tuberculosis

1. PULMONARY
TUBERCULOSIS (TB)

2. Pulmonary tuberculosis (TB)
 DEF:Tuberculosis is the infectious disease primarily
affecting lung parenchyma is most often caused
by mycobacterium tuberculosis.it may spread to
any part of the body including
meninges,kidney,bones and lymph nodes.
 It’s the one of the most prevalent infections of human beings
and contributes considerably to illness and death around the
world . It is spread by inhaling tiny droplets of saliva from
the coughs or sneezes of an infected person . It is slowly
spreading ,chronic , granulomatous bacterial infection
characterized by gradual weight loss

3. MYCOBACTERIUM TUBERCULI

4. CLASSIFICATION
 Class I (TB exposure)
 (+) exposure
 (-) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) chest radiograph

5. CLASSIFICATION
 Class II (TB infection)
 (±) exposure
 (+) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) chest radiograph

6. CLASSIFICATION
 Class III (TB disease)
 Has three or more of the ff. criteria
 (+) history of exposure to an adult/adolescent with active TB disease
 (+) Mantoux tuberculin test
 (+) signs and symptoms suggestive of TB
 Cough/wheezing > 2 weeks; fever > 2 weeks
 Painless cervical and/or other lymphadenopathy
 Poor weight gain; failure to make a quick return to normal after an
infection (measles, tonsillitis, whooping cough) or failure to respond to
approriate antibiotic therapy (pneumonia, otitis media)
 Abnormal Chest radiograph
 Laboratory findings suggestive of TB (histological, cytological,
biochemical, immunological or molecular)

7. CLASSIFICATION
 Class IV (TB inactive)
 A child/adolescent with or without history of previous
TB and any of the ff:
 (±) previous chemotherapy
 (+) radiographic evidence of healed/calcified TB
 (+) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) smear/culture for M. tuberculosis

8. ETIOLOGY
 Mycobacterium tuberculosis
 Droplet nuclei(coughing,sneezing,laughing)
 Exposure to TB

9. Risk Factors
 Age: infants and adolescents are at highest risk of
disease
 Close contact with an untreated sputum positive
patient
 Impaired host defenses: immunodeficiency states,
particularly that associated with HIV infection;
immunosuppression related to accompanying viral
infection, or drug induced; malnutrition.

10. Risk Factors
 Persons whose tuberculin skin test results converted to (+) In
the past 1-2 years.
 Persons who have CXR suggestive of old TB.
 IMMUNO COMPROMISED STATUS
(ELDERLY,CANCER).
 DRUG ABUSE AND ALCOHOLISM.
 PEOPLE LACKING ADEQUATE HEALTH CARE.
 IMMIGRANTS FROM COUNTRIES WITH HIGHER
INCIDENCE OF TB.
 INSTITUTIONALISATION(LONG TERM CARE
FACILITIES).

11. PATHOPHYSIOLOGY
 (INITIAL INFECTION OR PRIMARY INFECTION)
 ENTRY OF MICRO ORGANISM THROUGH DROPLET NUCLEI
 BACTERIA IS TRANSMITTED TO ALVEOLI THROUGH AIRWAYS
 DEPOSITION AND MULTIPLICATION OF BACTERIA
 BACILLI ARE ALSO TRANSPORTED TO OTHER PARTS OF THE BODY
THROUGH BLOOD STREAM AND LYMPHNODE
INFLAMMATION

12. PATHOPHYSIOLOGY
 PHAGOCYTOSIS BY NEUTROPHILS AND MACROPHAGES
 ACCUMULATION OF EXUDATE IN ALVEOLI
 BRONCHO PNEMONIA
 NEW TISSUE MASSES OF LIVE AND DEAD BACILLI ARE SURROUNDED BY
MACROPHAGES WHICH FORM A PROTECTIVE MASS AROUND GRANULOMAS
 GRANULOMAS THEN TRANSFORMS TO FIBROUS TISSUE MASS AND CENTRAL
PORTION OF WHICH IS CALLED GHON TUBERCLE

13. PATHOPHYSIOLOGY
 THE MATERIAL (BACTERIA AND MACROPHAGES
BECOMES NECROTIC FORMING CHEESY MASS
 MASS BECOMES CALCIFIED AND BECOMES
COLAGENOUS SCAR
 BACTERIA BECOME DORMANT AND NO
FURTHER PROGRESSION OF ACTIVE DISEASE
 (ACTIVE DISEASE OR RE INFECTION)
 INADEQUATE IMMUNE RESPONSE
 ACTIVATION OF DORMANT BACTERIA

14. PATHOPHYSIOLOGY
 GHON TUBERCLE ULCERATES AND RELEASING CHEESY MATERIAL INTO
BRONCHI
 BACTERIA THEN BECOME AIRBORNE RESULTING IN FURTHER SPREAD OF
INFECTION
 ULCERATED TUBERCLE HEALS AND BECOMES SCAR TISSUE
 INFECTED LUNG BECOME INFLAMMED
 FURTHER DEVOLOPMENT OF PNEUMONIA AND TUBERCLE FORMATION
 UNLESS THE PROCESS IS ARRESTED IT SPREADS DOWNWARDS TO THE HILUM
OF LUNGS AND LATER EXTENDS TO ADJASCENT LOBES

15. CLINICAL MANIFESTATIONS
CONSTITUTIONAL SYMPTOMS
 Anorexia
 Low grade fever
 Night sweats
 Fatique
 Weight loss
PULMONARY SYMPTOMS
 Dyspnea
 Non resolving bronchopneumonia
 Chest tightness
 Non productive cough
 Mucopurulent sputum with hemoptpysis
 Chest pain
EXTRA PULMONARY SYMPTOMS
 Pain
 Inflammation

16. ASSESSMENT AND DIAGNOSTIC FINDINGS
 HISTORY COLLECTION
 PHYSICAL EXAMINATION
 Clubbing of the fingers or toes (in people with advanced disease)
 Swollen or tender lymph nodes in the neck or other areas
 Fluid around a lung (pleural effusion)
 Unusual breath sounds (crackles)
 IF MILIARY TB;
 A physical exam may show:
 Swollen liver
 Swollen lymph nodes


17. ASSESSMENT AND DIAGNOSTIC FINDINGS
Tests may include:
 Biopsy of the affected tissue (rare)
 Bronchoscopy
 Chest CT scan
 Chest x-ray
 Interferon-gamma release blood
test such as the QFT-Gold test
to test for TB infection
 Sputum examination and cultures
 Thoracentesis
 Tuberculin skin test (also called a PPD test)

18. COMPLICATIONS
 Bones. Spinal pain and joint destruction may
result from TB that infects your bones(TB spine or
potss spine)
 Brain(meningitis)
 Liver or kidneys
 Heart(cardiac tamponade)
 Pleural effusion
 Tb pneumonia
 Serious reactions to drug therapy(hepato
toxicity;hypersentivity)

19. MEDICAL MANAGEMENT
 PULMONARY TB is treated primarily with antituberculosis
agents for 6 to 12 months.
 Pharmacological management
 FIRST LINE ANTITUBERCULAR MEDICATIONS
 Streptomycin
 Isoniazid or INH(Nydrazid)
 Rifampin
 Pyrazinamide
 Ethambutol(Myambutol)

20. MEDICAL MANAGEMENT
 SECOND LINE MEDICATIONS .
 Capreomycin
 Ethionamide
 Paraaminosalycilate sodium
 Cycloserine
 Vitamin b(pyridoxine) usually adminstered
with INH

21. MEDICAL MANAGEMENT
 THIRD LINE DRUGS
 Other drugs that may be useful, but are not
on the WHO list of SLDs:
 Rifabutin
 Macrolides:e.g.,clarithromycin (CLR)
 Linezolid(LZD)
 Thioacetazone(T)
 Thioridazine
 Arginine

22. MULTIDRUG THERAPY
 Multiple-drug therapy to treat TB means
taking several different antitubercular
drugs at the same time.
 The standard treatment is to take isoniazid,
rifampin, ethambutol, and pyrazinamide for
2 months. Treatment is then continued for
at least 4months with fewer medicines

23. Prevention
 ISOLATION
 Ventilate the room
 Cover the mouth
 Wear mask
 Finish entire course of medication
 vaccinations

24. CONCLUSION