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Primary tb by arif khan


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Primary tb by arif khan

  1. 1. Presented by :Arif Khan 5th Year 4th Group
  2. 2.  Primary tuberculosis is the initial infection of the host, usually being mild and asymptomatic. A healthy person recently infected with the mycobacterium may exhibit flu-like symptoms and has no reason to suspect tuberculosis. Left untreated, the bacilli infect and multiply within pulmonary alveolar macrophages, migrating to the hilar lymph nodes. An immune response is exhibited by the T-helper cells, and inflammation develops at multiple sites.  Primary pulmonary tuberculosis is seen in patients not previously exposed to M. tuberculosis. It is most common in infants and children and has the highest prevalence in children under 5 years of age .
  3. 3.  A person may test positive in the tuberculin skin test at this point, and a chest x-ray may shows opacities in the lungs. Tuberculosis gets its name from the small granulomas called tubercles, consisting of epitheliod cells, giant cells, and lymphocytes, where the bacteria are contained. In normal patients, the lesions in the lung tissue become fibrotic and heal, but are visible in x-rays for the patient's lifetime. During latency, a person cannot transmit tuberculosis to others.
  4. 4.  parenchymal disease: usually manifests as dense, homogeneous parenchymal consolidation in any lobe; however, predominance in the lower and middle lobes (subpleural sites) is suggestive of the disease, especially in adults 1  lymphadenopathy  miliary opacities  pleural effusion
  5. 5.  The primary infection is usually asymptomatic (majority of cases), although a small number go on to have symptomatic haematological dissemination which may result in miliary tuberculosis. Only in 5% of patients, usually those with impaired immunity, go on to have progressive primary tuberculosis.
  6. 6. Primary tuberculosis is always result of exogenous infection. The infection penetrates into organism by: - aerogenic (the most often way of penetration) - alimentary; - contact way.
  7. 7.  Primary TB infection may be asymptomatic,cause fevers and pleuritic pain or, rarely, progress to life threatening disease. Dur ing the primary pulmonary infection, symptoms may occur as the burden of bacilli increases and the host mounts a systemic immune response. Fever is the most common symptom.  On examination, a patient with primary pulmonary TB may have erythema nodosum, bluish red tender subcutaneous nodules several millimetres to several centimetres in diameter appearing on the legs, and phlyctenular conjunctivitis, hard raised red 1 to 3 mm nodules accompanied by a zone of hyperaemia located near the limbus on the bulbar conjunctiva of the eye.
  8. 8.  dullness over lung component with a big size.  Weakend breathing with streached exhale. Hemogram: Leucocytosis 10-13 T/l, insignificant shift to the left, lymphopenia, monocytosis, ESR 20-25 mm/h
  9. 9. Phases: 1) infiltrative or pneumonic; 2) resorbtion(suction,bipolarities); 3) scarring 4) calcification.
  10. 10.  In primary pulmonary tuberculosis, the initial focus of infection can be located anywhere within the lung and has non-specific appearances ranging from too small to be detectable, to patchy areas or consolidation or even lobar consolidation.  Radiographic evidence of parenchymal infection is seen in 70% of children and 90% of adults .
  11. 11.  In most cases, the infection becomes localised and a caseating granuloma forms (tuberculoma) which usually eventually calcifies and is then known as a Ghon lesion/Ghon complex/ primary complex.  Consists of 3 components:  Pulmonary component (Ghon’s Focus)  Lymphatic component  Lymph node component – Hilar & Tracheo- bronchial
  12. 12.  Pulmonary component:  lesion in the lung (Ghon focus or primary focus)  1-2cm solitary area located peripherally in the subpleural focus in the lower part of upper lobe or upper part of lower lobe  Micro: the lung lesion show tuberculous granuloma with caseous necrosis  Lymphatic component:  lymphatics draining lung lesion containing phagocytes with M tuberculosis bacilli  Lymph node component:  Enlarged hilar and tracheo-bronchial lymph node  Gross: the affected lymph nodes are matted and may show caseation necrosis  Micro: tuberculous granulomas, caseation necrosis and fibrosis.  Nodal lesions are the potential source of reinfection later.
  13. 13.  Complications connected with regional lymphadenitis:  - hematogenic dissemination  - lymphogenic dissemination  - pleuritis  - extending of specific process from lymphatic node  It’s results:  a) formation of fistula  b) dispersion of caseous masses, bronchogenic dessemination, bronchi tuberculosis  c) disorder of bronchial permeability, atelectasis
  14. 14.  The doctor or nurse will perform a physical exam. This may show:  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)  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)
  15. 15. The treatment of tuberculosis (TB) must satisfy the following basic therapeutic principles:  Any regimen must use multiple drugs to which Mycobacterium tuberculosis is susceptible  The medications must be taken regularly  The therapy must continue for a period sufficient to resolve the illness  New cases are initially treated with four drugs: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. After 2 months, they are then treated with a continuation phase of 4 months with isoniazid and rifampin. Patients requiring retreatment should initially receive at least 5 drugs, including isoniazid, rifampin, pyrazinamide, and at least 2 (preferably 3) new drugs to which the patient has not been exposed.