Tuberculosis :Medicine

8/7/2019 Tuberculosis :Medicine

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´A day is not wasted, If a

memory is madeµ

-Anonymous



Challenge : HIV co infection.

WHO declared the disease as global emergency.

Tuberculosis : From the word ´Tubercleµ, Necrotizingbacterial infection of mostly lungs and other organs .

Transmission :Aerosolized droplet nuclei .

Transmission depends on

intimacy & duration.

Infection to be differentiated

from disease.



Associated risk

HIV co-infection

Diabetes mellitus

LymphomaChronic lung

disease

Chronicrenal failure

Endogenousfactors



Incidence

Late Adolescence

Early Adulthood.

Age groups : Women are more to be infected th

anmen at an age 25-34 .

Opposite is true in old age.



Classification

Tuberculosis

Pulmonarydisease

Primarydisease

Post primarydisease

Extrapulmonarydisease

Other organs



Clinical picture

Fact : Before HIV, 80 % Tb was limited to lung

Today, 2/3rd of HIV infected patient·s have both

pulmonary & extra pulmonary or extra pulmonary

alone. Why??

Why infections of right lung are more common?

Pulmonary tuberculosis.



Pulmonary Tuberculosis

Primary disease : Initial infection

Common in children.

Localised to middle & lower zones . Hilar & paratracheal lymphadenopathy : Not detectable

on chest radiograph.

Evident ghon lesion .

Primary pulmonary tb progresses in impaired immunity

involving «



Pulmonary tuberculosis lesion



Complications

Pleural effusion

Progressive primarytuberculosis

Hilar/mediastinallymphandenopathy

Tuberculous empyema

Miliary tb ortuberculous meningitis .

Enlarged lymph nodes.



Chest Radiography

Primary tuberculosis Consolidation & Pleural effusion



Primary progressive tuberculosis



Post primary disease

Endogenous reactivation of latent infection.

Adult type.

Localized to apical & posterior segments of upper lobe. Satellite lesions.

Tuberculous pneumonia.



Clinical findings

Fever With night sweats

,Weight loss,

Anorexia

Malaise &

Weakness.

Intermittent & Low

grade.

Cough Initially non

productive .

Later with purulent

sputum.

Massive haemoptysis Erosion of fully

patent vessel .

Rasmussen·s

aneursym.

Pleuritic chest pain

Dyspnea & ARDS In extensive disease.

Chest examination Classical amphoric

breath sounds.

Haematologic study Mild anaemia . Leucocytosis.



Pulmonary Tuberculosis in AIDS

Person with skin test M.tb infection

who acquires HIV has 3-15 % risk

of active tuberculosis. HIV attaks the critical immnune mechanism

involved against tuberculosis.Early Late

Tuberculin test Usually positive Usually negative

Adenopathy Unsual Common

Pulmonary distribution Upper lobe Middle & Lower lobe.

Cavitation Present Typically absent.

Extra pulmonary disease 10 % of cases 50 % of cases.



CT-Scan:Immuno compromised patient



Extra pulmonary tuberculosis

Lymph nodes

Pleura

Genitourinary tract

Bones &Joints

Meninges

Peritoneum



I. Lymph node tuberculosis

Commonest presentation : > 25 % cases.

Frequent in any HIV infected patients.

C

ervical & supraclavicular lymph

nodesinvolved with painless swelling.

Differential diagnosis

Neoplastic disease - lymphoma.



II. Pleural tuberculosis

Involvement of pleura in primary tuberculosis.

Extent of reactivity : Effusion may be small or largeenough to cause pleuritic chest pain & Dyspnea.

Physical findings : Dullness to percussion &Absence of breath sounds.

Chest radiograph : Effusion & Parenchymal lesion.

Tb of upper airways :Advanced. Symptoms :Hoarseness, Dysphagia

with chronic productive cough.



III. Genitourinary tuberculosis

Accounts for 15 % .

Involves any portion of genitourinary tract.

Symptoms : Urinary frequency,Dysuria,

Haematuria & Flank pain.

Commonly diagnosed in females than males.

Females Males

Affects fallopian tubes. Affects Epididymis

Endometrium . Orchitis

Menstraul abnormalities &

Infertility .

Prostitis .



IV. Skeletal tuberculosis.

Accounts for 8 -9 % .

Reactivation of hematogenous foci or paravertebral

lymph nodes.

Weight bearing joints: Spine- Hips & Knees involved.

Pott·s disease & It·s catastrophic complication is

paraplegia.

Advanced disease causes kyphosis.

Tb of hip joint : Pain & Limping.

Tb of knee : Pain & Swelling.



V. Tuberculous meningitis.

Accounts for about 5 %

In children & adults with HIV.

Spread : Hematogenous spread or rupture of sub

ependymal tubercle into subarachnoid space. Chest radiography : Old pulmonary lesion or miliary

pattern.

Symptoms : Head ache, Confusion,

Altered sensorium, Neck rigidity * Paresis of ocular nerves.

* Cerebral arteries produce focal ischemia.

* Hydrocephalus.



Diagnosis

AFB Microscopy

Mycobacterial culture.

Radiographic procedures.

PPD skin testing.

Drug susceptibility testing.



Differential Diagnosis.

Aspiration pneumonia, Lung abscess.

Actinomycosis & Nocardiosis.

Mycotic infections.

Carcinoma of lung.

Pneumoconiosis.

Bronchiectasis.

Sarcoidosis.



Thank you

Tuberculosis :Medicine

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