1) Childhood tuberculosis accounts for around 10% of the global TB disease burden and remains a significant public health problem in India.
2) Diagnosis of childhood TB can be challenging as symptoms are often non-specific and microbiological confirmation is difficult. A high index of suspicion is required based on exposure history and clinical/radiological findings.
3) Revised guidelines by the Revised National Tuberculosis Control Programme (RNTCP) in India provide definitions for presumptive TB, presumptive drug resistant TB, and classifications based on anatomical site and treatment history to help standardize diagnosis and management of childhood TB.
- Childhood tuberculosis is challenging to diagnose due to difficulties in confirming infection status and obtaining bacteriological confirmation.
- Risk of developing active TB is highest in the first two years of life, with disseminated disease and mortality also more common in young children.
- Diagnosis relies on clinical features, radiology, tuberculin skin testing, and bacteriological confirmation through sputum/gastric aspirate sampling and culture.
- Treatment guidelines in India recommend 6 months of chemotherapy for all childhood contacts of active TB cases, and clinically diagnosed cases can now begin treatment if confirmation testing is negative.
This document discusses tuberculosis (TB) in children. It begins with an overview of the clinical spectrum of TB in children, which can include pulmonary, visceral, cutaneous, neuro, and perinatal manifestations. Pulmonary TB lesions in children typically include primary complexes and intrathoracic lymphadenopathy. Extrapulmonary TB involves sites like bone, joints, the gastrointestinal tract, and the central nervous system. The document then covers the diagnosis of TB in children, which involves clinical judgment based on exposure history and symptoms, the tuberculin skin test, chest x-ray, and bacteriological confirmation via sputum sampling or gastric aspiration. Interpretation of diagnostic tests and their limitations are also discussed.
This document discusses fever of unknown origin (FUO) in children. It defines FUO as a fever over 38°C that cannot be explained after 3 weeks of outpatient evaluation or 1 week of inpatient evaluation. Potential causes are divided into infectious and non-infectious categories. A thorough history, physical exam, and targeted investigations are important to identify the cause. Based on patient location and immune status, FUO can be further classified as classic, healthcare-associated, immune deficient, or HIV-related FUO. The most common causes vary according to these classifications.
Here are some key points regarding the feasibility of bacteriological diagnosis in children with TB:
- Sputum induction or gastric lavage are generally required to obtain specimens from children, as they typically cannot produce sputum on demand. This requires specialized equipment and trained personnel.
- Even with induced sputum or gastric lavage, specimen quality and volume may be low, reducing the sensitivity of bacteriological tests.
- Young children especially may not be able to cooperate with procedures like sputum induction.
- Extrapulmonary TB is more common in children than adults, so specimens from sites like lymph nodes, cerebrospinal fluid, etc. need to be obtained invasively via procedures like biopsy or lumbar puncture
Here are the first 5 steps in managing a newborn presenting with seizures on day 2 of life:
1. Ensure patent airway and provide oxygen via mask or endotracheal tube if needed.
2. Start IV access and obtain blood for glucose, calcium, magnesium, blood gas, CBC, CRP levels.
3. Give 10% dextrose bolus if hypoglycemia suspected.
4. Give phenobarbitone 20mg/kg loading dose if seizures persist after correction of hypoglycemia.
5. Start antibiotics like ampicillin and gentamicin to cover for sepsis until culture reports are available.
This document discusses chronic diarrhea in children, including definitions, causes, diagnosis, and treatment. It defines chronic diarrhea as diarrhea lasting 2-3 weeks or more. Common causes in infants include post-infectious lactase deficiency, celiac disease, cow's milk allergy, toddler's diarrhea, and infections like giardiasis. Diagnosis involves taking a thorough history and physical exam, with investigations tailored to the child's age and suspected causes, such as stool exams and tests for carbohydrate malabsorption.
This document discusses chronic diarrhea, defining it as diarrhea lasting more than 2 weeks. It outlines different types of diarrhea based on duration, including acute (<2 weeks), prolonged (7-14 days), and persistent (>14 weeks). The causes of chronic diarrhea are discussed for different age groups, including post-gastrointestinal infections, cow's milk protein intolerance, and celiac disease in infants. Pathophysiological causes of chronic diarrhea include secretory, osmotic, steatorrheal, inflammatory, and dysmotility mechanisms. The importance of a thorough history and physical exam is emphasized to guide diagnostic testing and treatment approaches, which may be curative, suppressive, or empirical depending on the underlying cause.
Wheezing in children can have many causes. It is often due to viral infections like RSV bronchiolitis in infants, which causes inflammation and narrowing of the small airways. Asthma is another common cause and presents with recurrent wheezing episodes. Younger children are more prone to wheezing due to their small airway size and lung mechanics. A thorough history, physical exam, and diagnostic testing can help identify the underlying condition causing wheezing to guide treatment.
- Childhood tuberculosis is challenging to diagnose due to difficulties in confirming infection status and obtaining bacteriological confirmation.
- Risk of developing active TB is highest in the first two years of life, with disseminated disease and mortality also more common in young children.
- Diagnosis relies on clinical features, radiology, tuberculin skin testing, and bacteriological confirmation through sputum/gastric aspirate sampling and culture.
- Treatment guidelines in India recommend 6 months of chemotherapy for all childhood contacts of active TB cases, and clinically diagnosed cases can now begin treatment if confirmation testing is negative.
This document discusses tuberculosis (TB) in children. It begins with an overview of the clinical spectrum of TB in children, which can include pulmonary, visceral, cutaneous, neuro, and perinatal manifestations. Pulmonary TB lesions in children typically include primary complexes and intrathoracic lymphadenopathy. Extrapulmonary TB involves sites like bone, joints, the gastrointestinal tract, and the central nervous system. The document then covers the diagnosis of TB in children, which involves clinical judgment based on exposure history and symptoms, the tuberculin skin test, chest x-ray, and bacteriological confirmation via sputum sampling or gastric aspiration. Interpretation of diagnostic tests and their limitations are also discussed.
This document discusses fever of unknown origin (FUO) in children. It defines FUO as a fever over 38°C that cannot be explained after 3 weeks of outpatient evaluation or 1 week of inpatient evaluation. Potential causes are divided into infectious and non-infectious categories. A thorough history, physical exam, and targeted investigations are important to identify the cause. Based on patient location and immune status, FUO can be further classified as classic, healthcare-associated, immune deficient, or HIV-related FUO. The most common causes vary according to these classifications.
Here are some key points regarding the feasibility of bacteriological diagnosis in children with TB:
- Sputum induction or gastric lavage are generally required to obtain specimens from children, as they typically cannot produce sputum on demand. This requires specialized equipment and trained personnel.
- Even with induced sputum or gastric lavage, specimen quality and volume may be low, reducing the sensitivity of bacteriological tests.
- Young children especially may not be able to cooperate with procedures like sputum induction.
- Extrapulmonary TB is more common in children than adults, so specimens from sites like lymph nodes, cerebrospinal fluid, etc. need to be obtained invasively via procedures like biopsy or lumbar puncture
Here are the first 5 steps in managing a newborn presenting with seizures on day 2 of life:
1. Ensure patent airway and provide oxygen via mask or endotracheal tube if needed.
2. Start IV access and obtain blood for glucose, calcium, magnesium, blood gas, CBC, CRP levels.
3. Give 10% dextrose bolus if hypoglycemia suspected.
4. Give phenobarbitone 20mg/kg loading dose if seizures persist after correction of hypoglycemia.
5. Start antibiotics like ampicillin and gentamicin to cover for sepsis until culture reports are available.
This document discusses chronic diarrhea in children, including definitions, causes, diagnosis, and treatment. It defines chronic diarrhea as diarrhea lasting 2-3 weeks or more. Common causes in infants include post-infectious lactase deficiency, celiac disease, cow's milk allergy, toddler's diarrhea, and infections like giardiasis. Diagnosis involves taking a thorough history and physical exam, with investigations tailored to the child's age and suspected causes, such as stool exams and tests for carbohydrate malabsorption.
This document discusses chronic diarrhea, defining it as diarrhea lasting more than 2 weeks. It outlines different types of diarrhea based on duration, including acute (<2 weeks), prolonged (7-14 days), and persistent (>14 weeks). The causes of chronic diarrhea are discussed for different age groups, including post-gastrointestinal infections, cow's milk protein intolerance, and celiac disease in infants. Pathophysiological causes of chronic diarrhea include secretory, osmotic, steatorrheal, inflammatory, and dysmotility mechanisms. The importance of a thorough history and physical exam is emphasized to guide diagnostic testing and treatment approaches, which may be curative, suppressive, or empirical depending on the underlying cause.
Wheezing in children can have many causes. It is often due to viral infections like RSV bronchiolitis in infants, which causes inflammation and narrowing of the small airways. Asthma is another common cause and presents with recurrent wheezing episodes. Younger children are more prone to wheezing due to their small airway size and lung mechanics. A thorough history, physical exam, and diagnostic testing can help identify the underlying condition causing wheezing to guide treatment.
This document provides information on chronic cough in children, including definitions, epidemiology, pathophysiology, causes, diagnostic approach, and management. It defines chronic cough as lasting 4 or more weeks based on expert guidelines. Specific cough has an identifiable cause while nonspecific cough does not after evaluation. Common causes include asthma, aspiration, and suppurative lung diseases. The diagnostic approach involves detailed history, physical exam focusing on cough characteristics, chest imaging, and additional tests as needed based on findings. Management targets treating the identified cause for specific cough or watchful waiting for most nonspecific cough cases.
This document provides guidance on evaluating and diagnosing childhood arthritis. It distinguishes arthritis from arthralgia based on clinical features. It lists various differential diagnoses for childhood joint pain or swelling including infectious, rheumatological, neoplastic and traumatic etiologies. It describes tender points seen in fibromyalgia. It outlines features that can distinguish inflammatory, mechanical and sinister causes of joint pain. The approach involves assessing onset, number and type of joints involved, associated systemic symptoms and precipitating factors. Key clues from history and physical exam are described. A review of systems guides evaluation of specific organ systems. Common clinical presentations like acute monoarthritis, chronic monoarthritis and polyarthritis are reviewed. Characteristics of juvenile idiopathic arthritis subtypes
Enteric fever, also known as typhoid fever, is caused by the bacteria Salmonella enterica typhi or Salmonella paratyphi A, B, or C. It is transmitted through the fecal-oral route and has an incubation period of 7-14 days. Clinical features include sustained high fever, abdominal pain, diarrhea or constipation, and rose-colored spots on the trunk. Complications can affect the central nervous system, cardiovascular system, respiratory system, gastrointestinal system, hepatobiliary system, genitourinary system, and bones. Treatment involves antibiotics, hydration, and rest. Prevention focuses on proper sanitation, hand washing, and vaccination.
This document provides an overview of common paediatric rashes. It begins with describing the anatomy of the skin and definitions of common rash morphologies such as macules, papules, vesicles and pustules. Common rashes that are described include scabies, acne, contact dermatitis, atopic dermatitis, impetigo, tinea and nonspecific viral rashes. Specific viral exanthems like measles, rubella and scarlet fever are also reviewed. Emergent rashes like erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are discussed in terms of their presentations, causes and treatments. References are provided at the end.
This document provides information on chronic liver disease in infants and children. It discusses the classification, etiology, differential diagnosis, and specific diseases that cause chronic liver disease. Some key points include:
- Chronic liver disease is seen in children of all ages and is defined as liver disease lasting more than 3-6 months. Cirrhosis refers to late-stage scarring of the liver.
- Common causes in infants include neonatal hepatitis, biliary atresia, and progressive familial intrahepatic cholestasis. In children, common causes are hepatitis B, hepatitis C, Wilson's disease, and autoimmune hepatitis.
- Clinical features may include jaundice, hepatomegaly, spl
This document provides an overview of the approach to chronic diarrhea. It defines chronic diarrhea as diarrhea lasting over 2-3 weeks and discusses etiology, risk factors, symptoms, examination findings, diagnostic workup and management. The diagnostic workup involves screening tests, intestinal function tests, biopsy and special investigations. Management includes supportive measures, identifying and treating the underlying cause, elimination diets and nutritional rehabilitation. Prevention focuses on improved nutrition, hygiene, breastfeeding and access to clean water.
Approach to a case of paediatric hepatitisRaghav Kakar
This document provides an overview of the approach to paediatric hepatitis. It discusses the main causes of hepatitis including viral (HAV, HBV, HCV, HDV, HEV), autoimmune, and drug-induced. For viral hepatitis, it covers the etiology, pathogenesis, clinical features, diagnosis, and management of each virus. It provides details on HAV including transmission via the fecal-oral route, clinical presentation of acute hepatitis, diagnosis via IgM antibodies, and treatment involving immunoglobulin for prevention. For HBV, it discusses the various modes of transmission including perinatal, clinical phases from acute to chronic infection, diagnostic markers, and treatment of acute versus chronic cases.
This document discusses several pediatric infectious diseases that present with fever and rash: measles, rubella, varicella, and hand, foot and mouth disease. It provides details on the causative agents, clinical manifestations, investigations, treatment, prevention, and complications of each disease. A case scenario is also presented describing a 9-month-old girl presenting with fever, rash, cough and conjunctivitis consistent with measles. Differential diagnoses and distinguishing features between measles and rubella are also summarized.
This document discusses pertussis (whooping cough), including its epidemiology, etiology, clinical features, complications, management, prognosis, and prevention. It describes pertussis as a highly contagious disease caused by the Bordetella pertussis bacteria. The clinical features are divided into three stages: catarrhal, paroxysmal, and convalescent. Diagnosis is based on a prolonged cough with bouts and symptoms like vomiting or inspiratory whoop. Management involves supportive care, antibiotics, and vaccination to prevent spread. Complications can include pneumonia, seizures, or death in infants.
This document provides guidance on evaluating and managing a patient presenting with chronic diarrhea. It defines chronic diarrhea as lasting 4 weeks or longer. A thorough history and physical exam are important to determine the cause, which can include infections, inflammatory bowel disease, malabsorption issues, and functional disorders. Initial testing involves stool studies and bloodwork. Empiric treatment starts with loperamide and dietary changes, while specific therapies target the underlying cause, if identified.
An 11-year-old boy presented with large volume hematemesis and edema of the feet and abdominal distension for 2 months. On examination, he had pallor, edema, mild jaundice, and moderate ascites. Laboratory tests showed pancytopenia, elevated liver enzymes and bilirubin, prolonged INR, and hypoalbuminemia. Imaging found nodular liver, splenomegaly, and varices. Endoscopy showed large esophageal varices. Testing ruled out viral hepatitis and autoimmune causes. Wilson's disease was suspected due to elevated urinary copper and was confirmed with low ceruloplasmin and elevated urinary copper post-penicillamine challenge. Treatment for Wilson's
This document provides guidance on evaluating and treating a child presenting with vomiting. It begins with definitions of related terms like nausea, retching, and regurgitation. It then reviews the major neurophysiological pathways that can induce vomiting. Etiologies are discussed including central, infectious, metabolic, and peripheral causes. An approach is outlined involving obtaining a thorough history and physical exam to determine potential causes and guide testing. Common etiologies are reviewed for different age groups. Complications, treatment principles targeting the underlying cause, and sick day management for diabetes are also summarized.
This document contains an OSCE (Objective Structured Clinical Examination) practice exam for pediatrics. It includes 10 multiple choice matching questions that pair drugs used in pregnancy with their expected adverse effects on the fetus. It also includes several short clinical vignettes followed by 5 questions each. The vignettes cover topics like interpreting an ABG result, identifying sickle cell anemia from a peripheral smear, making a diagnosis of retropharyngeal abscess from presented symptoms, and more. The goal of the summary is to provide a high-level overview of the content and focus of the practice exam.
Urinary tract infections are common in children, especially girls. The most common cause is Escherichia coli bacteria spreading from the intestines. Symptoms vary from mild cystitis to severe pyelonephritis. Diagnosis involves urinalysis and urine culture. Treatment depends on severity but commonly involves antibiotics like trimethoprim-sulfamethoxazole. Imaging with ultrasound is recommended for the first UTI in infants and children under 3, or those with fever or systemic illness, to check for anatomical abnormalities.
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
Pediatric headache by dr. milind bapatMilind Bapat
Headaches are common in children, affecting 39% by age 6 and 75% by age 15. Migraines, the most common type of primary headache in children, can cause school absences and impair academic performance. Evaluation of childhood headaches should consider secondary causes from infections, injuries, or intracranial pathology. For primary headaches like migraines, treatment involves acute abortive medications and lifestyle changes to prevent triggers as well as prophylactic medications if headaches are frequent or severe.
This document discusses fever without a clear source or focus of infection. It defines fever and describes how body temperature is regulated. Fever occurs when heat production exceeds heat loss. Common causes include infections, inflammation, and cancer. The pattern of fever can provide clues to the underlying cause. Management depends on the age of the child. For young infants, a full evaluation including lab tests and antibiotics is often needed due to the risk of serious bacterial infection. Older children have a lower risk but may still require testing and observation or empiric antibiotics depending on factors like vaccination history and appearance.
- Pediatric tuberculosis remains a major public health problem, with over 2.2 lakhs children affected each year in India alone.
- Risk factors for TB infection and disease in children include living in high TB endemic communities, exposure to untreated source cases such as family members with cavitary or smear-positive pulmonary TB, and HIV infection.
- Clinical manifestations of TB in children vary depending on the stage of disease from primary infection to reactivation disease, and can include pulmonary disease, disseminated disease affecting multiple organs, lymph node involvement, and extra-pulmonary manifestations such as TB meningitis.
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
This document provides information on chronic cough in children, including definitions, epidemiology, pathophysiology, causes, diagnostic approach, and management. It defines chronic cough as lasting 4 or more weeks based on expert guidelines. Specific cough has an identifiable cause while nonspecific cough does not after evaluation. Common causes include asthma, aspiration, and suppurative lung diseases. The diagnostic approach involves detailed history, physical exam focusing on cough characteristics, chest imaging, and additional tests as needed based on findings. Management targets treating the identified cause for specific cough or watchful waiting for most nonspecific cough cases.
This document provides guidance on evaluating and diagnosing childhood arthritis. It distinguishes arthritis from arthralgia based on clinical features. It lists various differential diagnoses for childhood joint pain or swelling including infectious, rheumatological, neoplastic and traumatic etiologies. It describes tender points seen in fibromyalgia. It outlines features that can distinguish inflammatory, mechanical and sinister causes of joint pain. The approach involves assessing onset, number and type of joints involved, associated systemic symptoms and precipitating factors. Key clues from history and physical exam are described. A review of systems guides evaluation of specific organ systems. Common clinical presentations like acute monoarthritis, chronic monoarthritis and polyarthritis are reviewed. Characteristics of juvenile idiopathic arthritis subtypes
Enteric fever, also known as typhoid fever, is caused by the bacteria Salmonella enterica typhi or Salmonella paratyphi A, B, or C. It is transmitted through the fecal-oral route and has an incubation period of 7-14 days. Clinical features include sustained high fever, abdominal pain, diarrhea or constipation, and rose-colored spots on the trunk. Complications can affect the central nervous system, cardiovascular system, respiratory system, gastrointestinal system, hepatobiliary system, genitourinary system, and bones. Treatment involves antibiotics, hydration, and rest. Prevention focuses on proper sanitation, hand washing, and vaccination.
This document provides an overview of common paediatric rashes. It begins with describing the anatomy of the skin and definitions of common rash morphologies such as macules, papules, vesicles and pustules. Common rashes that are described include scabies, acne, contact dermatitis, atopic dermatitis, impetigo, tinea and nonspecific viral rashes. Specific viral exanthems like measles, rubella and scarlet fever are also reviewed. Emergent rashes like erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis are discussed in terms of their presentations, causes and treatments. References are provided at the end.
This document provides information on chronic liver disease in infants and children. It discusses the classification, etiology, differential diagnosis, and specific diseases that cause chronic liver disease. Some key points include:
- Chronic liver disease is seen in children of all ages and is defined as liver disease lasting more than 3-6 months. Cirrhosis refers to late-stage scarring of the liver.
- Common causes in infants include neonatal hepatitis, biliary atresia, and progressive familial intrahepatic cholestasis. In children, common causes are hepatitis B, hepatitis C, Wilson's disease, and autoimmune hepatitis.
- Clinical features may include jaundice, hepatomegaly, spl
This document provides an overview of the approach to chronic diarrhea. It defines chronic diarrhea as diarrhea lasting over 2-3 weeks and discusses etiology, risk factors, symptoms, examination findings, diagnostic workup and management. The diagnostic workup involves screening tests, intestinal function tests, biopsy and special investigations. Management includes supportive measures, identifying and treating the underlying cause, elimination diets and nutritional rehabilitation. Prevention focuses on improved nutrition, hygiene, breastfeeding and access to clean water.
Approach to a case of paediatric hepatitisRaghav Kakar
This document provides an overview of the approach to paediatric hepatitis. It discusses the main causes of hepatitis including viral (HAV, HBV, HCV, HDV, HEV), autoimmune, and drug-induced. For viral hepatitis, it covers the etiology, pathogenesis, clinical features, diagnosis, and management of each virus. It provides details on HAV including transmission via the fecal-oral route, clinical presentation of acute hepatitis, diagnosis via IgM antibodies, and treatment involving immunoglobulin for prevention. For HBV, it discusses the various modes of transmission including perinatal, clinical phases from acute to chronic infection, diagnostic markers, and treatment of acute versus chronic cases.
This document discusses several pediatric infectious diseases that present with fever and rash: measles, rubella, varicella, and hand, foot and mouth disease. It provides details on the causative agents, clinical manifestations, investigations, treatment, prevention, and complications of each disease. A case scenario is also presented describing a 9-month-old girl presenting with fever, rash, cough and conjunctivitis consistent with measles. Differential diagnoses and distinguishing features between measles and rubella are also summarized.
This document discusses pertussis (whooping cough), including its epidemiology, etiology, clinical features, complications, management, prognosis, and prevention. It describes pertussis as a highly contagious disease caused by the Bordetella pertussis bacteria. The clinical features are divided into three stages: catarrhal, paroxysmal, and convalescent. Diagnosis is based on a prolonged cough with bouts and symptoms like vomiting or inspiratory whoop. Management involves supportive care, antibiotics, and vaccination to prevent spread. Complications can include pneumonia, seizures, or death in infants.
This document provides guidance on evaluating and managing a patient presenting with chronic diarrhea. It defines chronic diarrhea as lasting 4 weeks or longer. A thorough history and physical exam are important to determine the cause, which can include infections, inflammatory bowel disease, malabsorption issues, and functional disorders. Initial testing involves stool studies and bloodwork. Empiric treatment starts with loperamide and dietary changes, while specific therapies target the underlying cause, if identified.
An 11-year-old boy presented with large volume hematemesis and edema of the feet and abdominal distension for 2 months. On examination, he had pallor, edema, mild jaundice, and moderate ascites. Laboratory tests showed pancytopenia, elevated liver enzymes and bilirubin, prolonged INR, and hypoalbuminemia. Imaging found nodular liver, splenomegaly, and varices. Endoscopy showed large esophageal varices. Testing ruled out viral hepatitis and autoimmune causes. Wilson's disease was suspected due to elevated urinary copper and was confirmed with low ceruloplasmin and elevated urinary copper post-penicillamine challenge. Treatment for Wilson's
This document provides guidance on evaluating and treating a child presenting with vomiting. It begins with definitions of related terms like nausea, retching, and regurgitation. It then reviews the major neurophysiological pathways that can induce vomiting. Etiologies are discussed including central, infectious, metabolic, and peripheral causes. An approach is outlined involving obtaining a thorough history and physical exam to determine potential causes and guide testing. Common etiologies are reviewed for different age groups. Complications, treatment principles targeting the underlying cause, and sick day management for diabetes are also summarized.
This document contains an OSCE (Objective Structured Clinical Examination) practice exam for pediatrics. It includes 10 multiple choice matching questions that pair drugs used in pregnancy with their expected adverse effects on the fetus. It also includes several short clinical vignettes followed by 5 questions each. The vignettes cover topics like interpreting an ABG result, identifying sickle cell anemia from a peripheral smear, making a diagnosis of retropharyngeal abscess from presented symptoms, and more. The goal of the summary is to provide a high-level overview of the content and focus of the practice exam.
Urinary tract infections are common in children, especially girls. The most common cause is Escherichia coli bacteria spreading from the intestines. Symptoms vary from mild cystitis to severe pyelonephritis. Diagnosis involves urinalysis and urine culture. Treatment depends on severity but commonly involves antibiotics like trimethoprim-sulfamethoxazole. Imaging with ultrasound is recommended for the first UTI in infants and children under 3, or those with fever or systemic illness, to check for anatomical abnormalities.
This document discusses chronic kidney disease (CKD) in pediatrics. It defines CKD as kidney damage lasting at least 3 months as determined by structural abnormalities and/or a glomerular filtration rate below 60 mL/min/1.73m2. The stages of CKD are described based on GFR. Common causes in children include congenital abnormalities and glomerulonephritis. The pathogenesis involves hyperfiltration injury and other factors like proteinuria that accelerate kidney damage. Management aims to address complications through careful monitoring, nutrition, treatment of mineral bone disorders, and controlling blood pressure and electrolyte abnormalities.
Pediatric headache by dr. milind bapatMilind Bapat
Headaches are common in children, affecting 39% by age 6 and 75% by age 15. Migraines, the most common type of primary headache in children, can cause school absences and impair academic performance. Evaluation of childhood headaches should consider secondary causes from infections, injuries, or intracranial pathology. For primary headaches like migraines, treatment involves acute abortive medications and lifestyle changes to prevent triggers as well as prophylactic medications if headaches are frequent or severe.
This document discusses fever without a clear source or focus of infection. It defines fever and describes how body temperature is regulated. Fever occurs when heat production exceeds heat loss. Common causes include infections, inflammation, and cancer. The pattern of fever can provide clues to the underlying cause. Management depends on the age of the child. For young infants, a full evaluation including lab tests and antibiotics is often needed due to the risk of serious bacterial infection. Older children have a lower risk but may still require testing and observation or empiric antibiotics depending on factors like vaccination history and appearance.
- Pediatric tuberculosis remains a major public health problem, with over 2.2 lakhs children affected each year in India alone.
- Risk factors for TB infection and disease in children include living in high TB endemic communities, exposure to untreated source cases such as family members with cavitary or smear-positive pulmonary TB, and HIV infection.
- Clinical manifestations of TB in children vary depending on the stage of disease from primary infection to reactivation disease, and can include pulmonary disease, disseminated disease affecting multiple organs, lymph node involvement, and extra-pulmonary manifestations such as TB meningitis.
Tuberculosis is a chronic, wasting, communicable disease, which made a huge comeback with the HIV pandemic, making it an opportunistic infection, and and an AID-defining infection. This presentation explores the different types of tuberculosis in terms of their locations (pulmonary and extra-pulmonary) as well as in terms of their drug susceptibility. It also addresses the approach to the management of each one of these.
All infectious disease covered by rakesh ranaRakeshRana54
This document provides information on meningitis, tuberculosis, typhoid, and leprosy. It discusses the etiology, signs and symptoms, types, and pathophysiology of each condition. Meningitis is caused by bacterial or viral infections that spread from other body sites to the membranes covering the brain and spinal cord. Tuberculosis is an infectious disease commonly affecting the lungs caused by Mycobacterium tuberculosis. It spreads through airborne droplets. Typhoid is a bacterial infection caused by Salmonella Typhi through contaminated food and water. Leprosy is a chronic infectious disease caused by Mycobacterium leprae that mainly affects the skin and nerves. It is transmitted through direct contact and has different clinical classifications
Pulmonary tuberculosis is caused by the bacterium Mycobacterium tuberculosis. It is transmitted via airborne droplets when people with active TB cough, sneeze or spit. Primary tuberculosis occurs when someone is initially infected, usually resulting in a self-limited infection. Post-primary tuberculosis occurs after a latent period and is usually due to reinfection or reactivation of a latent infection. Diagnosis involves microbiological testing of sputum samples, chest imaging, and tuberculin skin testing or interferon-gamma release assays. Radiographic findings can help determine if a case is active or inactive.
Meningitis is an infection of the membranes covering the brain and spinal cord. It is usually caused by bacterial or viral infections elsewhere in the body. Bacterial meningitis has a rapid onset and is more severe, while viral meningitis has a milder presentation. Symptoms include fever, headache, and neck stiffness. Complications can include hearing loss, learning disabilities, seizures, and death.
1. Clinical manifestations of paediatric tuberculosis can be non-specific and tuberculosis is more difficult to diagnose in children compared to adults. Children are more likely to develop severe or disseminated disease if tuberculosis is undiagnosed or untreated.
2. Diagnosis of tuberculosis in a child is a sentinel event that requires contact investigation to be critical.
3. Congenital tuberculosis transmission from mother to child is rare but carries high risks of neonatal mortality and morbidity, so early diagnosis and treatment of infected newborns is important.
The document discusses pediatric respiratory and cardiac diseases. For respiratory diseases, it covers common illnesses like upper respiratory infections, laryngitis, bronchitis, pneumonia and asthma. It also discusses less common conditions like epiglottitis, croup, sinusitis and tuberculosis. For cardiac diseases, it begins with an overview of fetal, transitional and pediatric circulation. It then covers congenital heart defects categorized as left-to-right shunts, right-to-left shunts, and obstructive lesions. Physical exam findings and management strategies are also summarized. The document provides detailed information on evaluation and treatment of various pediatric respiratory and cardiac conditions.
Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and can affect the lungs (pulmonary TB) or other organs (extrapulmonary TB). It spreads through the air when people with active TB cough, sneeze or speak. While most exposed people develop latent TB infection, 10% will develop active disease. Diagnosis involves chest x-rays, sputum smear and culture tests, and treatment requires a multi-drug regimen to prevent drug resistance. HIV co-infection increases the risks of developing active TB and facing treatment challenges.
This document provides an overview of pulmonary and extrapulmonary tuberculosis. It discusses the microbiology of M. tuberculosis and describes the pathogenesis and typical presentations of pulmonary TB, including epidemiology, transmission, risk factors, clinical presentation, diagnosis, and treatment. It also reviews common forms of extrapulmonary TB, such as TB lymphadenitis, pleural-pericardial-peritoneal TB, CNS tuberculosis, skeletal TB, miliary TB, and multidrug-resistant TB. The take-home message is that TB remains a global health burden that can affect multiple body systems and requires a high index of suspicion for diagnosis.
RETROPHARYNGEAL ABSCESS
Retropharyngeal abscess ia an infection of the retropharyngeal space
Retropharyngeal space is a potential space posterior to the pharynx and the cervical oesophagus
Often presents late, most times in airway obstruction
It is life threatening,adequate care and management is needed
Mortality and morbidity often follows delayed or missed diagnosis
The document discusses various types of neck swellings including their causes, characteristics, investigations, and treatments. It categorizes swellings as congenital, inflammatory, or neoplastic. Examples of congenital swellings include thyroglossal cyst and branchial cyst. Inflammatory swellings can be due to infections like tuberculosis or non-neoplastic conditions such as goiter. Neoplastic swellings include benign tumors of salivary glands or carotid body tumors as well as malignant lesions. Thorough history, exam, and appropriate imaging and pathology tests are needed to identify the specific cause of a neck swelling.
The document discusses tuberculosis in children, including its epidemiology, etiology, clinical features, diagnosis, and management. It notes that tuberculosis is endemic in Pakistan, with over 200,000 new cases annually. Children under 15 account for 20% of cases. The causative agent is Mycobacterium tuberculosis. Clinical features vary depending on the site of infection, and may include cough, fever, lymph node enlargement, and meningitis. Diagnosis involves tuberculin tests, chest X-rays, and culture of fluid/tissue samples. Standard drug regimens include isoniazid and rifampin for 6-12 months. Prevention involves BCG vaccination, contact screening, and prophylactic treatment of
This document discusses bronchiectasis, which is the abnormal dilatation of the bronchi. It can be caused by congenital issues, infections, or other lung diseases. People with bronchiectasis experience a chronic cough with large amounts of sputum, as well as recurrent lung infections and damage. Diagnosis involves imaging tests and sputum cultures. Treatment focuses on airway clearance through physiotherapy, use of bronchodilators and antibiotics to treat infections, and sometimes surgery. Managing the underlying cause is important to prevent progression and improve prognosis.
Epidemiology
Leading infectious cause of death globally among children < 5 yr
More than 99% of pneumonia deaths are in low- and middle-income countries
Effective vaccines against measles and pertussis contributed to the decline in pneumonia-related mortality during the 20th century.
H.influenzae type b uncommon following licensure of a conjugate vaccine in 1987
PCVs has been an important contributor to the further reductions in pneumonia-related mortality
Etiology
Microorganisms (most)
Noninfectious
Aspiration (food or gastric acid, foreign bodies, hydrocarbons)
Hypersensitivity reactions
Drug- or radiation-inducedpneumonitis
Strep pneumoniae (pneumococcus) is the most common bacterial pathogen in children 3 wk to 4 yr
Mycoplasma pneumoniae and Chlamydophila pneumoniae are the most frequent bacterial pathogens in children age 5 yr and older.
S. aureus pneumonia often complicates an illness caused by influenza viruses.
This document provides information on extrapulmonary manifestations of tuberculosis (TB), including cutaneous TB. It discusses various types of cutaneous TB such as tuberculous chancre, lupus vulgaris, scrofuloderma, and tuberculids. Risk factors, clinical features, diagnosis, and treatment are described for each type. Causative organisms include Mycobacterium tuberculosis as well as atypical mycobacteria. Diagnostic tests include tuberculin skin tests, interferon gamma release assays, and sputum/tissue cultures. Treatment typically involves a combination of anti-TB medications.
Similar to Childhood tuberculosis & Revised RNTCP guidelines (20)
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Childhood tuberculosis & Revised RNTCP guidelines
1. Childhood Tuberculosis
&
Revised RNTCP guidelines
Topic presentation by : Dr. Saurav Kumar Upadhyay
1st Year, Junior resident
Dept. of Pediatrics
SVPPGIP
SCBMCH,Cuttack
2. TUBERCULOSIS
• Chronic infectious disease caused by Mycobacterium
tuberculosis.
• Caused human disease for more than 4000 years
• First recognized as clinical entity by Schonlein who used the
term Tuberculosis
• The term derived from english term “tubercle” or lesion of
consumption
3. BURDEN OF TB
• In India ,
every day more than 6000 develop TB disease
more then 600 people die of TB ie. 2 deaths every 5 minutes
• India has highest burden of both TB and MDR TB and
second highest of HIV associated TB
• Approx 3 % among new TB cases and 12to17 % among
previously treated TB cases have MDR TB
4. • 10% disease burden is assigned to children.
• Annual risk of tuberculosis infection in developing countries in
children is 2-5%.
• Estimated lifetime risk of developing TB as indicated by positive
tuberculin test is 10%.
• In India, over 1,00,000 children die from TB every year.
5. TERMINOLOGY
• EXPOSURE :
Significant contact with an adult or adolescent with infectious
TB but lacks proof of infection .
• INFECTION : Occurs when the individual inhales droplet nuclei
containing M.tb which survive intracellularly within the lung
and associated lymphoid tissue . Hallmark is +TST +/- CXR .
Signs, symptoms and Physical examination normal .
6. • DISEASE : Signs or symptoms becomes apparent
• Not all infected individual have the same risk of developing
disease
• Immunocompetent adult : 5 to 10 % life time risk
• Younger than 1yr : 40% within 9 months
• HIV infected : 30 times higher risk
7. TRANSMISSION
• Inhalation of air borne mucus droplet nuclei 1-5 micron in
diameter
• Chance of transmission increases with
Positive AFB strain
Extensive UL infiltrates / cavity
Copious production of thin sputum
Severe and forceful cough
• Environmental factors
8.
9. AT RISK
• Exposed to high risk adults
• Slum dwellers
• Street children
• IV drug abuser
• Malnutrition
11. • Bone and joint disease
• Abdomen and GI disease
• Genitourinary Disease
• Perinatal disease
12. PRIMARY PULMONARY DISEASE
• PRIMARY FOCUS : Ghon’s :
Usually at the site of first implantation
• Usually single and subpleural
• Most cases : heals and disappears or fibrosis or calcifies.
13. • PRMARY COMPLEX : Parenchymal Pulmonary focus and Hilar
lymph nodes and draining lymphadenitis
• Complication arises more commonly from regional adenitis
than primary focus
• HALLMARK : relatively large size Regional lymphadenitis
compared with relatively small size of initial lung focus
14.
15. CHILDREN vs ADULTS
• In adults ,
• Regional lymphadenitis is less marked
• Bronchial erosion less frequent
• Less risk of dissemination
• Cavity formation
• Thus in adults primary infection tends to be more local and
pulmonary
16. PROGRESSIVE PRIMARY PULMONARY
DISEASE
• Rare but serious
• Primary focus enlarges steadily and develops large caseous
center
• Enlarging focus Can slough necrotic debris into adjacent
bronchus leading to intrapulmonary dissemination
17. COMPLICATIONS OF PRIMARY FOCUS
• Rupture into plueral space
• Rupture into bronchus : cavity
• Enlarged focus , laminated or coin shadow
18. COMPLICTIONS OF REGIONAL NODE
• Incomplete ( ball valve ) bronchial obstruction , emphysema of
middle and lower lobes
• Complete : collapse of lower lobe
• Rupture into pericardium : TB pericardial effusion
19. SEQUELAE OF BRONCHIAL
COMPLICATIONS
• Stricture of bronchus at site of erosion
• Cylindrical bronchiectasis in area of old collapse
• Wedge shadow : contracture and fibrosis of segmental lesion
• Linear scar of fibrosis following segmental lesion
20. SYMPTOMS
• Primary complex – mild fever , anorexia , wt loss , decreased
activity , cough
• Progressive primary complex – high grade fever , cough .
Expectoration and hemoptysis – cavity and ulceration of
bronchus
• Endobronchial TB – wheeze , fever , troublesome cough ,
dyspnea , cyanosis .
• Wheezing child not responding to bronchodilators less than 2
yrs consider
21. PLEURAL EFFUSION
• Follows rupture of subpleural focus. Also by hematogenous
spread from primary focus .
• Hypersensitivity to tuberculoproteins
• Fever, cough, dyspnea, pleuritic chest pain
22.
23. MILIARY TB
• First 3 to 6 months after infection
• Heavy hematogenous spread of tubercle bacilli causing
disease in 2 or more organs
• CXR : SNOW STROM apperance
24.
25. CUTANEOUS TB
• Associated with primary complex – direct inoculation into
traumatized area ; painless nodule , leading to non healing ulcer
with regional lymphadenitis
• Associated with hematogenous dissemination- Papulonecrotic
tuberculids – papules with soft centres on trunk , thighs and face
• Lupus Vulgaris : Well demarcated annular plaque with central
scarring
• Verrucosa cutis – large tuberculids on arm and legs
30. SCROFULA
• TB of superficial LNs
• Mc form of extrapulmonary TB in children
• Tonsillar / submandibular – paratracheal nodes
• Supraclavicular – primary lesion of UL lung
• Inguinal , epitrochlear , axillary – TB skin or skeletal
system causing regional lymphadenitis
• U/L , discrete , non tender , firm . Systemic signs and
symptoms except low grade fever are absent , TST usually
reactive . CXR : Normal in 70%
• Respond well to ATT
42. Renal TB
• Tubercles in glomeruli leads to shedding of tubercle bacilli
into tubules
• Caseous mass / cavity between cortex and pyramids
• TB cystitis
• Symptoms : Dysuria , hematuria , sterile pyuria
43.
44. SKELETAL TB
• In order of frequency
• Vertebrae > knee > hip> elbow
• Upper extremities and non weight bearing bones ( skull ,
clavicle ) rarely involved
• TB SPONDYLITIS – Thoracic / lumbar / both in order of
frequency
• SPINA VENTOSA : Pic next slide
• Xray : narrowing of disc space, collapse of vertebral body ,
extensive destruction with kyphosis (POTTS DISEASE )
• COMPLICATIONS – Paravertebral abscess , psoas abscess ,
paraplegia ,quadriplegia
45. SPINA VENTOSA of 4th metacarpals
thickening , soft tissue swelling and discharging
wound
49. TB MENINGITIS
• PATHOPHYSIOLOGY
• Rupture of subcortical focus (rich ) into Subarachnoid space
• Inflammatory exudates Form over base of brain and along
cerebral vessels as they pass over hemispheres
• Adhesions along base and roof of 4th ventricle lead to
obstruction and hydrocephalus
• Involvement of CN 3 , 6 , 7 and optic chiasma
51. Diagnosis
• Signs of meningeal irritation
• CXR
• CT BRAIN – basal exudates , inflammatory granulomas
• Tuberculin testing
• Retinoscopy for choroid tubercles
• LP : elevated pressure – 30 to 40 cm h20
cobweb coagulum
100-500 cells
sugar <40mg/dl rarely <20
protein 400-5000mg/dl
AFB Smear and culture
52. TUBERCULOMAS
• Adults : supratentorial , children : infratentorial , base near
cerebellum
• Usually singular but may be multiple also .
• CT/ MRI Brain : discrete lesions with significant surrounding
edema . Contrast enhancement : ring like lesion
• D/D Neurocysticercosis
53. • Tuberculoma
• May present at any age
• Progressive neurological deficit
• Ring size is usually >20mm
Irregular with significant cerebral
edema
• May be supratentorial /
Infratentorial
• Likely to cause midline shift
• MRS has lipid peak.
• T2 relaxation time shorter.
• Neurocysticercosis
• Rare before the age of 3 years
• Generally no neurological
deficit,postictal focal deficits of
varying severity resolves within a
matter of days /weeks.
• Usuall smaller,regular outline, less
cerbral edema
• Usually supratentorial
• No midline shift
• No lipid peak
• T2 relaxation time longer.
54.
55. PREGNANCY AND NEWBORN
• Prematurity , IUGR , LBW and prenatal mortality .
• Congenital TB is rare because mc result of female genital tract
TB is infertility
• Occurs from lesion of placenta – primary focus is fetal liver
with periportal LN involvement
• Aspiration or ingestion of infected amniotic fluid – primary
focus is liver
• However mc route of infection for neonate is postnatal
airborne transmission from adult with infectious pulmonary TB
56. PERINATAL DISEASE
• Symptoms may present at birth but commonly begin by 2nd/3rd week
of life .
• Signs : respiratory distress , fever , HSM , poor feeding , lethargy ,
irritability , LN , failure to thrive , ear discharge and skin lesions
• Generalized LN and meningitis occur in 30-50 %
• CXR : Miliary pattern
• TST : Often neg . Can become positive in 1-3 months .
• Gastric aspirate and other specimens yields good results
• Mortality rate remains high because of delayed diagnosis .
57. HIV and TB
• 30 times increased risk
• Diagnosis is difficult – TST neg , culture confirmation is
difficult , C/F are similar to many other HIV related infections .
• Treatment is difficult- More often severe , progressive and
likely to be extrapulmonary , high rates of drug resistance ,
recurrent disease are more common
• Mortality rate depends on CD4 count . Increased mortality
rates are attributed to progressive HIV disease than TB .
• Hence HIV infected children with potential exposures should
be promptly evaluated ,conversely all child with TB should be
tested for HIV
58. IRIS
• Immune reconstitution inflammatory syndrome
• Starting of HAART
• Transient worsening of symptoms such as fever increasing LN ,
exacerbation of intracerebral tuberculoma , pleural effusions
• Reason : effects of immune reconstitution , although
hypersensitivity reaction to antigens released by TB bacilli
may also contribute
60. PRESUMPTIVE PAEDIATRIC TB
• Children with persistent fever and / or cough for more than 2
weeks
• Loss of weight * / no wt gain
• History of contact with infectious TB cases **
*unexplained past 3 months / No wt gain 3 months . Loss of wt
more than 5% as compared to highest wt recorded in last 3
months
**In a symptomatic child , contact with a person with any form of
active TB with in last 2 yrs
61. PRESUMPTIVE DR TB
• Failed treatment with first line drugs
• TB non responders
• Contacts with DR TB
• Found positive on any follow up sputum smear
• Previously treated TB
• HIV Co-infection
62. CASE DEFINITIONS
• MICROBIOLOGICALLY CONFIRMED TB : AFB +/ culture+/
positive through quality assured rapid diagnostic molecular test
• CLINICALLY DIAGNOSED TB :Presumptive TB pt who is not
microbiologically confirmed but diagnosed with Active TB by a
clinician on basis on Xray /history of exposure to infectious
case/ Evidence of TB infection (TST+) / clinical signs
64. ANATOMICAL SITE
• PULMONARY TB : Any microbiologically or clinically diagnosed
TB Involving lung parenchyma or the tracheobronchial tree .
• EXTRAPULMONARY TB : Other organs
65. H/O TREATMENT
• NEW CASE : never had treatment or taken ATT Less than one
month
• PREVIOUSLY TREATED PATIENTS : one month or more treatment
in the past
1. RECURRENT TB Case : A TB patient previously declared as
successfully treated and is subsequently found to be
microbiologically confirmed TB
2.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
66. 3.TREATMENT AFTER LOSS OF FOLLOW UP A TB patient
previously treated for TB for 1 month or more and was
declared loss to follow up in their most recent course of
treatment and subsequently found microbiologically confirmed
TB
4.OTHER PREVIOUSLY TREATED PATIENTS : are those who have
previously been treated for TB but whose outcome is unknown
or undocumented
67. DRUG RESISTANCE
• MR : One first line Anti TB drug
• PDR : More than one first line Anti TB drug other than both H
and R
• MDR : Resistance to both H and R With or without resistance
to other first line drugs based on results from quality assured
lab
• RR : Resistance to R detected using phenotypic or genotypic
methods , with or without resistance to other Anti TB drug
excluding INH . Managed as MDR TB
• XDR : MDR +Resistance to a FQs (oflox, levo or moxi) +second
line injectable AntiTB drug (Kanamycin, amikacin,
capreomycin)
68. DIAGNOSTIC TOOLS
TESTS FOR MICROBIOLOGICAL CONFIRMATION
• All efforts should be undertaken for microbiologically
confirming Presumptive TB pts .
• Under RNTCP acceptable methods are
• SPUTUM SMEAR MICROSCOPY(AFB)
Zeihl-Neelson staining
Fluroscence staining
69. ZIEHL-NEELSEN STAINING GRADING
FINDING NO OF FIELDS GRADING RESULT
No AFB in 100 oil
immersion field
100 0 Neg
1-9 AFB per 100 oil
immersion field
100 scanty Pos
10-99 AFB per 100
oil immersion fields
100 1+ Pos
1-10 AFB per oil
immersion field
50 2+ Pos
>10 AFB per oil
immersion field
20 3+ Pos
70. • CULTURE
Solid : Lowenstein Jensen media
Automated liquid culture system ex : BACTEC MGIT 960 ,
BactiAlert etc
. Drug sensitivity testing
Modified PST for MGIT 960 system
• RAPID MOLECULAR DIAGNOSTIC TESTING
Line probe assay
CBNAAT
71. RADIOGRAPHY
• Used as screening tool to increase sensitivity of diagnostic
algorithm
• Any abnormality should further be evaluated for
microbiological confirmation
• Diagnosis based on CXR will be termed as CLINICALLY
DIAGNOSED TB
72. TST
• Complimentary in children in combination with microbiological
investigation,contact history, CXR and symptoms
• A positive Tuberculin skin test/Mantoux test was defined as an
induration of 10 mm or more, measured 48-72 hours after
Intradermal injection with 2 TU Tuberculin PPD RT 23 or 5
TU of PPD-S
• <5mm : negative ; no active ds
• 5to 10 mm : boderline ; postive in immunocompromised host,
contact history
• >10 mm : positive, suggests disease in presence of clinical
features
73. • STORAGE:-
stored in dark place at 2-200 C
Opened vials should not be kept for >2days
74.
75. False negative
• Patient related:-
Infection(measles,mumps,HIV)
Heavy load of antigen in miliary TB,TBM.
Live attenuated viral vaccines
CRF
PEM(gradeIII,IV)
Intake of steroids,immunosuppresants
Extremes of age
Stress
• Others
Faulty technique
Denatured tuberculin
76. False positive
• Infection with non –tuberculous mycobacteria.
• Recent BCG vaccination.
• Infection at the site of test
94. CLINICAL
• At least monthly .
• Improvement of chest symptoms
• Increase in weight
• Control of co-morbid conditions
95. LABORATORY
• Sputum smear examination in case of Pulmonary TB at the
end of IP and end of treatment
• Negative : good prognosis
96. CXR
• End of IP
• End of treatment
• Whenever required
97. LONG TERM FOLLOW UP
• After completion : End of 6, 12, 18 & 24 months
• In presence of any clinical symptoms, sputum microscopy /
culture should be considered
98. MDR/XDR TB FOLLOW UP
• MICROBIOLOGICAL : One sputum will be collected and
examined by culture at least 30 days apart from 3 to 7th
month of treatment (i.e. At the end of months 3,4,5,6,7 ) and
at 3 monthly intervals (ie. At the end of months
9,12,15,18,21,24) .
• If any culture during CP / end of treatment is positive then it
should be followed by monthly cultures for 3 months
99. • Weight : monthly
• CXR : at the end of IP / end of treatment / whenever required
• Physical examination : including ADR every monthly for 6
months then every 3 months for 2 yrs
• S.creatinine : monthly for First 3 months then every 3 months
during injectable phase
100. • ECG : once monthly if Moxifloxacin is used
• TFT : Start and whenever required if PAS & Ethionamide is
used.
• CBC : weekly in first month then monthly
• Electrolytes : monthly till Inj Capreomycin used
• LFT : monthly in IP and 3 monthly in CP
• CXR : every 6 monthly in XDR TB
101. EPTB FOLLOW UP
• Treatment response best assessed clinically
• If required imaging
• Extension of IP/CP may be considered in consultation with the
specialist concerned
103. DRUG SENSITIVE TB
• CURED : microbiologically confirmed TB at beginning of
treatment who was smear negative or culture negative at end
of complete treatment
• TREATMENT COMPLETED : Completed treatment without
evidence of failure or clinical deterioration but no record to
show that the smear or culture results of biological specimen
in last month of treatment was neg , either because test was
not done or because result is unavailable
104. • TREATMENT SUCCESS : Cured / treatment complete
• FAILURE : Biological specimen is postive by smear / culture at
end of treatment
• FAILURE TO RESPOND : A case of paediatric TB who fails to
have microbiological conversion to negative status or fails to
respond clinically / detoriates after 12wks of complaint IP
shall be deemed to have failed response provided alternate
diagnosis/ reasons for non responders have been ruled out
105. • LOST TO FOLLOW UP : Patient whose treatment was
interrupted for 1 consecutive month or more
• TREATMENT REGIMEN CHANGED : First line regimen to DRTB
• DIED : During course of ATT
106. RR/MDR-TB/XDR-TB
• CURE : Treatment completed as recommended without
evidence of failure and 3 or more consecutive cultures taken
atleast 30 days apart are negative after IP
• TREATMENT COMPLETED : Completed as recommended
without evidence of failure but no record
• TREATMENT SUCCESS : Cured / treatment complete
107. • TREATMENT FAILED : Treatment terminated or need for
permanent regimen change of atleast 2 or more ATT drugs in
CP because of
- Lack of microbiological conversion by end of IP OR
- Microbiological reversion in CP after conversion to
negative OR
- Evidence of additional acquired resistance to FQs / second
line injectables
108. • CONVERSION (To negative ) : Conversion to negative when
two consecutive cultures taken at least 30 days apart are
found to be negative
• REVERSION (To negative ): 2 consecutive cultures taken
atleast 30 days apart are found to be positive . For the
purpose of defining TREATMENT FAILED , reversion is
considered only when it occurs in the continuation phase