Pulmonary TB

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What are the highlights on TB ,what to do to prevent or treat

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Pulmonary TB

  1. 1. Highlights on Pulmonary Tuberculosis Prof. Dr. Saad S Al-Ani Senior Pediatric Consultant Head of Pediatric department Khorfakkan Hospital
  2. 2. <ul><li>TB Diagnosis </li></ul><ul><li>“ The first rule of TB diagnosis: is to think of TB….” </li></ul><ul><ul><li>Include TB in your differential diagnosis when history, symptoms are consistent with TB diagnosis </li></ul></ul><ul><ul><li>Order the appropriate diagnostic tests </li></ul></ul>
  3. 3. Pulmonary infections Predisposing factors 1.Decreased cough reflex 2.Injury to cilia 3.Decreased function of alveolar macrophages 4.Edema or congestion 5.Retention of secretions
  4. 4. <ul><ul><ul><li>3.Progressive primary pneumonia </li></ul></ul></ul><ul><ul><ul><li>Miliary dissemination ( blood stream ). </li></ul></ul></ul><ul><li>Pulmonary tuberculosis </li></ul>Primary <ul><ul><li>1.Single granuloma within parenchyma </li></ul></ul><ul><ul><li>and hilar lymph nodes ( Ghon complex ). </li></ul></ul><ul><ul><ul><li>2.Infection does not progress </li></ul></ul></ul><ul><ul><ul><li>(most common). </li></ul></ul></ul>
  5. 5. <ul><li>Secondary </li></ul>Pulmonary tuberculosis Cont. <ul><ul><ul><ul><ul><li>Infection (mostly through reactivation) in a previously sensitized individual </li></ul></ul></ul></ul></ul><ul><ul><li>Pathology </li></ul></ul><ul><ul><ul><ul><ul><li>Cavitary fibrocaseous lesions </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Bronchopneumonia </li></ul></ul></ul></ul></ul><ul><ul><ul><li>Miliary TB </li></ul></ul></ul>
  6. 6. Typical Progression of Pulmonary tuberculosis <ul><ul><li>1.Pneumonia </li></ul></ul>2.Granuloma formation with fibrosis 3.Caseous necrosis <ul><ul><li>4.Calcification </li></ul></ul>5.Cavity formation
  7. 7. Pulmonary tuberculosis
  8. 8. Acid-Fast (Kinyoun) Stain of Mycobacterium
  9. 9. Mycobacterium Tuberculosis Stained with Fluorescent Dye
  10. 10. Fibrocaseous
  11. 11. Miliary
  12. 12. Granuloma
  13. 13. Mycobacterium
  14. 14. Not Everyone Exposed Becomes Infected <ul><li>Probability of transmission depends </li></ul><ul><li>on: </li></ul><ul><ul><li>1.Infectiousness </li></ul></ul><ul><ul><li>2.Type of environment </li></ul></ul><ul><ul><li>3.Length of exposure </li></ul></ul>10% of infected persons will develop TB disease at some point in their lives <ul><ul><li>* 5% within 1-2 years </li></ul></ul><ul><ul><li>* 5% at some point in their lives </li></ul></ul>
  15. 15. Treatment of TB Disease <ul><li>Include four 1st-line drugs in initial regimen </li></ul><ul><ul><li>1.Isoniazid (INH) </li></ul></ul><ul><ul><li>2.Rifampin (RIF) </li></ul></ul><ul><ul><li>3.Pyrazinamide (PZA) </li></ul></ul><ul><ul><li>4.Ethambutol (EMB) </li></ul></ul>Never add a single drug to a failing regimen
  16. 16. Barriers to Adherence <ul><li>Stigma </li></ul><ul><li>Extensive duration of treatment </li></ul><ul><li>Adverse reactions to medications </li></ul><ul><li>Concerns of toxicity </li></ul><ul><li>Lack of knowledge about TB </li></ul><ul><li>and its treatment </li></ul>
  17. 17. Improving Adherence <ul><li>Adherence is the responsibility of the provider, </li></ul><ul><li>not the patient and can be ensured by: </li></ul>-Patient education <ul><ul><li>Directly observed therapy (DOT) </li></ul></ul><ul><ul><li>Case management </li></ul></ul><ul><ul><li>Incentives/enablers </li></ul></ul>
  18. 18. Directly Observed Therapy (DOT) *Health care worker watches patient swallow each dose of medication *DOT is the best way to ensure adherence <ul><li>Should be used with all intermittent regimens </li></ul>Reduces relapse of TB disease and acquired drug resistance
  19. 19. Remember “ A decision to test is a decision to treat.” Thank you

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