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Diagnosis of Pulmonary Tuberculosis Presenter: 4A Ri 范綱志 Sep. 29,2008
Why diagnosis important? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for prior infection Tuberculin skin test 篩出感染者
Screening for prior infection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mantoux Tuberculin Test ,[object Object],[object Object],[object Object],[object Object],[object Object]
Mantoux test ,[object Object],[object Object],[object Object]
Reading of Mantoux test ,[object Object],[object Object],[object Object]
Classifying the tuberculin reaction ,[object Object],[object Object],[object Object],[object Object],[object Object]
Classifying the tuberculin reaction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Classifying the tuberculin reaction ,[object Object],[object Object]
Factors may affect TST ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Boosting ,[object Object],[object Object],[object Object]
Two-Step Testing ,[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for prior infection ,[object Object],[object Object],[object Object],[object Object]
Diagnosis of Pulmonary TB
Diagnosis of disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical History
Medical History ,[object Object],[object Object],[object Object],[object Object],[object Object]
Medical History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Medical History ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Physical Examination
Physical Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chest radiography
Chest radiography ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Chest radiography ,[object Object],[object Object],[object Object],cavity in patient‘s RUL classic" for adult-type, reactivation tuberculosis
Classic adult TB CXR ,[object Object],[object Object],[object Object]
Chest radiography ,[object Object],[object Object],[object Object]
X-ray-based evaluation causes over-diagnosis of TB NTI, Ind J Tuberc, 1974 Over- diagnosis
Bacteriologic Exam
Specimen Collection ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Three Specimens ,[object Object],[object Object],[object Object],[object Object]
Three sputum smears are optimal
Number of sputum samples required ,[object Object],[object Object],[object Object],[object Object],[object Object]
Number of sputum samples required ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Smear Examination ,[object Object],[object Object],[object Object],[object Object]
AFB Smear ,[object Object],[object Object]
AFB smear AFB (shown in red) are tubercle bacilli
Reporting on AFB Microscopy Number of bacilli seen Result reported None per 100 oil immersion fields Negative 1-9 per 100 oil immersion fields Scanty, report exact number 10-99 per 100 oil immersion fields 1+ 1-10 per  oil immersion field 2+ > 10 per oil immersion field 3+
Proportion of patients with pulmonary TB who have positive AFB smears   AFB positivity in  TB patients 0 10 20 30 40 50 60 70 HIV  Negative Early HIV Late HIV
Open tuberculosis ,[object Object],[object Object],[object Object]
Cultures Colonies of  M. tuberculosis  growing on media ,[object Object],[object Object],[object Object],[object Object],[object Object]
Cultures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AFB smear vs. Cultures ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microscopy is more objective  and reliable than X-ray Inter-observer agreement
Microscopy is a more specific test than X-ray for TB diagnosis Specificity
Diagnosis of Pulmonary TB Cough 3 weeks AFB X 3 Broad-spectrum antibiotic 10-14 days If symptoms persist, repeat AFB smears, X-ray If consistent with TB Anti-TB Treatment If 1  positive , X-ray and  evaluation  If 2/3  positive : Anti-TB Rx If   negative :
Diagnosis of pulmonary TB
Recommended Diagnostic Approach
Take Home Message ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Source ,[object Object],[object Object]
Thanks for your attention!

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