tuberculosis

1. TB

2. If the importance of a disease for mankind
is measured from the number of fatalities
which are due to it, then tuberculosis must be
considered much more important than those
most feared infectious diseases, plague,
cholera, and the like. Statistics have shown
that 1/7 of all humans die of tuberculosis.
Robert Koch (1882)

3. Disease load

4. History of TB
o 500000 ago homo erectus fossil
o Old testament describe curse of consumption
o Rigveda; yaksma
o Peru found evidence; 6000yrs old
o Phthisiology
o 1816 Laennec; steth
o 1882; robert koch
o 1895 Roentgen
o Rest cure, collapse therapy, royal touch
o Nazi killed 30000 poland patients.
o 1906-1921; BCG Vaccine
o 1946; streptomycin

9. Primary
complex
Complete
healing
Caseation
Reactivation
later
Progress
Progressive PC
Collapse cavity
Pleural
effusion
Pneumonia
Dissemination

12. Dissemination
Lymph
adenopathy CNS TB
TBM Tuberculoma
Pericarditis
Pott’s spine
Arthritis
Miliary TB
Ascites
Peritonitis
Diarrhea

13. Extrapulmonary TB
67
13
6
5
4
LN 67%
CNS 13%
pleural 6%
miliary 5%
bone TB 4%

14. • Primary focus
• Primary complex
• Progressive primary complex
• Progressive pulmonary disease
• Disseminated/extrapulmonary disease

15. Pleural TB
• Rupture of subpleural focus
• Emptying of mediastinal node
• Dissemination
• Unilateral
• Pain/cough/breathless/dullness

16. Lymphadenopathy
• 10% of total TB
• Commonest extrthoracic
• 2-10years
• Anterior cervical nodes
• 6-12months after initial infection
• MATTED
• Paradoxical increased after treatment

18. CNS TB
• <2yrs
• 2-6m after primary
• Rich focus in brain/meninges/spinal cord
• Stages
– 1. nonspecific
– 2.intermediate
– 3.advanced; 50% sequalae

21. Miliary TB
• <5yrs
• Hepatomegaly
• Splenomegaly
• LN
• Choroid tubercle

22. Skeletal TB
• Late complication
• 1-2%
• Thoracolumbar spine;anterior vert body
• Gibbus,kyphosis,osteomyelitis
• Pott’sabcess

24. Abdominal TB
• Enteritis, peritonitis
• Mesenteric LN
• Omental thickening
• Doughy abdomen

25. Wallgren’s time table
2-6 months Disseminated TB, meningitis
3-9m lymph node, endobronchial TB
1-3yrs bone and joint, pleural effusion
5-25yrs renal
Reactivation adolescents

27. Skin TB
• 10-15 yrs
• Scrofuloderma
• Lupus vulgaris
• Verrucosa cutis

28. Congenital TB
• 2-8 weeks after birth
• HSM
• LN
• Miliary TB

29. When to suspect?
• Fever,
• Malaise
• Weight loss
• Night sweats
• Productive cough
• Chest pain
• Hemoptysis

30. Case definition
• Fever/cough >2weeks
• Weight loss unexplained
• Contact history

31. Diagnosis
• Mantoux
• Culture
• CBNAAT
• IGRA
• Xray

33. Culture

34. Ziehl neelsen staining

35. CBNAAT

36. Interferon gamma release assay
• More positivity in latent infection

37. RNTCP

38. Drug Dosage mg/kg Side effects
INH 5-10 Peripheral neuritis
Rifampacin 10-20 Orange coloured urine
Ethambutol 15-25 Optic neuritis
Pyrazinamide 25-30 Hyperuricemia
Streptomycin 20 Ototoxic /renal toxicity

39. Q
• What are the new methods to diagnose TB?
• What are the false negative situations for TST?
• What is bactec culture?