2. Infectious disease caused by mycobacterium
Its a multisystem disease
Commonly affect the lungs
Estimated 1.5 million deaths in 2006 worldwide
Common in undeveloped countries
◦ Mainly due to HIV resurgence
◦ Political instability and wars
4. Inhalation
Tubercle reaches alveoli
Macrophages/lymphocyte recruitment
They aggregate to form granulomas
Numerous granulomas unite to form ghon focus
If hillar lymph node is involved ⤍ranke complex
5. Ghon focus becomes encapsulated by fibrous tissue
and calcified
◦ Or inflammation progresses to cause TB disease
Seeding to distant organs may occur before
encapsulation- via blood stream or lymph
Lesions can lie dormant for many years
◦ Reactivation may occur in case of immuno-suppression
CMI characterises tissue destruction in TB
6. Primary TB
◦ Previously non infected individual
◦ Can be latent or progressive disease
Secondary TB
◦ Reactivation of latent or
◦ Re-infection
Pulmonary TB
◦ Confined to lungs
Extra pulmonary TB
◦ Other tissues involved
7. Extremes of ages
Contact with PTB infected person
Overcrowding
Smoking
Immuno-suppresion like HIV infection
Previous TB infection
Diabetes
Malignancy
8. Pulmonary TB
◦ Cough-often with hemoptysis
◦ Fever
◦ Drenching night sweats
◦ Weight loss
◦ Unresolving pneumonia
◦ Pleural effusion
◦ Pneumothorax
◦ Assymtomatic
10. Milliary TB- means disseminated TB
◦ Fever
◦ Night sweats
◦ Weight loss
◦ Dry cough
◦ Normal asucaltation findings (may find wide spread
crackles)
◦ Hepato-spenomegally may occur
◦ Widespread millet seed like lesion on CXR
11. TB lymphadenitis
◦ Commonly affected nodes
Cervical
Mediastinal
Axillary and
Inguinal; in that order
◦ Painless
◦ Initially mobile but become matted with time
◦ Abscess may form with a discharging sinus
12. Gastrointestinal TB
◦ Ileocecal disease common
◦ Fever, anorexia, weight loss and night sweats
◦ Acute abdomen
Intestinal obstruction
◦ Thickened intestinal wall and abdominal lymphadenopathy
on imaging
◦ Peritonitis with or without ascites
14. CNS
◦ Tuberculous meningitis, SOL, encephalitis
Bone and joint TB
◦ Spine affected mostly in bone TB (Potts dse)
Discitis
Low back pain
Vertebral body involvent with angulation ad kyphosis
Abscess may form
◦ Knee and hip commonly affected joints
Athritis-pain and swelling
Loss of joint space on Xray
15. Genito urinary TB
◦ Hematuria frequency and dysuria
◦ Sterile pyuria
◦ Infertility and chronic pelvic pain due to
Endometritis,
Salpingitis and
Tubo-ovarian abscess
◦ Epididymitis and prostatitis
Skin TB
◦ Lupus vulgaris
16.
17. Sputum for Z-N staining (AFBs)
Sputum for gene xpert (nucleic acid amplfication)
◦ Other body fluids like FNA fluid, ascitic, pleural, CSF can serve as
specimen for above tests
Sputum culture (L-J medium)
Chest X-ray
◦ Cavitations
◦ Hillar lymphadenpathy
◦ Pleural effusion
◦ Milliary pattern
CBC
◦ Lymphocytosis
◦ Anemia
Histopathology
18. Drugs used
◦ Rifampicin (R)
◦ Isoniazid (H)
◦ Pyrazinamide (Z)
◦ Ethambutol (E)
All forms of TBs treated for 6 months except TB
bone, joint and TBM (12 months)
19. Phases
◦ Intensive phase
2 months
RHZE used
◦ Continuation phase
4 months
10 months for TBM, Joint and bone TB
RH used
◦ 2RHZE/6RRH
◦ 2RHZE/10RH
20. Drugs side effects
◦ Isoniazid
Peripheral neuropathy
◦ Rifampicin
Hepatotoxicity,
Discoloration of body fluids
◦ Ethambutol
Optic neuritis
◦ Pyrazinamide
Arthralgia,
Hepatotoxicity
21. Adjuvant therapy
◦ Corticosteroids
◦ Pyridoxine to counter peripheral neuropathy
◦ Nutritional support
◦ Treatment of complications
E.g. Draining of pleural fluid
Directly observed treatment.
22. PTB
◦ Repeat Gene x-pert at 2 months
To check conversion to negative
◦ Repeat Microscopy (Z-N staining) at
2months
5 months
After treatment completion
23. TB that is resistant to at least
◦ Isoniazid and rifampicin
◦ With or without resistance to other other drugs
Currently detected by gene x-pert
Mortality rate high
Treated as per culture and sensitivity results
Extra drug resistant TB
◦ Resisitance to isoniazid and rifampicin plus to a quinolone
or an injectable second line
24. Vaccination
◦ BCG
Avoid overcrowding
Proper hygiene
Isoniazid preventive therapy
◦ Under fives with positive contact with smear positive TB
◦ HIV infected who turn negative for Tb screening
◦ All prisoners irrespective of HIV status
◦ Duration is 6 months
Proper identification and effective treatment of
cases
25. Good with treatment
Bad without treatment
◦ 25 % of untreated die in the first year
Less than 5 % relapse
*TB INA TIBA
