One third of the world is infected with tuberculosis, with over 1 million deaths reported annually. Tuberculosis is caused by bacteria in the Mycobacterium tuberculosis complex and is more common in developing countries. Symptoms include cough and abnormal chest x-rays. Diagnosis involves sputum smear, culture, and molecular tests. Treatment for active tuberculosis involves a combination of antibiotics over 6 months, while latent tuberculosis is treated with one or two antibiotics. Granulomas formed during infection help regulate the immune response and minimize tissue damage. Tuberculosis remains a major global health problem despite efforts to diagnose and treat those affected.

1. Why TB
 One third of the world is reported to be infected.
 8.2 million cases were active.
 1.2-1.4 million death were reported( World Health
Organization. 2013.).
 Tuberculosis is more common in developing
countries.
Tuberculosis (TB)

2.  37 million lives were saved through diagnosis
and treatment between 2000 and 2013.
 In 2013 an estimated 480,000 people
developed multidrug resistant tuberculosis
(MDR-TB).
 Tuberculosis is the leading killer of HIV positive
people.

3. What cause it
Mycobacterium tuberculosis complex
It includes:
Mycobacterium tuberculosis
Mycobacterium africanum
Mycobacterium bovis
Mycobacterium microti
M. tuberculosis divides every 15–20 hours

4. MOTT
M. kansasii, M. simiae and M.
marinum
M. Scrofulaceum
M. avium
M. Ulcerans
M. abscessus, M. fortuitum

5. Microscopy
M. tuberculosis is characterized by
caseating granulomas containing
Langhans giant cells, which have a
"horseshoe" pattern of nuclei.
Organisms are identified by their red
color on acid-fast staining.

6. Ziehl-Neelsen staining

7. • granuloma that provides a protection and
enable the bacilli to sustain a long-term
persistent infection.
• Protective granulomas are formed by
cytokines.
• Granulotomatous lesions are important in
both regulating the immune response and
minimizing tissue damage.
• T cells help maintain Mycobacterium within
the granulomas.

8. Diagnosis
Diagnosis of active tuberculosis depend on
 signs of lung disease for more than
two weeks .
 Abnormal chest x-ray.
 Multiple sputum samples for smear
culture and PCR.
 (PPD) test.
 (QFT) test
 All tests are initial evaluation for
tuberculosis.

9. Latent tuberculosis infection (LTBI)
is the presence of M. tuberculosis
organisms without symptoms or
radiographic or bacteriologic evidence of TB
disease.
Approximately 90%–95% of those infected
will not progress from LTBI to TB disease
(CDC).
Diagnosis is made be positive PPD or QFT

10. Treatment
active tuberculosis
isoniazid
Rifampicin
Pyrazinamide
Ethambutol
The four drugs are used for the first
two months.
rifampicin and isoniazid for the last
four months.

11. For latent TB treatment only rifampicin
and isoniazid are used both together or
one of them.
WHO recommend directly observed
therapy (DOT), the nurse or health care
worker watch the patient while taking
the medicine.

12. Anatomy

13. where
• Right upper lobe:

14. • Right middle lobe:

15. • Left upper lobe

16. TB granuloma

17. TB fibrosis of lung

20. Miliary TB. Multiple tiny nodules scattered throughout both
lungs

23. TB

24. TB

25. TB or Not TB?

26. Lung abscess

27. Alveolar microlithiasis.

28. Right heart failure. Well-defined masses seen with the right mid and
lower zones. These ‘pseudotumours’ represent encysted pleural fluid
within the horizontal and oblique fissures (arrows).
Heart failure

29. interstitial pneumonitis (UIP) formerly
cryptogenic fibrosing alveolitis.

30. Kartagener syndrome Triad of features
Situs inversus (50%).
Nasal polyposis and chronic sinusitis.
Bronchiectasis.

31. Mesothelioma. In this case, there are more extensive lobulated
pleural masses

32. ‘Cannon ball’ metastases

33. Miliary metastases.

34. Pneumoconiosis –Multiple small dense bilateral
pulmonary nodules.

35. Pneumoconiosis
Sarcoid.
organising pneumonia.
Lymphoma.
Metastatic disease.

36. Sarcoidosis. Egg shell calcification of both hila

37. Silicosis. Egg shell calcification of both hila.

38. Previous varicella pneumonia

39. Wegner’s granulomatosis. Large cavitating lung lesion

40. Squamous cell carcinoma

41. Aspergillomas

42. Sources and refrences
About 35,300,000 results (0.26 seconds)
A–Z of Chest Radiology
By Rakesh R. Misra is a Consultant Radiologist in
the Department
of Radiology at Wycombe Hospital,
Buckinghamshire Hospitals UK.
WHO site.
CDC- USA
Presentation prepared by:
Dr. Mohamed Elafiz
General practitioner – Medical commission
March 4,2015