In the early days of the COVID pandemic, the World Tuberculosis Day was marked, with the Theme: "It is Time". It is time to take action, to ensure universal access to treatment, to stop stigma and discrimination, and to end TB. I had the opportunity to present this topic as part of the wellness efforts for our staff members. Many of our patients live with TB, many of our staff develop TB in the process, and the COVID pandemic was already in the country, complication case identification and case management of the disease.

1. WORLD TB DAY Mar.2020

2. AN EMPLOYEE WELLNESS PROGRAMME

3. HOSTED BY MRS FOKKER & TEAM

4. DELIVERED BY DR KD DELE

5. HELD ON
18TH MARCH 2020 FOR 24TH OF MARCH

6. 2020
THEME:

7. IT’S TIME FOR WHAT?

9. BUT FIRST, LET’S
TOUCH ON COVID-19
Disclaimer:
Information regarding
COVID-19 presented here
was valid as of 18th March
2020…
And was for the purpose of
staff wellness of the above
named hospital

10. nCOVID-19
• Unprecedented
• Global pandemic
• World on shutdown
mode
• & Lockdown mode
• & Panic mode
• & Paranoia
• & Stock piling mode
Corona Virus Disease 2019

11. WHAT MANAGING A “COVID-19 PATIENT”
LOOKS LIKE

12. The National Institute for Communicable Diseases – NICD

13. 18th March 2020 update
(It then exploded into a global pandemic.)

14. “SOCIAL DISTANCING” 101

16. BACK TO “END TB”

18. ISOLATING TB PATIENTS: DEATH SENTENCE
Isolation, collapsing lungs and spitting bans

19. ISOLATING TB PATIENTS: DEATH SENTENCE

21. HOW ARE WE DOING?

22. COMPARE, SAY GHANA

23. COMPARE, SAY NIGERIA

24. COMPARE, SAY PAKISTAN

25. SOUTH AFRICA: HOW ARE WE DOING?

26. SOUTH AFRICA: HOW ARE WE DOING?

27. SOUTH AFRICA: HOW ARE WE DOING?

28. Outline cont’d…
• Sign & symptoms
• Clinical examination
• Investigation
• Treatment
• Side effect of drugs
• Complications
• TB & HIV
• Prevention

29. DO YOU KNOW THIS PLACE?
Empilweni TB Hospital

30. TB: SYMPTOMS & SIGNNS

33. TB ALGORITHM
*IMPORTANT*

34. TB DIAGNOSIS

35. TB DIAGNOSIS
• DEPENDS ON THE SITE!
• The LUNG is the primary site for Tuberculosis

36. EXTRA PULMONARY TB
• 1) Lymph node TB ( tuberculous lymphadenitis)
• 2) Pleural TB
• 3) TB of Upper airways
• 4) Genitourinary TB
• 5) Skeletal TB
• 6) Gastrointestinal TB
• 7) TB Meningitis & Tuberculoma
• 8) TB Pericardiatis
• 9) Milliary
• 10) Other Less common Extra Pulmonary TB

37. Xpert MTB/RIF
• GXP is the a molecular
testing
• It is the first line testing
modality.
• May be used on sputum
and other body fluids
and tissues for the
diagnosis of TB

38. Xpert MTB/RIF

39. GeneXpert Technology

41. GXP REPORT
• See the algorithm in
previous slides

42. Dr Nowshad ALAM

43. SMEAR MICROSCOPY: rapid; 40-70% yield on sputum
Ziehl-Neelsen:
• Acid fast bacilli
• Requires 5000 -10 000 bacilli/ml
• Low tech
Auramine-O fluorescent:
• 10% more sensitive
• More expensive

44. SMEAR MICROSCOPY: rapid; 40-70% yield on sputum
• Smear grading for sputum microscopy:
• 3+ over 10 AFB’s per field
• 2+ 1 to 10 per field
• 1+ 10 - 99 per 100 fields
• Scanty 1-9 per 100 fields
• Neg. no AFB per 100 fields
• Remember smear quantification NOT equivalent to Xpert® MTB/RIF
quantification

45. TB CULTURE
Solid media:
Lowenstein-Jensen media
Time to positivity: 23-30days
• gold standard
•Picks 5-10 bugs
•75-90% yield on
sputum
• 5-10%
contamination
rates
• Allows species
identification &
sensitivity
Liquid media:
Automated eg. Bactec MGIT
960
Time to positivity: 10-22 days
Now largely replaced solid
media

46. OTHER DIAGNOSTIC MODALITIES
• Pleural aspirate in Pleural Effusion
• Pericardial aspirate in TB Pericarditis
• Abdominal ultrasound for TB Abdomen
• Ascitic tap for TB Abdomen
• Lumbar puncture (CSF) for TB Meningitis
• Biopsy – e.g. in lymph node, skin lesions
• … and so forth

47. URINARY LAM
lateral flow-lipoarabinomannan assay

48. CHEST XRAY IN TB
• 1. Infiltrate or consolidation: coarse reticulonodular densities Dense
homogenous opacity
• 2. Any cavitary lesion
• 3. Nodule with poorly defined margins
• 4. Pleural effusion
• 5. Hilar or mediastinal lymphadenopathy
• 7. Other - Any other finding suggestive of active TB, such as miliary TB.
• *. OLD TB: Discrete fibrotic scar/volume loss or retraction/upper lobe
bronchiectasis

49. CHEST XRAY

50. OTHE XRAY FINDINGS

51. CT BRAIN IN TBM
Tuberculoma in the brain
Implication of ring enhancing
brain lesion:
you treat for longer

52. TB SPINE
• TB spine:
• Look for paraplegia – lower
motor neuron lesion type

53. TB PERICARDITIS

54. TB LYMPHNODES

55. TB TREATMENT

56. TB TREATMENT: RHZE/RH

57. TB TREATMENT: RHZE/RH
• For drug sensitive TB
• i.e. Rifampicin sensitive on Gene
Xpert:
• 4 FOR 2 (RHZE for 2months)
• Then
• 2 FOR 4 (RH for 4months)
• CONSIDERATIONS:
• Weight adjust for everyone
• Renally adjust in renal impairment
• Liver friendly in DILI (drug induced
liver injury)
• MDR/XDR management (if drug
resistant)

58. TB TREATMENT: RHZE/RH

59. OTHER CONSIDERATIONS

61. PEOPLE WITH UNDIAGNOSED,
UNTREATED & CONTAGIOUS TB
ARE FREQUENTLY SEEN
IN HOSPITAL SETTINGS

62. WHAT’S WRONG WITH THIS PICTURE?
PROTECT THE CHILDREN!

63. TEACH COUGH ETIQUETTE

64. JUST DON’T DO THIS!

65. DON’T DO THIS EITHER

66. THE WORLD MAY COME TO THIS 

67. HIV & TB:
DUAL PANDEMIC

69. Long Dark Way To Go, But There Are Shining
Lights On The Way
DORA Hospital Corridor