Tuberculosis is a chronic infectious disease caused by the Mycobacterium tuberculosis bacterium. It primarily affects the lungs and is transmitted through airborne droplets. Common symptoms include cough, fever, weight loss and night sweats. Diagnosis involves sputum smear tests, chest x-rays and the Mantoux tuberculin skin test. Treatment consists of a multi-drug regimen over several months. Prevention focuses on vaccination, public education, isolation of infected individuals and improved sanitation.

1. TUBERCULOSIS
Microbiology
Muhammad Iqbal
Lecturer
KMU

2. Definition
• A chronic and infectious mycobacterial disease whic
h is characterized by tubercles in the affected area.
• S/S: Perpetual Cough, Fever, Weight loss, Night swe
ats, Loss of appetite, Fatigue, Pain while breathing.
• Causative Organism: Mycobacterium tuberculosis
It is aerobic acid fast bacillus

3. Other Types
• Mycobacterium tuberculosis- human tubercle baci
lli
• Mycobacterium bovis- cattle and man infection
• Mycobacterium avium- infection in birds and man.

4. • Incubation Period: 4—12 weeks
• Source and Reservoir: Infected person and infe
cted cow’s milk.
• Rout of Entry: Nose & throat (inhalation)
• Mode of transmission:
– Spreads through the air when an infected person C
oughs, Speaks, Laughs, Sneezes
– Through Infected dust particles

5. • Occurrence: Pandemic
• Prevention & Control:
A) Vaccination— BCG (Bacillus Calmette Guerin)
B) Public education, adequate diagnostic and curative faciliti
es, Isolation, concurrent and terminal disinfection, Enviro
nmental sanitation

6. Clinical Manifestation
 Pulmonary tuberculosis
• ƒPersistent cough for 3 weeks or more
• ƒProductive cough with or without blood-stain
ed sputum
• ƒShortness of breath and chest pain
• ƒIntermittent fever, night sweats, loss of weigh
t, loss of appetite, fatigue and malaise.

7. Clinical manifestation cont..
TB of bones and joints
• ƒLocalized pain and/or swelling, pus discharge,
muscle weakness, paralysis and stiffness of joi
nts.

8.  Intestinal TB
• ƒLoss of weight and appetite
• ƒAbdominal pain, diarrhea/constipation
• ƒMass in the abdomen
• ƒAscites (fluid in the abdominal cavity)
Tuberculosis meningitis
• ƒ
Headache, fever, vomiting, neck stiffness and m
ental confusion of insidious onset.

9. Diagnosis
1. Clinical manifestations
2. Sputum smears for acid-fast bacilli (AFB), whi
ch is the Golden standard. However, one positiv
e result does not justify starting anti TB treatme
nt since errors can never be excluded.

10. Diagnosis cont…
4. Radiological examination: This is unreliable bec
ause it can be caused by a variety of conditions or
previous TB patients who are healed may have ch
est x-ray giving the appearance of active TB.

11. 5. Histopathological examination: Biopsies for
extrapulmonary TB.
6. Tuberculin test (mantoux): Helpful in non-
BCG vaccinated children.

12. Treatment of TB (ATT)
• Rifampicin
• Isoniazid
• Ethambutol
• Pyrazinamide
• Streptomycin sulphate

13. Drug regimens (prescribed course of therapy)
Total Duration 9 months:
1) Initial Phase (2 months)
ƒ DOT (Direct observe therapy) strategy for initial two
months
2) Continuation Phase
7 months
Note: New drugs Myrine-P are available in combination
form for 6 months

14. Prevention and control
1. Chemotherapy of cases
2.Chemoprophylaxis for contacts
3.Immunization of infants with BCG
4. Educate patients with TB about the mode of disease tra
nsmission and how to dispose their sputum and cover their
mouth while coughing, sneezing, etc.

15. Prevention cont…
Public health education about the modes of disease tra
nsmission and methods of control:
•ƒImproved standard of living
•ƒAdequate nutrition
•ƒHealth housing
•ƒEnvironmental sanitation
•ƒPersonal hygiene; etc.
•ƒActive case finding and treatment

16. Nursing care
1. Educate the patient how and when to take the presc
ribed medication.
2. Tell the patient not to stop the medication unless he
/she is told to do so.
3. Tell the patient to come to the health institution if h
e/she develops drug side effects.
4.Advice the patient on the importance of taking adequ
ate and balanced diet and to eat what is available at ho
me.
5.Involve the family in teaching on medication.
6.Tell the patient that Rifampicin colors the urine orang
e.

18. • Tuberculin is a glycerol extract of the tubercle
bacillus. Purified protein derivative (PPD) tube
rculin
• https://en.wikipedia.org/wiki/Mantoux_test

19. • A systemic bacterial infectious disease characterized
by high continuous fever, malaise and involvement
of lymph nodes.
• S/S: Malaise, Fever, headache, dry cough, rela
tive bradycardia, rashes on trunk
• Causative Organism: Salmonella Typhi
Other important members of salmonella include S. pa
ratyphi A & B.
• Source & reservoir: Man is the only known reserv
oir of infection --- cases or carriers.
Typhoid Fever

20. Incubation period : 1-3 weeks
Period of communicability: A case is infectious a
s long as the bacilli appear in stool.
Occurrence: pandemic (Worldwide)
Salmonellae are gram – ve rods, Motile with peri
trichous flagella

22. • Age group---At any age but mainly in children an
d young adults.
• Occupation---working environment
• Socio-economic factors----inadequate sanitation f
acilities and unsafe water supplies.
• Nutritional status----mal-nutrition
Predisposing Factors

23. Carriers may be temporary or chronic.
Temporary (convalescent or incubatory) carriers
usually excrete bacilli up to 6-8 weeks.
5 % patients may become carriers.
After one year, 3-4 per cent of cases continue to
excrete typhoid bacilli which are then called ch
ronic carriers.

24. Clinical manifestations
• First week
Fever, headach, myalgia, relative bradycardia, constip
ation, annorexia, Leucopoenia—White cell count is les
s than 4000/mm
• ƒ
Second week
Rashes on chest and abdomen, splenomegaly, a
bdominal tenderness

25. Rose spots

26.  Diagnosis
• Clinical presentation
• ƒ
Widal test (but not as much reliable)
• Typhidot (IgM—recent infection , IgG—remote infec
tion)
• Blood culture
 Treatment
• Ciprofloxacin 500 mg B.D or ceftriaxone for 14 days.
• Chronic carriers should be treated for 4 weeks

27. Prevention and Control
MEASURES DIRECTED TO RESERVOIR
• Case detection and treatment
• Isolation from handling food etc.
• Education on hand washing
• Disinfection of stools and urine
• Detection & treatment of carriers

28. Cont…
MEASURES AT ROUTES OF TRANSMISSION
• Water & Food sanitation
• Excreta disposal
• Fly control
MEASURES FOR SUSCEPTIBLES
• Immunization--- TAB vaccine
• Health education

30. • In medicine, the Faget sign — sometimes calle
d sphygmothermic dissociation — is the unusu
al pairing of fever with bradycardia (slow pulse
). (Fever is usually accompanied by tachycardi
a (rapid pulse), an association known by the e
ponym "Liebermeister's rule".)