 559
were diagnosed and notified to the NTLP.
EPIDEMIOLOGY
In developing countries, 1.3 million new cases of
the disease occur in children under 15 years of
age, and 450,000 children die each year of
tuberculosis.

12. Risk factors for TB Infection
1. Contact with a person with active
Pulmonary TB (PTB) especially
Bacteriologically confirmed PTB and
closer contacts (household and close
contacts). Close contacts include
schools.
2. Living in countries with a high TB burden
such as Uganda
3. High HIV rates in the community because
people living with HIV have an increased

13. Risk factors for TB Disease
1. Young age ( especially less than 2 years).
2. Human Immune Deficiency Virus (HIV)
infection
3. Malnutrition
4. Other Immune-suppressive conditions
like post measles disease

14. Risk factors for Severity of
Disease
1. Young age (especially less than 2 years)
2. HIV infection
3. Lack of BCG vaccination

15. Etiology
Tuberculosis (TB) is usually caused by a
bacterium, Mycobacterium tuberculosis
(M.tb) complex (such as Mycobacterium
tuberculosis, Mycobacterium bovis,
Mycobacterium africanum and
Mycobacterium microti).
Mycobacterium tuberculosis are pleomorphic,
weakly gram-positive curved rods.
Mycobacteria are acid fast, which is the
capacity to form stable mycolate complexes
with arylmethane dyes.

16. Mycobacteria grow slowly; culture from
clinical specimens on solid synthetic
media usually takes 3 to 6 weeks. Drug-
susceptibility testing requires an additional
4 weeks. Growth can be detected in 1 to 3
weeks in selective liquid media using
radiolabeled nutrients.

17. Transmission
Transmission of tubercle bacilli occurs when
a patient suffering from pulmonary TB who
is not on effective treatment expels into
the environment air containing droplets
with the bacilli (coughing, singing or
sneezing). The liquid in the droplets
evaporates leaving the droplet nuclei
containing the bacilli.

18. Several patient-related factors are
associated with an increased chance of
transmission. Of these a positive acidfast
smear of the sputum most closely
correlates with infectivity.
Children with primary pulmonary
tuberculosis disease rarely, if ever, infect
other children or adults. Tubercle bacilli
are relatively sparse in the endobronchial

19. When young children cough, they rarely
produce sputum, lacking the tussive
force necessary to project and suspend
infectious particles of the requisite
size.
Most infectious patients become
non-infectious within 2 weeks of
starting effective treatment, and
many become non-infectious within
several days.

20. Pathogenesis of TB
infection
This occurs in five steps which are
1) Entry into macrophages
2) Replication in the macrophages
3) The Th1 response
4) Th1 mediated macrophages activation
5) Granulomatous inflammation and tissue
damage

21. o Entry into the macrophages (0-3weeks)
This is by phagocytosis mediated by protein
molecules on both MTB and phagocyte i.e.
the mannose and C3b on MTB
bind with mannose receptor and
CR3 respectively on the
phagocytes

22. o Replication in macrophages (first
3weeks)
After being phagocytised The MTB multiply
in the vesicle after inactivating the
macrophages though blocking formation of
phagolysosomal contents They block
phagolysosomal formation by:-
1. Inhibiting Ca++ signal
2. Inhibiting of recruitment and assembly
of the proteins that mediate
phagolysosomal formation
After the multiplication phase some

23. o The Th1 response(3-4weeks)
Th1 response is mounted roughly three
weeks after infection and this involves
activation of the macrophages.
®Innate immune receptors TLR2 recognize
the multiple pathogen then the TLR2
become stimulated by the mycobacterial
ligands thus this makes them activated
The activated TLR2 stimulate the dendritic
cells
Stimulated dendritic cells migrate to near
by lymph node then produce IL12

24. o Th1 mediated activation of macrophages
and killing of the bacteria
Th1 cell in the lymph node or lungs
produce INF-gamma this cause
classical activation of the
macrophages Activated macrophages
produces cytokines for example
IL1,IL2,IL3,IL6,IL8,IL23,more IL12 on
addition to maturation of
phagolysosomes in the infected
macrophages, activation off Nitric
oxide synthesis All those
proinflammatory mediates are

25. oG ranulomatous inflammation and Tissue
damage
The activated macrophages aggregate
around the microbes forming giant cells thus
forming G h a n c o m p l e x s , m i l l i a r y
c o n s o l i d a t i o n
due to the inflammatory mediates
produced by the Activated
macrophages affects the normal
parenchymal cells of the lungs
causing caseation necrosis of the
tissues also erosion of lung blood

26. NOTE:-
1.in primary TB Ghan focus are
formed at the lower part of the
upper lung lobe and upper
part of the lower lobe close to
the the lateral pleural border.
2.In secondary TB granulation
occurs /involves the apex of
the upper lobe of one or both

27. Symptoms suggestive of PTB
among children
1. Persistent cough for 2 weeks or more
2. Persistent fever for 2 weeks or more
3. Weight loss or poor weight gain for 1 month or
more
4. History of close or household TB contact
5. Reduced playfulness or decreased activity in
the presence of any of the above symptoms
6. Older children may present with any of the
following in addition to the above:- excessive
night sweats, chest pain, haemoptysis
7. Symptoms of TB among neonates are non
specific and may include:- lethargy, poor
feeding, low birth weight, non resolving

28. Symptoms suggestive of EPTB
among children, adolescents and
adults
o TB adenitis: Painless swellings in the
neck or armpits with or without
discharging sinus
o TB meningitis: Headache, irritability,
abnormal headache, vomiting (without
diarrhea), lethargy, reduced loss of
consciousness, convulsions, neck
stiffness, bulging fontanelle
o Miliary TB: Non specific symptoms such
as lethargy, fever, wasting

29. o Abdominal TB: Abdominal swelling,
abdominal masses
o TB spine: Deformity of the spine, lower limb
weakness, paralysis, inability to walk
o Bone and joint TB: Swelling of long bones
(usually painless), difficulty in movement:
o Pericardial TB: Difficulty in breathing, easy
fatigability, palpitations, chest pain
o Rasmussen's aneurysm is a pulmonary
artery aneurysm associated with a cavitary
lung lesion.

30. In new born TB presents with
following
o History of maternal TB or HIV infection.
o History of un-resolving pneumonia or contact
with an index TB case
Non-specific symptoms that may include any of
the following:
1. Poor feeding
2. Lethargy
3. Low birth weight
4. Poor weight gain

31. Symptoms of PTB in children less
than 5 years
1. Persistent Cough for ≥ 2 weeks
2. Persistent Fever for ≥2 weeks
3. Poor weight gain for ≥ 1month
4. Painless swellings in the neck, armpit, or
groin (lymph nodes)
5. History of a close contact with a PTB
case.
6. Reduced physical activity

35. Standard TB Case Definitions
1. Presumptive TB refers to a patient who
presents with symptoms or signs suggestive
of TB (previously known as a TB suspect).
2. Bacteriologically confirmed TB case is
one from whom a biological specimen is
positive by smear microscopy, culture or
Nucleic Acid Amplification (such as Xpert
MTB/RIF). All such cases should be notified,
regardlessof whether TB treatment has

36. 3. A clinically diagnosed TB case is one
who does not fulfil the criteria for
bacteriological confirmation but has been
diagnosed with active TB by a clinician or
other medical practitioner who has
decided to give the patient a full course of
TB treatment.

37. Classification of TB Infection
o Classification based on Anatomical Site of
the disease
1. Pulmonary tuberculosis PTB
2. Extra-pulmonary tuberculosis (EPTB);
Refers to any bacteriologic ally confirmed or
clinically diagnosed case of TB involving
organs other than the lungs, e.g. pleura,
lymph nodes, abdomen, genitourinary tract,
skin, joints bones, and meninges.
A patient with both pulmonary and extra-

38. Gibbus
(acute angulation of spine)

39. o Classification based on History of
treatment
1. New patients: These are patients who have
never been treated for TB or have taken anti-TB
drugs for less than one month.
2. Previously treated TB patients: These are
patients who have received one month or more of
anti TB drugs in the past. They are sub classified
as follows:-
i. Relapse patients have previously been treated
for TB, completed treatment, were declared cured
or treatment completed at the end of their most
recent course of treatment, and are now

40. ii) Treatment after failure patients: are those
who have previously been treated for TB and
whose treatment failed at the end of their most
recent course of treatment.
iii) Treatment after loss to follow-up patients:
have previously been treated for TB and were
declared lost to follow-up at the end of their
most recent course of treatment. (These were
previously known as treatment after default
patients).
iv) Other previously treated patients are those
who have previously been treated for TB but
whose Outcome after their most recent course

41. o Classification based on HIV infection
status
1. HIV-positive TB patient
2. HIV-negative TB patient
3. HIV status unknown TB patient
o Classification based on Drug
resistance
Mono resistance: resistance to one first-line
anti-TB drug only.

42. Poly drug resistance: resistance to more
than one first-line anti-TB drug (other than
both Isoniazid and Rifampicin).
Multidrug resistance: resistance to at least
both Isoniazid and Rifampicin.
Extensive drug resistance: resistance to
any fluoroquinolone and to at least one of
three second line injectable drugs
(Capreomycin, Kanamycin and Amikacin),
in addition to multidrug resistance.

43. Rifampicin resistance:
Resistance to Rifampicin detected using
phenotypic (usual drug susceptibility testing,
DST) or genotypic methods (commonly Xpert
MTB/Rif), with or without resistance to other
anti-TB drugs.
“Pre-XDR” TB: refers to an isolate that is
resistant to either a fluoroquinolone or a
second-line injectable, but not both. It is a
commonly used designation but not officially
accepted terminology by WHO or the global
TB community.

44. Methods used in lab diagnosis of TB
Microscopy
It is the most commonly available test currently
for diagnosis of TB. It can be either
ZiehlNeelsen microscopy or Fluorescence
microscopy . It can be used to examine sputum
specimen or gastric aspiration fluid or any other
body material suspected to contain the TB
bacilli.

45. Xpert MTB/Rif
is the most used NAAT(Nuclear Acid Amplification
Test) in Uganda. Xpert MTB/Rif is an automated
DNA test for Mycobacteria and for the mutation
that causes resistance to Rifampicin.
The following body fluids or samples can be examined
for TB using XpertMTB/Rif: Sputum, Lymph node
tissue and aspirates, Pleural fluid, Cerebrospinal
fluid and Gastric aspirates
http://www.who.int/tb/areas-of-work/laboratory/ policy
statements/en/.

46. Culture
Culture is done using LJ media(Löwenstain-
Jensen media) or DST media. culture of MTB is
very sensitive and specific but expensive as its
a complex and sophisticated procedure.
It require specialized laboratory setup and culture
results are available only after 6 to 8 weeks for
LJmedia, culture results of DSTmedia can take
a very long period.
If available, culture can be used for diagnosis or
confirmation of the diagnosis of TB in patients
with PTB and EPTB. Since it is more sensitive
than smear, culture may also have a role in the
diagnosis of smear-negative, HIV-positive TB

47. TB LAM test MTB cell wall antigen
lipoarabinomanna
is based on the detection of LAM in urine and has
the potential to be point-of-care tests for TB.
WHO recommends the test to assist the
diagnosis of TB in HIV positive adult inpatients
with signs and symptoms of TB (pulmonary
and/or extra-pulmonary) with a CD4 cell count
less than or equal to 100 cells/μL, and people
living with HIV who are deemed“seriously ill”.
http://www.who.int/tb/areas-of-
work/laboratory/policy_statement_lam_web.pdf

48. CSF Analysis.
Those pt who present with CNS signs and
symptoms on addition to chronic cough, B-
syptoms. ℅ meningealTb
® how to analyse CSF Analysis results in line
with TBM
DISCUSS AS A CLASS

49. Radiology; CXR
Radiology investigations such as chest X-ray:
Features of chest X-ray consistent with TB
disease include cavitation milliary picture,
pleural effusion and mediastinal lymph
gland enlargement with lung infiltration.
Although the findings of radiology are nonspecific,
abnormalities like any heterogeneous opacities
andcavitation, if located in the upper parts of
the lung, are more likely to be caused by TB

54. Ultrasound
Diagnostic ultrasound is a useful test in the
diagnosis of extra pulmonary TB. For
example,ultrasound is useful in abdominal TB in
which case you can see omental thickening,
increase in mesenteric thickness and an
increase in the mesenteric echogenicity (due to
fat deposition), combined with retroperitoneal
and mesenteric lymphadenopathy.
Presence of dilated and matted small bowel loops
and ascites further substantiate the diagnosis.
Calcifications within granulomas due to TB in the

55. Histology
Pathology can play a complementary role in
confirming the diagnosis of EPTB, such as
tuberculosis lymphadenitis. Multiplication of
tubercle bacilli in any site of the human body
causes a specific type of inflammation, with
formation of characteristic granuloma that can
be found on histological examination.
Samples can be taken in the following ways:
1. Fine needle aspiration of the lymph nodes:
affected peripheral lymph nodes, particularly
cervical nodes, can be aspirated.
2. Tissue biopsy: serous membranes (pleura,
pericardium and peritoneum), skin, lymph

56. C OM P L I C A TI O N S OF TB I N
C H I L D R E N
TO BE DISSCUSSED BY THE
ENTIRE CLASS

57. Management of Tuberculosis and
FDC
Early diagnosis and effective treatment is the key
to stop the spread of TB and to improve
treatment outcomes of patients suffering from
TB.
Individuals should start treatment as soon as
possible after a diagnosis of TB is made and
should be treated according to NTLP
recommended regimens (for Uganda) under
Directly Observed Treatment (DOT)
And the drugs are usually given as fixed-dose
combinations (FDC). The FDCs contain two or
more drugs in a single tablet with known

58. FDC tablets have the following
advantages:
1. Prescription errors are minimized.
Dosage recommendations are more
accurate and adjustment of the dose
according to patient weight is easier.
2. The patient has fewer tablets to swallow,
which contributes to adherence.
3. If the treatment is not supervised, patients
cannot be selective about which the
drugs to swallow

59. The aims of treatment are to:
1. Cure the TB patient
2. Prevent complications and death from TB
disease
3. Prevent TB relapse
4. Reduce TB transmission
5. Prevent development of drug-resistant TB

60. Anti-TB medicines and there side
effects,Route of administration,
contraindications, and important drug
interactions.
The first-line anti-TB medicines, together
with their standard abbreviations, are
shown below:
1. Rifampicin (R)
2. Isoniazid (H)
3. Pyrazinamide (Z)
4. Ethambutol (E)

61. Initial phase : The initial phase is the
first two months of treatment. The combination
of 4 drugs used during this phase is Isoniazid,
Rifampicin, Pyrazinamide and Ethambutol
(RHZE).
Using these 4 drugs, results in rapid killing of the
tubercle bacilli. Patients become non-infectious
in about 2 weeks. Symptoms reduce, and
most smearpositive cases become smear-
negative within the first 2 months.
Conti nuati on phase : The
continuation phase is the second part of

63. Adjunc tiv e treatment in
TB
1. Pyridoxine (vitamin B6). 25mg OD given
concomitantly with Isonizid for the duration of
treatment to prevent peripheral Neuropathy.
® isonizid interfere with vitamin B6
metabolism thus leading to vitB6 deficiency.
2. Prednisolone in TB pt in whom complication
of fibrosis are anticipated because of severe
inflammation such as Tb meningitis

64. TB Treatment Regimens
Anti-TB drugs are given in combinations
called regimens. The regimens have the
following characteristics;
A. Contain at least one of the most effective
anti-TB drugs (Rifampicin or Isoniazid) in
both the initial and continuation phase of
treatment
B. Must be written in abbreviation that
clearly identifies the drugs in the initial
and continuation phases of treatment

69. Treatment monitoring
Laboratory monitoring– Sputum microscopy
(or culture) must be used for monitoring all
pulmonary TB patients.
S p u t u m s m e a r s a r e p e r f o r m e d
a t t h e e n d o f t h e i n i t i a l p h a s e
( 2 m o n t h s ) , a t b e g i n n i n g o f 5
m o n t h s a n d b e g i n n i n g o f 6 t h
m o n t h o f t r e a t m e n t .
This should be done for both smear-positive
and smear-negative pulmonary TB patients

71. Treatment out comes

72. Isoniazid preventive therapy
(IPT)
IPT is currently strongly advocated by NTLP for all
HIV positive persons and under 5 child contacts of
patients with active TB. NTLP has published an
IPT health workers guide to assist health workers
in initiating IPT.
I t i s i m p o r t a n t t h a t b e f o r e I P T i s
i n i t i a t e d t h a t a c t i v e T B i s
e x c l u d e d . T h i s i s d o n e t o a v o i d
m o n o t h e r a p y f o r a c t i v e T B b e c a u s e

73. P r o v i d i n g I P T t o P L H I V d o e s n o t
i n c r e a s e t h e r i s k o f d e v e l o p i n g
I s o n i a z i d r e s i s t a n t T B . Therefore,
concerns regarding the development of
Isoniazid resistance should not be a barrier to
providing IPT.
 Children living with HIV who do not have
any one of the following symptoms: poor weight
gain, fever, or current cough are unlikely to
have active TB And are candidates of IPT.

74. Children living with HIV who have any
one of the following symptoms: poor weight
gain, fever, current cough or contact
history with a TB case may have TB.
These children should be evaluated for
TB and other conditions.
If the evaluation shows no TB, such children
should be offered IPT except if they less than 1
year. Children less than 1 year can be offered
IPT if they are active TB contacts

75. Children living with HIV who are more than 12
months of age: For those who are unlikely to
have active TB and have no contact with a TB
case should receive Six months of IPT (10
mg/kg/day).
Children living with HIV who less than 12
months are of age (infants) This group
should only receive IPT if there is a history
of contact with a TB case and they have
no active TB.

76. SUMMARY QUESTIONS ON
IPT
o What is TB preventive therapy?
TB preventive therapy refers to the use of anti-TB
medicines to prevent the progression from TB infection
to TB disease. The commonly used preventive therapy
is Isoniazid preventive therapy however other regimen
may be available in the future
o Who is eligible for TB preventive therapy?
The following categories of patients are eligible for TB
preventive therapy UPON EXCLUSION of active TB
disease
1. Children under the age of 5 years with a positive history
of contact with an active PTB case.
2. HIV positive children aged 12 months and above
irrespective of TB exposure status
3. HIV positive children under 12 months of age with a

77. o What is the dose and duration of Isoniazid
preventive therapy?
Isoniazid should be given at a dose of 10mg/kg
as a single daily dose for 6 months.
P y r i d o x i n e should be administered
together with Isoniazid in order to prevent
Isoniazid related side effects. Closely monitor
patients on preventive therapy for possible side
effects

78. NUTRITION CARE AND SUPPORT FOR TB
PATIENTS

79. BCG VACCINATION
1. BCG is a live attenuated Mycobacterium
bovis vaccine that protects against TB
2. Effective in protecting against severe forms
of TB
3. BCG is administered on the right upper
shoulder (Check scar or child health card)
4. Administered to all newborns or neonates
immediately after delivery or at first contact
irrespective of HIV exposure status.
5. A neonate of the mother with PTB should be
assessed for active TB disease before BCG
vaccination.

80. Latent TB
Diagnosis of latent TB is confirmed by
positive Tuberculin skin test(TST) the
commonest method for TST is the
manotoux method.
A standard dose of tuberculin units (TU - 0.1
ml) is injected intradermally and read 48 to
72 hours later.

81. The reaction is read by measuring the diameter of
induration across the forearm in millimeters. If
there is no induration, the result should be
recorded as "0 mm". Erythema (redness)
should not be measured
1. >/=5mm high Risk group
2. >/=10mm moderate risk group
3. >/=15mm low risk group.
TST has +ve when the TST has a diameter of
5mm and above in HIV +ve pt and 10mm and
above for HIV -ve pt .

82. TREATMENT OF TUBERCULOSIS IN
SPECIAL
SITUATIONS
oPregnancy (during ANC)
The NTLP-recommended regimen of
2RHZE/4RH for susceptible TB is safe for use
in pregnancy. All pregnant women diagnosed
with TB should be screened for HIV and if
positive managed according to national TB-HIV
management guidelines.

83. oBreastfeeding
A breastfeeding woman who has TB should
be treated with a full course of a standard
regimen recommended by the NTLP.
Concentrations of anti-TB drugsin breast
milk are too low to prevent or treat TB in
infants. The child should therefore be
investigated for TB disease and, if found to
have TB disease, must be given full course
of anti-TB treatment.
If the child does not have TB disease, give
Isoniazid preventive therapy (10mg/kg body
weight) for 6 months

84. Mother and child should stay together and
breastfeeding should continue normally but
standard TB infection prevention measures are
recommended.
•BCG vaccination of the child should then
be postponed until the end of Isoniazid
preventive therapy.

85. oTreatment of patients with drug
induced liver injury
Suspect liver damage when a patient on anti-
TB drugs has developed jaundice plus or minus
other symptoms of liver injury such as
abdominal pain, nausea and vomiting
If the liver enzymes (ALT/AST) are
elevated more than three times the
normal upper limit, all medications
including non-TB medications should
be discontinued and the patient
monitored until the enzymes normalise

87. oTreatment of Patients with
Renal Failure
Isoniazid, Rifampicin, and Pyrazinamide may
be given in normal dosage to patients with renal
failure, since these drugs are eliminated almost
entirely by biliary excretion or are metabolised
into non-toxic compounds.
Patients with severe renal failure who are
receiving Isoniazid should also receive
pyridoxine to prevent peripheral neuropathy.
These patients should be referred to a higher

88. oBone, Joint, and Spinal
Tuberculosis
TB can virtually affect any tissue in the body.
TB infects bone, joint tissues and the spine. TB
of these tissues requires extended TB
treatment durations longer than the standard six
months.
(12month) 2 RHZR/10RH
There is additional benefit of surgical
debridement in combination with chemotherapy

89. oTB Meningitis
TB meningitis requires longer duration of treatment
than TB in pulmonary site. The range of duration is
9-12 months.
The usual regimens of TB treatment are used.
However, a choice can be made between
ethambutol and an injectable aminoglycoside. In
adults, ethambutol is usually sufficient. I n
c h i l d r e n , t h e r e i s p r e f e r e n c e f o r a n
a m i n o g l y c o s i d e .
Adjunctive corticosteroid therapy recommended in
the treatment of TB meningitis with

90. oTB/HIV CO-INFECTION
HIV is the strongest risk
factor for developing
tuberculosis (TB) disease in
those with latent or new
Mycobacterium tuberculosis
infection.
The risk of developing TB disease
is between 20 and 37 times

91. TB prevention in HIV
1. Intensified TB case-finding:- All people living with
HIV (children, adolescents & adults), wherever
they receive care should be regularly screened for
TB using the Intensified TB Case Finding too
2. Isoniazid preventive therapy (IPT)
3. Infection Control
4. Co-trimoxazole preventive therapy (CPT)
5. Provider Initiated HIV testing and counselling
6. HIV prevention methods in the TB clinics
7. Provision of antiretroviral treatment

92. After diagnosis of HIV/TB Co-infection
before you iniate ARVs start with
antiTBs for 8weeks then introduce the
ARVs this helps to prevent IRIS
recommended firstline regimen:
ABC+3TC+DTG
oIn the absence of DTG formulations
initiate on Abacavir + Lamivudine+
Ritonavir-boosted Lopinavir
(ABC+3TC+LPV/r).

93. Immune rec ons titution
inflammatory s y ndrome
Immune reconstitution inflammatory
syndrome (IRIS) is a condition seen in
some cases of AIDS or
immunosuppression, in which the immune
system begins to recover, but then
responds to a previously acquired
opportunistic infection with an

94. Persons living with AIDS are more at risk
for IRIS if they are starting HAART for the
first time, or if they have recently been
treated for an opportunistic infection

95. There are two common IRIS scenarios. The first is
the “unmasking” of an occult opportunistic
infection. The second is the “paradoxical”
symptomatic relapse of a prior infection despite
microbiologic treatment success. Often in
paradoxical IRIS, microbiologic cultures are
sterile.
https://en.wiktionary.org/wiki/occult#Adj1
Bolognia, Jean; Schaffer, Julie V; Cerroni, Lorenzo, eds. (2018). "Immune Reconstitution
Inflammatory Syndrome (IRIS)". Dermatology. p. 1378. ISBN 978-0-7020-6342-8.
OCLC 1016978099. Archived from the original on 2022-08-19. Retrieved 2021-04-27

100. 1. Neslson Essentials of pediatrics 7th edition
section 16 chapter 124 from page 407 to 412.
2. World Health Organization. WHO consolidated
guidelines on drug-resistant tuberculosis
treatment. 2019.
3. Xu P, Chen H, Xu J, Wu M, Zhu X, Wang F, et
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4. NTLP(Uganda) manual 3rd edition march
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5. Davidson's principles and practice of medicine

101. "If I can stop one heart from breaking I shall not
live in vain; if I can stop one life the aching or
cool one pain, or help one fainting robin unto its
nest again, I shall not live in vain.
- M W E B A Z A
V I C T O R . J