This document summarizes key aspects of pulmonary tuberculosis, including: 1. Pulmonary tuberculosis is diagnosed by considering TB in the differential diagnosis when symptoms are present and ordering appropriate diagnostic tests. 2. Factors like decreased cough reflex and impaired immune function can allow tuberculosis bacteria to infect the lungs and spread. 3. Treatment requires a multi-drug regimen administered under direct observation to ensure adherence and prevent drug resistance, as non-adherence can allow the disease to relapse or spread.

1. Highlights on Pulmonary Tuberculosis Prof. Dr. Saad S Al-Ani Senior Pediatric Consultant Head of Pediatric department Khorfakkan Hospital

2. TB Diagnosis “ The first rule of TB diagnosis: is to think of TB….” Include TB in your differential diagnosis when history, symptoms are consistent with TB diagnosis Order the appropriate diagnostic tests

3. Pulmonary infections Predisposing factors 1.Decreased cough reflex 2.Injury to cilia 3.Decreased function of alveolar macrophages 4.Edema or congestion 5.Retention of secretions

4. 3.Progressive primary pneumonia Miliary dissemination ( blood stream ). Pulmonary tuberculosis Primary 1.Single granuloma within parenchyma and hilar lymph nodes ( Ghon complex ). 2.Infection does not progress (most common).

5. Secondary Pulmonary tuberculosis Cont. Infection (mostly through reactivation) in a previously sensitized individual Pathology Cavitary fibrocaseous lesions Bronchopneumonia Miliary TB

6. Typical Progression of Pulmonary tuberculosis 1.Pneumonia 2.Granuloma formation with fibrosis 3.Caseous necrosis 4.Calcification 5.Cavity formation

7. Pulmonary tuberculosis

8. Acid-Fast (Kinyoun) Stain of Mycobacterium

9. Mycobacterium Tuberculosis Stained with Fluorescent Dye

10. Fibrocaseous

11. Miliary

12. Granuloma

13. Mycobacterium

14. Not Everyone Exposed Becomes Infected Probability of transmission depends on: 1.Infectiousness 2.Type of environment 3.Length of exposure 10% of infected persons will develop TB disease at some point in their lives * 5% within 1-2 years * 5% at some point in their lives

15. Treatment of TB Disease Include four 1st-line drugs in initial regimen 1.Isoniazid (INH) 2.Rifampin (RIF) 3.Pyrazinamide (PZA) 4.Ethambutol (EMB) Never add a single drug to a failing regimen

16. Barriers to Adherence Stigma Extensive duration of treatment Adverse reactions to medications Concerns of toxicity Lack of knowledge about TB and its treatment

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

18. Directly Observed Therapy (DOT) *Health care worker watches patient swallow each dose of medication *DOT is the best way to ensure adherence Should be used with all intermittent regimens Reduces relapse of TB disease and acquired drug resistance

19. Remember “ A decision to test is a decision to treat.” Thank you