Post on 18-Jan-2017
PULMONARY TUBERCULOSIS (TB)Presented by ASER MOHAMED KAMAL
Pulmonary tuberculosis (TB) DEF:Tuberculosis is the infectious disease primarily
affecting lung parenchyma is most often caused by mycobacterium tuberculosis.it may spread to any part of the body including meninges,kidney,bones and lymphnodes.
It’s the one of the most prevalent infections of human beings and cotnributes considerably to illness and death around the world . It is spread by inhealing tiny droplets of salaiva from the coughs or sneezes of an infected person . It is slowly spreading ,chronic , granulomatus bacterial infection charactarized by gradual wieght loss
MYCOBACTERIUM TUBERCULI
TYPES PULMONARY TUBERCULOSIS AVIAN TUBERCULOSIS( MICROBACTERIUM
AVIUM ;OF BIRDS) BOVINE TUBERCULOSIS(MYCOBACTERIUM
BOVIS ;OF CATTLE) MILIARY TUBERCULOSIS / DISSEMINATED
TUBERCULOSIS
CLASSIFICATION Class I (TB exposure)
(+) exposure (-) Mantoux tuberculin test (-) signs and symptoms suggestive of TB (-) chest radiograph
CLASSIFICATION Class II (TB infection)
(±) exposure (+) Mantoux tuberculin test (-) signs and symptoms suggestive of TB (-) chest radiograph
CLASSIFICATION Class III (TB disease)
Has three or more of the ff. criteria (+) history of exposure to an adult/adolescent with active TB
disease (+) Mantoux tuberculin test (+) signs and symptoms suggestive of TB
Cough/wheezing > 2 weeks; fever > 2 weeks Painless cervical and/or other lymphadenopathy Poor weight gain; failure to make a quick return to normal after an
infection (measles, tonsillitis, whooping cough) or failure to respond to approriate antibiotic therapy (pneumonia, otitis media)
Abnormal Chest radiograph Laboratory findings suggestive of TB (histological, cytological,
biochemical, immunological or molecular)
CLASSIFICATION Class IV (TB inactive)
A child/adolescent with or without history of previous TB and any of the ff: (±) previous chemotherapy (+) radiographic evidence of healed/calcified
TB (+) Mantoux tuberculin test (-) signs and symptoms suggestive of TB (-) smear/culture for M. tuberculosis
INCIDENCE With the increased incidence of AIDS, TB
has become more a problem in the U.S., and the world.
It is currently estimated that 1/2 of the world's population (3.1 billion) is infected with Mycobacterium tuberculosis
Global Emergency Tuberculosis kills 5,000 people a day
2.3 million die each year
ETIOLOGY Mycobacterium tuberculosis Droplet
nuclei(coughing,sneezing,laughing) Exposure to TB
Risk Factors1. Age: infants and adolescents are at highest risk
of disease2. Close contact with an untreated sputum positive
patient3. Impaired host defenses: immunodeficiency
states, particularly that associated with HIV infection; immunosuppression related to accompanying viral infection, or drug induced; malnutrition.
4. Other disease staes: Hodgkin’s lymphomas, diabetes mellitus, leukemia, malignancy (head and neck) severe kidney disease, silicosis, prolonged treatment with corticosteroids
Risk Factors5. Persons whose tuberculin skin test results converted to (+) In the past 1-2 years.6. Persons who have CXR suggestive of old TB.7. IMMUNO COMPROMISED STATUS (ELDERLY,CANCER).8. DRUG ABUSE AND ALCOHOLISM.9. PEOPLE LACKING ADEQUATE HEALTH CARE.10. IMMIGRANTS FROM COUNTRIES WITH HIGHER INCIDENCE OF TB.11. INSTITUTIONALISATION(LONG TERM CARE FACILITIES).
PATHOPHYSIOLOGY (INITIAL INFECTION OR PRIMARY INFECTION)
ENTRY OF MICRO ORGANISM THROUGH DROPLET NUCLEI
BACTERIA IS TRANSMITTED TO ALVEOLI THROUGH AIRWAYS
DEPOSITION AND MULTIPLICATION OF BACTERIA
BACILLI ARE ALSO TRANSPORTED TO OTHER PARTS OF THE
BODY THROUGH BLOOD STREAM AND LYMPHNODE
INFLAMMATION
PATHOPHYSIOLOGY
PHAGOCYTOSIS BY NEUTROPHILS AND MACROPHAGES
ACCUMULATION OF EXUDATE IN ALVEOLI
BRONCHO PNEMONIA
NEW TISSUE MASSES OF LIVE AND DEAD BACILLI ARE
SURROUNDED BY MACROPHAGES WHICH FORM A PROTECTIVE
MASS AROUND GRANULOMAS
GRANULOMAS THEN TRANSFORMS TO FIBROUS TISSUE MASS AND
CENTRAL PORTION OF WHICH IS CALLED GHON TUBERCLE
PATHOPHYSIOLOGY
THE MATERIAL (BACTERIA AND MACROPHAGES
BECOMES NECROTIC FORMING CHEESY MASS
MASS BECOMES CALCIFIED AND BECOMES
COLAGENOUS SCAR
BACTERIA BECOME DORMANT AND NO
FURTHER PROGRESSION OF ACTIVE DISEASE
(ACTIVE DISEASE OR RE INFECTION)
INADEQUATE IMMUNE RESPONSE
ACTIVATION OF DORMANT BACTERIA
PATHOPHYSIOLOGY GHON TUBERCLE ULCERATES AND RELEASING CHEESY MATERIAL
INTO BRONCHI
BACTERIA THEN BECOME AIRBORNE RESULTING IN FURTHER
SPREAD OF INFECTION
ULCERATED TUBERCLE HEALS AND BECOMES SCAR TISSUE
INFECTED LUNG BECOME INFLAMMED
FURTHER DEVOLOPMENT OF PNEUMONIA AND TUBERCLE
FORMATION
UNLESS THE PROCESS IS ARRESTED IT SPREADS DOWNWARDS TO
THE HILUM OF LUNGS AND LATER EXTENDS TO ADJASCENT LOBES
CLINICAL MANIFESTATIONSCONSTITUTIONAL SYMPTOMS Anorexia Low grade fever Night sweats Fatique Weight lossPULMONARY SYMPTOMS Dyspnea Non resolving bronchopneumonia Chest tightness Non productive cough Mucopurulent sputum with hemoptpysis Chest painEXTRA PULMONARY SYMPTOMS Pain Inflammation
ASSESSMENT AND DIAGNOSTIC FINDINGS
HISTORY COLLECTION
PHYSICAL EXAMINATION
Clubbing of the fingers or toes (in people with advanced disease)
Swollen or tender lymph nodes in the neck or other areas
Fluid around a lung (pleural effusion)
Unusual breath sounds (crackles)
IF MILIARY TB;
A physical exam may show:
Swollen liver
Swollen lymph nodes
Swollen spleen
ASSESSMENT AND DIAGNOSTIC FINDINGS
Tests may include: Biopsy of the affected tissue (rare) Bronchoscopy Chest CT scan Chest x-ray Interferon-gamma release blood test such as the QFT-Gold test to test for TB infection Sputum examination and cultures Thoracentesis Tuberculin skin test (also called a PPD test)
QUANTIFERON GOLD TEST QFT-Gold test measures interferon-
gamma in the testee's blood after incubating the blood with specific antigens from M. Tuberculosis proteins
COMPLICATIONS Bones. Spinal pain and joint destruction may
result from TB that infects your bones(TB spine or potss spine)
Brain(meningitis) Liver or kidneys Heart(cardiac tamponade) Pleural effusion Tb pneumonia Serious reactions to drug therapy(hepato
toxicity;hypersentivity)
MEDICAL MANAGEMENT PULMONARY TB is treated primarily with antituberculosis
agents for 6 to 12 months.
Pharmacological management
FIRST LINE ANTITUBERCULAR MEDICATIONS
Streptomycin 15mg/kg Isoniazid or INH(Nydrazid) 5 mg/kg(300 mg max perday) Rifampin 10 mg/kg Pyrazinamide 15 – 30 mg/kg Ethambutol(Myambutol) 15 -25 mg/kg daily for 8 weeks and
continuing for up to 4 to 7 months
MEDICAL MANAGEMENT SECOND LINE MEDICATIONS .
Capreomycin 12 -15 mg/kg Ethionamide 15mg/kg Paraaminosalycilate sodium 200 -300 mg/kg Cycloserine 15 mg/kg Vitamin b(pyridoxine) usually adminstered
with INH
MEDICAL MANAGEMENT THIRD LINE DRUGS Other drugs that may be useful, but are
not on the WHO list of SLDs: Rifabutin Macrolides:e.g.,clarithromycin (CLR) Linezolid(LZD) Thioacetazone(T) Thioridazine Arginine
MULTIDRUG THERAPY Multiple-drug therapy to treat TB means
taking several different antitubercular drugs at the same time.
The standard treatment is to take isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months. Treatment is then continued for at least 4months with fewer medicines
Prevention
ISOLATION
Ventilate the room
Cover the mouth
Wear mask
Finish entire course of medication
vaccinations
CONCLUSION