Prof. Dr. Saad S. Al Ani discusses the diagnosis and treatment of pulmonary tuberculosis (TB), emphasizing the importance of considering TB in differential diagnoses when symptoms are present. He outlines the typical progression of the disease, various predisposing factors, and the initial treatment regimen involving four first-line drugs. The presentation also highlights barriers to treatment adherence and strategies for improving patient compliance, including directly observed therapy.

1. Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
aliarqialani@gmail.com
High Lights
On
Pulmonary Tuberculosis

2. To Diagnose Tuberculosis
 Order appropriate diagnostic
tests
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‘ The first rule of TH diagnosis :
Is to think of TB…….’
 Include TB in your differential
diagnosis when history ,
symptoms are consistent with TB
diagnosis

3. Decreases cough reflex
Injury to the cilia
Decreased function of alveolar
macrophages
Presence of edema or congestion
Retention of secretions
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Pulmonary infections
Predisposing factors

4. Primary
1. Single granuloma within
paranchyma and hilar lymph nodes
(Ghon complex)
2. Infection does not progress
(most common)
3. Progressive primary pneumonia ,
Miliary dissemination (Blood stream)
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4
Pulmonary Tuberculosis

5. CHEST X-RAY SHOWING BILATERAL HILAR
ADENOPATHY OF PRIMARY PULMONARY TB
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https://en.wikipedia.org/wiki/Tuberculosis_radiology

6. • Secondary
 Infection ( mostly through reactivation)
in a previously sensitized individual
 Pathology
Cavitary fibrocaseous lesions
 Bronchopneumonia
 Miliary TB
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Pulmonary Tuberculosis

7. Typical Progression of
Pulmonary Tuberculosis
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Pneumonia
Granuloma formation with fibrosis
Caseous necrosis
Calcification
Cavity formation

8. CASEATION AND CAVITATION IN UPPER LOBE OF
THE LUNGS IN PULMONARY TUBERCULOSIS
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http://www.jotscroll.com/forums/11/posts/158/pulmonary-tuberculosis

9. TUBERCULOUS BACILLI (ACID-FAST BACILLI) PRESENT IN
LARGE QUANTITIES WITHIN THE INFLAMMATORY INFILTRATE
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https://www.researchgate.net/figure/Tuberculous-bacilli

10. THIS FLUORESCENT ACID-FAST STAINED (SMITHWICK)
PHOTOMICROGRAPH REVEALED PRESENCE OF
MYCOBACTERIUM TUBERCULOSIS BACTERIA
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https://www.alamy.com/stock-photo/fluorescent-micrograph.html

11. FIBROCASEOUS TB
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https://www.slideshare.net/mohaa1989/chest-surgical-pathology-x-rays
Fibrocaseous TB of both superior lobes with cavitations on
the right side

12. MILIARY TB
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https://radiopaedia.org/cases/miliary-tuberculosis-pathology-1

13. GRANULOMA
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https://www.researchgate.net/figure/Typical-architecture-of-a-TB-granuloma
Typical architecture of a TB granuloma.
(A) Representative granuloma with central necrosis from mini pig lung
tissue. Histological samples were formalin-fixed cut and stained with
hematoxylin-eosin.
(B) (B) Schematic of the cellular constituents of a TB granuloma.
Source: Guirado and Schlesinger (2013).

14. NOT EVERYONE EXPOSED BECOMES INFECTED
Probability of transmission depends on:
 Infectiousness
 Type of environment
 Length of exposure
10% of infected persons will develop TB
disease at some points in their lives
 5% within 1-2 years
 5% at some point in their lives
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15. TREATMENT OF TB DISEASE
Includes four 1st-line drugs in initial
regimen:
1. Isoniazid (INH)
2. Rifampin (RIF)
3. Pyrazinamide (PZA)
4. Ethambutol (EMB)
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16. BARRIERS TO ADHERENCE
Stigma
Extensive duration of a treatment
Adverse reactions to medications
Concerns of toxicity
Lack of knowledge about TB and its
treatment
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17. IMPROVING ADHERENCE
Adherence is the responsibility of the
provider, NOT the patient and can be
ensured by:
 Patient education
 Directly Observed Therapy (DOT)
 Case management
 Incentives / enablers
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18. DIRECTLY OBSERVED THERAPY (DOT)
Health care worker watches the patient
swallows each dose of medication
DOT is the best way to ensure
adherence
Should be used with all intermittent
regimen
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19. ‘A decision to test
is
A decision to treat’
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http://worldartsme.com/remember-faces-clipart.html#

20. REFERENCES
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1. https://en.wikipedia.org/wiki/Tuberculosis_radiology
2. http://www.jotscroll.com/forums/11/posts/158/pulmonary-tuberculosis
3. https://www.researchgate.net/figure/Tuberculous-bacilli
4. https://www.alamy.com/stock-photo/fluorescent-micrograph.html
5. https://www.slideshare.net/mohaa1989/chest-surgical-pathology-x-rays
6. https://radiopaedia.org/cases/miliary-tuberculosis-pathology-1
7. https://www.researchgate.net/figure/Typical-architecture-of-a-TB-granuloma

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