A 40-year-old woman presented with a 3-week history of cough, fever, weight loss, and night sweats. Physical examination revealed decreased breath sounds and rales in the lungs. Chest x-ray showed dense opacities in the right middle and lower lobes, consistent with pulmonary tuberculosis. The patient was diagnosed with pulmonary TB based on clinical presentation, chest x-ray findings, and positive PCR test for M. tuberculosis. She was started on a standard 4-drug antituberculosis treatment regimen for 6-12 months to treat her active pulmonary TB infection.

1. TUBERCLOSIS
Madeeha Farooq
MID 4th
year
University of Lahore
Case
A 40-year-women was admitted to the hospital from
home after 3 week of cough, profuse nocturnal,fever, a
30-poundweight loss, chills, loss of appetiteand night
sweats. He was seen by an emergency room physician
who noted signs of depression. The patient has a history
of HIV.
Patienthistory
Patient name xxx
Age 40years

2. Sex female
30-poundweight loss
Suffering from cough since 3 weeks
Night sweats
Human immune deficiency viruse (HIV)
Physical examination
Physical examination findings associated with TB depend
on the organs involved. Patients with pulmonary TB have
abnormal breath sounds.
Appearanceof the Patient
 Cachexia
 Pallor
Vitals
 Tachypnea
 Tachycardia
 Fever
Lungs
 Decreased breath sounds
 Rales
 Rhonchi

3.  Bronchial
breath sounds
Differential
Diagnosis
lung cancer
pleural indentation
pulmonarytuberculosis
pneumonia
investigations
chest x ray
Dense homogenous opacity in right, middle and lower
lobe of primary pulmonaryTB.
Microbiologicalexamination

4. The polymerasechain reaction (PCR)
The TB-PCR test is ordered to diagnose and detects
M. Tuberculosis from other mycobacteria. It also helps
monitor treatment for TB.
Serologictests

5. Tuberculosis skin test
The tuberculinskin test
---M. tuberculosis
 Purified protein derivative (PPD)
0.1 mL (5 TU) of standard PPD is injected on the
volar surface of the forearm
recorded after 48 to 72 hours

6. BRONCHOSCOPY
Bronchoscopyis commonly used for investigating
patients with possible pulmonarytuberculosis (TB) when
spontaneoussputumis smear negative.
CT scan
Diagnosis
Pulmonary tuberculosis

7. Tuberculosis
Tuberculosis(TB) is a disease
caused by bacteria called
Mycobacterium tuberculosis.
The bacteria usually attack the
lungs, but they can also
damage otherparts of the
body. TB spreads through the
air when a person with TB of the lungs or throat coughs,
sneezes, or talks.
PulmonaryTB
PulmonaryTB is a bacterial
infection of the lungs that
can cause a range of
symptoms, includingchest
pain, breathlessness, and
severe coughing.
systemic tuberculosis
systemic tuberculosis is a potentiallylife-threateningtype
of tuberculosisthat occurs when a large number of the
bacteria travel through the bloodstreamand spread
throughoutthe body.

8. sign and symptoms of tuberculosis
 Coughing for three or more weeks.
 Coughing up blood or mucus.
 Chest pain, or pain with breathing or coughing.
 Unintentional weight loss.
 Fatigue.

9.  Fever.
 Night sweats.
 Chills.
Etiology
Tuberculosis(TB) is caused by a type of bacteriumcalled
Mycobacterium tuberculosis.

10. Pathophysiology
Complications
 Spinal pain. Back pain and stiffness are
common complicationsof tuberculosis.
 Joint damage. ...
 Swelling of the membranes that cover your brain
(meningitis). ...

11.  Liver or kidney problems. ...
 Heart disorders.
Treatment
If you have an active TB disease you will probablybe
treated with a combination of
antibacterial medications for a period of six to 12 months.
The most common treatment for active TB
is isoniazid INH in combination with three other drugs
rifampin, pyrazinamide and ethambutol.

12. Antituberculosisdrugs
 Isoniazid (INH)
 peripheral neuritis
 Rifampin (RFP)
 Pyrazinamide (PZA)
 Ethambutol(EMB)
 Streptomycin (SM)
Initial chemotherapy
both adults and children consist of a 6-month regimen that
is based on an initial 2-month bactericidal phase of INH
and RFP and PZA and either EMB or SM.
• Patients with cavitary pulmonarytuberculosis and
delayed sputum-culture conversion should have their
treatment extended by 3 months for a total course of
9 months.
• For patients with sputumculture-negative pulmonary
tuberculosis, the durationof treatment may be
reduced to 4 months
Recurrent chemotherapy
• Recurrencerefers to the circumstance in which a
patient becomes and remains culture-negative while
receiving antituberculosis drugs

13. • at some point after completion of therapy either
becomes culturepositive again or experiences
clinical or radiographic deteriorationconsistent with
active tuberculosis
• Recurrenceof pulmonarytuberculosis, due to
inadequateinitial chemotherapy, brings about
secondary drug-resistance, persistent positive sputum
smear, and delay recurrence
• Usual agents would includeEMB, a fluoroquinolone,
and an injectableagent such as SM, alizarin,
kanamycin or capreoraycin,
• at least two to three susceptibleor never used drugs
added to the regimens.
• A five-drug combination in intensive phase and three
in consolidationphase are suitable.
• Continuousadministration of 18 to 24 months after
conversion of sputumis necessary.

14. Surgery
• Indications of surgery
noneffective and multidrug-resistant cavities
large caseous lesions
tuberculousempyema
bronchial fistula
and uncontrolledmassive hemoptysis.
The recommendation was for the use of partial lung
resection (lobectomy or wedge resection) alongside
the provision of medication. A lobectomy is a type
of surgery, mostly used for lung cancer, in which one

15. lobe of a lung is removed. A lobe may be removed to
prevent the spread of TB to anotherlobe.