Management of PTB

1. Overview of Diagnosis and Management of
Drug Sensitive Pulmonary TB(DS-PTB)
Dr Ravi Kumar Sharma
Assistant Prof.
Dept. of Respiratory Medicine
GMC Haldwani

2. OVERVIEW
• Basics
• Definition of PTB/EPTB
• Clinical Presentation
• Diagnosis
• Treatment
• QnA
2

3. BURDEN OF TB IN INDIA
• TB is one of the top burdensome infectious diseases in
India.
• Incidence for the year 2021 is 210 per 100,000
( 1 lakh) population
• Apx. 28% of the world's new TB cases occur in India.
• 30 Lakh new TB cases each year (TB incidence).
• An estimated 5 Lakhs deaths per year
• Around 40 % of the population infected with TB
TB Kills More adults in India than
other infectious Diseases
Every Day;
>6000 develop TB
>600 deaths per day
2 Death Every 5 Mins
3
40 % Infected
with TB
This makes all of us to be
here today

4. What is Tuberculosis (TB)?

5. 5

6. 6

7. 7

8. Site Specific
symptoms; In
EPTB
8

9. 9

10. 10

11. 11

12. CLASSIFICATION OF TB CASE
12

13. Classification by H/O previous TB
Treatment

14. How to Diagnose Pulmonary TB?
1. Clinical History ( Symptoms/Signs)
2. Physical Exam
3. Basic Blood work( CBC, LFT, RFT, RBS, HIV)
4. Chest X Ray
5. Sputum Examination( AFB I II, CBNAAT)
Stepwise Process

15. History.
Typical symptoms of TB may include:
1.GENERAL: fever, lethargy, anorexia,
weight loss, enlarged and tender lymph
nodes.
2.PULMONARY:
 Cough (usually > 2wk),
 Sputum (initially dry, purulent or blood-
stained)
 Breathlessness,
 Pleuritic chest pain.

16. Important point to ask in history of
Pulmonary TB
1. Fever ; Low grade, evening rise
2. Cough ; Insidious onset, > 2wk
3. Hemptysis; onset, duration,quantity
4. Weight loss; Unexplained and unintentional weight loss of > 3 Kg in
the previous 6 months is known as ‘significant’ weight loss.
Loss of 5% of body weight over 6–12 months should prompt further
evaluation( HPIM)
Associated general symptoms like; fever, lethargy, anorexia, weight loss,
enlarged and tender lymph nodes

17. Chest X Ray in PTB
Any Abnormal Shadow can be present.
A Great Masquerader
Cavitation
B/L Upper Zone
Consolidation
Therefore any abnormal shadow in High Prevalence
countries(Including INDIA) MUST be evaluated for
1.TB 2. TB 3. TB, before moving to other Diagnosis….

18. Sputum Examination
• Smear for AFB I II CBNAAT/ Gene Xpert LPA ( FL,SL)

19. Diagnostic Algorithm for PTB

21. Pyridoxin in dose of 25 mg/day for
adults and 10 mg per day for pediatric
patient during the entire course of
ATT.. MUST

22. Pyridoxin in dose of 25 mg/day for
adults and 10 mg per day for pediatric
patient during the entire course of
ATT.. MUST

24. To conclude..
• TB is a common heath problem in our country
• Always Evaluate PTB in Pts having cough > 2wk
• Any CXR finding can mimic Tuberculosis
• Appropriate ATT is needed to treat tuberculosis