Investigations and Treatment of Tuberculosis

1. INVESTIGATIONS AND
TREATMENT OF
TUBERCULOSIS
PRESENTED BY:- Dr. VANSHIKA UPPAL
MPT( ORTHOPAEDICS)

2. INVESTIGATIONS TOOLS
A) PHYSICAL EXAMINATION
• A physical examination is done to assess the patient's general health. It
cannot be used to confirm or rule out TB. However, certain findings
are suggestive of TB. For example, blood in the sputum, significant
weight loss and drenching night sweats may be due to TB.

3. MAJOR IMMUNOLOGICAL TEST
1. ALS Assay
• Antibodies from Lymphocyte Secretion is an immunological assay to detect active
diseases like tuberculosis, typhoid etc. The principle is based on the secretion of
antibody from in vivo activated plasma B cells found in blood circulation for a
short period of time in response to TB-antigens during active TB infection rather
than latent TB infection.
2. Transdermal Patch
• A similar approach to the ALS assay.
• The transdermal patch is a suggested method of detecting :-
active M.tuberculosis circulating within blood vessels of patient. This skin patch
contains antibodies recognizing the secreted bacterial protein MPB-64 passing
through the blood capillaries of the skin creating an immunological response.

4. 3) Mantoux skin test
• The Mantoux test or Mendel–Mantoux test is a tool for screening for tuberculosis (TB) and
for tuberculosis diagnosis. It is one of the major tuberculin skin tests used around the world, largely
replacing multiple-puncture tests such as the tine test.
• PROCEDURE:- In the Mantoux test, a standard dose of 5 tuberculin units or 2 TU of Statens
Serum Institute (SSI) tuberculin RT23 in 0.1 ml solution, according to the National Health
Service, is injected intradermally (between the layers of dermis) on the flexor surface of the left
forearm, mid-way between elbow and wrist.
• When placed correctly, injection should produce a pale wheal of the skin, 6 to 10 mm in diameter.
The result of the test is read after 48–96 hours but 72 hours (3rd day) is the ideal.
• A person who has been exposed to the bacteria is expected to mount an immune response in the
skin containing the bacterial proteins. The response is a classical example of delayed-type
hypersensitivity reaction, a type IV of hypersensitivities.

6. 4) Heaf test
• The Heaf test, a diagnostic skin
test, was long performed to
determine whether or not
children had been exposed
to tuberculosis infection.
• It was administered by a Heaf
gun a spring-loaded instrument
with six needles arranged in a
circular formation which was
inserted in the wrist or shoulder.

7. 5) Nucleic acid amplification tests (NAAT)
• NAATs for TB are a heterogeneous group of tests that use either
the polymerase chain reaction (PCR) technique or transcription-
mediated amplification (TMA) or other forms of nucleic acid
amplification methods to detect mycobacterial nucleic acid.
6) Radiography
• Chest X-ray and CT
In active pulmonary TB, infiltrates or consolidations and/or
cavities are often seen in the upper lungs. However, lesions may
appear anywhere in the lungs.

8. • Tuberculosis creates cavities
visible in x-rays like this one
in the patient's right upper
lobe.

9. 7) FDG PET/CT
• FDG PET/CT can play several useful roles in patients with confirmed
or suspected TB. These roles include detection of active TB lesions,
assessment of disease activity, differentiation between active and latent
disease, assessment of disease extent (staging), monitoring response to
treatment, and identification of potential biopsy target

10. TREATMENT FOR TUBERCULOSIS
A. The aims of treatment of tuberculosis are:-
1. To cure the patient and restore quality of life and productivity
2. To prevent death from active TB or its late effects
3. To prevent relapse of TB
4. To reduce transmission of TB to others
5. To prevent the development and transmission of drug resistance.

11. MEDICAL TREATMENT
Drug
Recommended dose
Daily 3 times per week
Dose and range
(mg/kg body
weight)
Maximum
(mg)
Dose and range
(mg/kg body
weight)
Daily maximum
(mg)
Isoniazid 5 (4–6) 300 10 (8–12) 900
Rifampicin 10 (8–12) 600 10 (8–12) 600
Pyrazinamide 25 (20–30) – 35 (30–40) –
Ethambutol 15 (15–20) – 30 (25–35) –
Streptomycin
a
15 (12–18) 15 (12–18) 1000
Essential antituberculosis drugs
RECOMMENDED DOSES OF FIRST-LINE
ANTITUBERCULOSIS DRUGS FOR ADULTS.

12. PHYSIOTHERAPY TREATMENT
• Pulmonary Tuberculosis People with pulmonary TB are typically not treated in
physical therapy because medications are vital for curing TB. However, therapists
are able to provide percussion and postural drainage to clear secretions out of the
lung.
• Patients may present in clinic with musculoskeletal problems with unknown
causes or arthritic pain. PT's should be prepared to take a thorough history and a
proper examination in order to better identify TB. A patient could also be seen in
physical therapy if they have had surgery on their back, in which case the normal
rehabilitation protocols would be followed.