2. Defination
• Tuberculosis is a potentially fatal contagious disease that can affect almost
any part of the body but is mainly an infection of the lungs
• Neo-latin word
• Tubercle- Round nodule/ swelling
• Osis- condition
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3. EPIDEMIOLOGY
• There is a high incidence ofTB in HIV infected patients
• About 10.4 million people fell ill withTB in 2016 and 10% of these were co-
infected with HIV. (WHO, 2017)
• Majority of cases are in Africa(65%) and Asia
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7. PATHOGENESIS
• Exposure to source or mycobacteria>aerosolization of droplet
nuclei>bacteria reach lungs and enter macrophages> bacteria multiply in
macrophages>granulomatous lesion begins to form(caseous necrosis
known Gohn forcus>Gohn complex )>( may calcify and reactivate with
immunosuppression)>lesion liquefies and spread to blood and organs
leading to death or>bacteria coughed up in sputum
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8. Clinical Presentation
• Persistant productive cough(may be bloody)
• Weight loss
• Coughing up blood or mucus
• Chest pain
• Shortness of breath
• Fever
• Night sweats
• Fatigue
• Symptoms based on type ofTB
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9. Types
• PULMONARYTB
> 80% of people ofTB
• PrimaryTuberculosis
The infection of an individual who has not been previously infected or immunized is called primary tuberculosis
or Ghon’s complex or childhood tuberculosis
Lesions forming after infection is peripheral and accompanied by hilar which may not be detected on chest
radiography
• SecondaryTuberculosis
The infection that individual who has been previously infected is called secondary or post primary or
reinfection or chronic tuberculosis
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10. Cont
• Extra pulmonaryTB
20% of patients ofTB patient
Affected sites in body are
• Lymph nodeTB (tuberculosis lymphadenitis)
Seen frequently in HIV infected patients
Symptom-painless swelling of lymph nodes most commonly at cervical and supraclavicular. Systemic systems are
limited to HIV infected patients.
• PleuralTB
Involvement of pleura is common in primaryTB and results from penetration of tubercle bacilli into pleural space.
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11. • TB of upper airways
Involvement of larynx, pharynx and epiglottis
Symptoms- Dysphagia, chronic productive cough
• GenitourinaryTB
15% of all extra pulmonary cases, any part of the genitourinary tract get infected.
Symptoms-urinary frequency, dysuria, hematuria
• SkeletalTB
Involvement of weight bearing parts like spine, hip, knee
Symptom- pain in hip joints and knees, swelling of knees, trauma.
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12. Cont
• Gastrointestinal TB
Involvement of any part of GI tract
Symptom-abdominal pain, diarrhea, weight loss
• TB meningitis andTuberculosis
5% of all extra pulmonaryTB
Results from hematogenous spread of first and second degree TB
• TB Pericarditis
1-8% of all extra pulmonaryTB cases
Spread is due to entry of infection into pulmonary vein producing lesions in different extra pulmonary sites
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13. Investigations
• Sputum culture
• Zeihl-nelson stain
• Radiography
• Chest X-ray
• Tubeculin skin test (PPD)> 48-72 hours later checked for a reaction
• Lipoarabinomannan LAMTB test
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14. TB LAMTest
>Lipoarabinomannan (LAM) test, it is a test done on a pt withTB>sample is
Urine
>More useful in pf who are severe ill and those who can not produce sputum
>Also in those pt who have low CD4 cell count, below 100 cells/mm (eg.
HIV)and those who have no positive symptoms of tb but there hx of tb in the
family
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15. Cont
• HIV positive people with pulmonaryTB may have a higher frequency of having sputum
negative smears
• The tuberculin test often fails to work, because the immune system has been damaged
by HIV ;it may not even show a response even though the person is infected withTB
• Chest x-ray will show less cavitation
• Hence LAM test Antigen can be more infective.
• Cases of extra pulmonaryTB are more common
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17. BCG vaccine
• Bacille calmette Guerin (BCG)
• Only vaccine available for protection against tuberculosis
• It is the most effective in protecting children against the disease
• Given 0.1ml intradermally
• Duration of protection 15-20 years
• Efficacy 0 to 890%
• Should be given to all healthy infants as soon as possible after birth unless the child
presented with symptomatic HIV infection.
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18. Management/Treatment
PTB and all non severe
• Intensive phase
• 2RHZE
Continuation phase
• 4RH
R=rifampicin, H=isoniazid, Z=pyrazinamide, E=ethambutol
• CNSTB treat for 12M (2RHZE+10RH)
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19. SECOND LINE REGIMENT
• If DR suspected, sputum collected for xpert to confirm DR-TB / MDR
• Poor drug adherence,poor storage, incorrect mx by clinician,suboptimal dosage are some of the
causes for resistence
Intensive tx
• 4-6 Km-Mfx-Eto-Z-E-high dose H
Continuation phase
• 5 Mfx-Cfz-Z
• Add B6 100mg
Km=KANAMYCIN, Mfx=moxfloxacin, Cfz=ciprofloxacin, Eto=ethionamide
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20. THIRD LINE
• Individualized according to Hx of contact,drug tx and susceptibility results,
adherence and other factors
• New, repurposed drugs such as bedaquiline,delaminid and clofazimine
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21. Multi-Drug ResistanceTB
• TB caused by strains of mycobacterium tuberculosis that are resistant to at
least isoniazid and rifampicin, the most effective anti-TB drug
• Globally, 3.6% are estimated to have MDR-TB
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22. Extensively drug resistanceTB
• Extensively drug- resistanceTB (XDR-TB) is a form ofTB caused by bacteria
that are resistant to isoniazid and rifampicin (i.e MDR-TB) as well as any
fluoroquinolone and any of the second-line antiTB injectable drugs
(amikacin, kanamycin or capreomycin).
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23. COMMON SIDE EFFECTS OFTB drugs
• Isoniazid- peripheral neuropathy,hepatitis,psychosis
• Rifampicine-orange discolouration of body fluids, hepatotoxic
• Pyrazinamide-hepatotoxic, rash hyperureacemia
• Ethambutal-optic neurits
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