This document discusses tuberculosis (TB), including relevant physical examination findings, diagnostic tests, and treatment. On physical examination, abnormal breath sounds and dullness on percussion over the upper lobes may be present. Diagnostic tests include blood tests to rule out other diseases, sputum culture and staining to identify the bacteria, chest x-ray showing consolidations or effusions, and biopsy for histological examination. Treatment involves a multi-drug antibiotic regimen under directly observed therapy to ensure adherence and prevent resistance. Education on proper hygiene and completing the full treatment course is also important.

1. Tuberculosis
Done By: Dalal F. Alanazi
Medical student at KFU

2. Objectives
• Physical examination that particular
relevance in this case scenario?
• Investigation with the result that
expected from investigation tests?
• Treatment with additional steps of
advising according to hygiene principles?

3. Physical examination
- Pulmonary TB: have abnormal breath sounds,
especially over the upper lobes.
• Auscultation: may reveal a crackling sound .
• On percussion: Dull sound is noticeable.

4. Investigation

5. Blood tests
Radiological
examination
Microbiological
examination
Biopsy
Sputum
Immunological test

6. Blood tests
• Exclude a possible disease, including lung
cancer.
• Detection of extrapulmonary TB.
• Interferon-gamma release assay: tests
measure T-cell interferon-gamma response to
antigens that are highly specific for M
tuberculosis. These tests cannot determine if a
person has latent TB infection or has progressed
to TB disease.

7. Radiological examination
• The x-ray demonstrates several finding:
- Consolidation with or without cavitation.
- Pleural effusion.
- Thickening or widening of the mediastinum.
*caused by adenopathy*

8. Consolidation without
cavitation.
Pleural effusion.
Thickening of the
mediastinum.
CT scan which revealed an
infiltrate with a mass-like
pattern of consolidation.

9. Sputum
- Sputum is thick mucus that produced during a
cough productive.
- Taking a sputum sample (more than 3, with
one early morning sample, before starting
treatment if possible).
- and send for samples for culture for staining.

10. Microbiological examination
• Stains:
- Rapid identification of the presence of
bacteria by immediate stains is essential.
- It requires fluorescence microscopy to
highlights bacilli.
Auramine-rhodamine
staining
Ziehl–Neelsen stain

11. • Culture:
- The majority of the developed world uses
liquid/broth culture of mycobacteria in
addition to solid media as time to culture is
shorter than for solid culture.
- The use of microscopic-observation drug-
sensitivity (MODS) assay allows detection of
bacteria and determination of the antibiotic
sensitivity of the infecting strain.

12. • Nucleic acid amplification (NAA):
- NAA is increasingly used for rapid identification
of MTb complex.
- It is useful in differentiating between MTb and
non-tuberculosis mycobacteria (NTM).
- Identifying TB in smear-negative sputum
specimens.

13. Immunological test
• Tuberculin skin test: The primary screening
method for TB infection (active or latent) is the
Mantoux tuberculin skin test. It involves
injecting a substance called PPD tuberculin
into the skin of your forearm.
- The cell-mediated immune response that
results in a measurable delayed-type
hypersensitivity response to intradermal
inoculation of tuberculin purified protein
derivative. Used to check for latent TB.

15. Biopsy
• Aspiration of pleural fluid (thoracocentesis):
and other investigations have not revealed the
cause of a pleural effusion.

16. • Bronchoalveolar lavage is a medical
procedure in which a nasoendoscopic or
bronchoscope is passed through the mouth
or nose into the lungs then collect the fluid
for examination.
- Bronchoscope is a thin flexible tube, with a
light on the end. helping of needle lung
biopsy.
- Thoracoscopy: a small material used for
resection of masses within the pleural cavity
and thoracic cavity – it’s inserted a tube like a
bronchoscope.
• Histology: the hallmark is presence of
caseating granuloma.*

17. Treatment
Directly observed
therapy (DOT)
Antibiotic treatment

18. Directly observed therapy
• It’s widely recommended with an aim to achieve
treatment-completion.
• DOT is defined as treatment supervised by a
healthcare professional or family member where
the person is observed swallowing their
medication.
• This is due to the majority of relapsed disease or
treatment failure is due to lack of adherence,
interrupted therapy or incorrect treatment.

19. Antibiotic treatment

20. Stay
home
Ventilate
the room.
bacille
Calmette-
Guerin
vaccine
Finish your
entire
course of
medication
Wear a
mask
Cover your
mouth
Education

22. Reference
• http://www.nhs.uk/Conditions/Tub
erculosis/Pages/Diagnosis.aspx
• http://emedicine.medscape.com/ar
ticle/230802-overview
• http://www.cdc.gov/tb/topic/testin
g/bloodtest.htm
• http://www.cdc.gov/tb/topic/testin
g/
• http://www.mayoclinic.org/disease
s-
conditions/tuberculosis/basics/test
s-diagnosis/con-20021761
• http://www.homerton.nhs.uk/our-
services/services-a-
z/p/pathology/microbiology/microb
iology-tests/s/sputum-(mcs)/

23. Thank you