The document provides an extensive overview of tuberculosis (TB), including its global prevalence, pathology, clinical features, diagnostic investigations, and management strategies. TB is primarily caused by the Mycobacterium tuberculosis complex, with key symptoms including fever, weight loss, and chronic cough. Management typically involves a six-month multidrug therapy regimen and highlights the importance of diagnostic tests such as sputum examination and chest imaging.

1. Harindu Udapitiya,
Temporary Lecturer,
Division of Pharmacology.
Tuberculosis

2. Overview
1. Imporatance
2. Pathology of TB
3. Clinical features
4. Investigations
5. Management

3. 1. Importance
• It is estimated that one-third of the world’s
population are infected with tuberculosis.

4. • Sri lanka-About 9000 new cases of
tuberculosis are notified every year, of which
around 60% are smear-positive pulmonary TB
cases.

6. Important for us

7. 1.Pathology of TB
• Tuberculosis is caused by four main
mycobacterial species.
1. Mycobacterium tuberculosis
2. Mycobacterium bovis
3. Mycobacterium africanum
4. Mycobacterium microti

8. Transmission
• Person-to-person through
the air by a person with
active TB disease of the
lungs .
• Less frequently
transmitted by: Ingestion
of M. bovis found in
unpasteurized milk

9. Manifestations

10. Primary secondary
• Seen in non immune
people.
• Usually childhood cases
• Subpleural mid zone
• Lymph nodes are always
involved
• Seen in immune people
• Often adults
• Lung apices
• Lymph nodes are not
always involved

11. 3. Clinical features

12. Symptoms
• 1. General symptoms
• 2. Pulmonary TB
• 3. Extrapulmonary TB

13. 1.General Symptoms
1. Evening law grade fever
2. Night sweating
3. Loss of weight
4. Loss of appetite
5. fatigue

16. 2. Pulmonary TB
1. Chronic cough
2. Chest pain
3. haemoptysis

17. 3. Extrapulmonary TB

18. Signs
• General Ex
1. Cachexia
2. Lymphadenopathy
3. Clubbing
4. Cutaneous lessions

19. • Respiratory Ex
1. Signs of respiratory depression
2. Signs of pleural effusion, collapse
3. Signs of consolidation
4. Signs of fibrosis

20. 4. Investigations
1. Investigations for diagnosis
2. Supportive Investigations

21. 1.Investigations for diagnosis
1.Sputum examination
– Early morning sputum culture
– 3 days
– from laryngeal swab or bronchial washing In small
children.Gastric lavage can be examined.
– Stain for AFB with Ziehl-Neelson stain.

22. 2. Sputum culture
– Lowenstein-Jensen
– often requires more than 3-4 weeks

23. 3. Tuberculin skin test (Mantoux test)
• intradermal injection of 5 units of
PPD (0.1 mL), preferably with a 26-,
27-, or 30-gauge needle.
• The results should be read between
48 and 72 hours after
administration.
• Induration of less than 5 mm
constitutes a negative result

24. 4. Nucleic Acid Amplification Tests
• In tissue, polymerase chain reaction (PCR)
amplification techniques can be used to detect M
tuberculosis -specific DNA sequences.

25. 2.Supportive Investigations
1. Chest x ray
Hilar
lyphadenopathy

26. Upper lobe
fibrosis

27. cavitation

28. • 2. CT Scan
• To diagnose TB that has spread throughout the body
(miliary TB) and to detect lung cavities caused by TB.
• 3. MRI
• In bone TB

29. 5. Management
• Multidrug therapy

30. • Usually 6 months, sometimes 9 months
• Four drugs for two months Isoniazid ,Rifampicin,
Ethambutol ,Pyrazinamide
• Two drugs for four or seven months Isoniazid,
Rifampicin
• DOT is given

31. • Patients with TB who are receiving pyrazinamide
should undergo baseline and periodic serum uric
acid assessments.
• patients with TB who are receiving long-term
ethambutol therapy should undergo baseline and
periodic visual acuity and red-green color perception
testing.

32. Latent TB
• Isoniazid +/- rifampacin
CNS TB
• 12 months Tx

33. Prevention
• BCG vaccine

34. Summery
1. Pathology of TB
Primary Vs secondary TB
2. Clinical presentation
Symptoms
Signs

35. 3. Investigations
Ix for Dx
Supportive Ix
4. Management

36. References
• Kumar and clerk
• Medscape
• Robbins’ Pathologic
• CDC guidelines