Tuberculosis of Ankle Joint

8/13/2019 Tuberculosis of Ankle Joint

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CASE PRESENTATION ONTB

OFANKLEJOINT

By

R.S.Pavani


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SYMPTOMS

Inflammation & Swelling of joints

Fever and weight loss

Difficulty walking and muscle spasms

Pain starts in certain spots like spine, hip, and

nee

Bones become weak leading to fractures and

deformites


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COMPLICATIONS

Bones. Spinal pain and joint destruction may result fromTB that infects your bones. In many cases, the ribs areaffected.

Brain. Tuberculosis in your brain can cause meningitis, asometimes fatal swelling of the membranes that cover your

.

Liver or kidneys.Your liver and kidneys help filter wasteand impurities from your bloodstream. These functionsbecome impaired if the liver or kidneys are affected bytuberculosis.

Heart. Tuberculosis can infect the tissues that surroundyour heart, causing inflammation and fluid collections thatmay interfere with your heart's ability to pump effectively.This condition, called cardiac tamponade, can be fatal.


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RISK FACTORS


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PATIENT DETAILS

Age 45 yrs

Gender Female

Weight 35 kgs

Unit Ortho-III


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REASON FOR ADMISSION

c/o pain and swelling in left ankle of left dorsum of

foot from past 6 months which increased in

n ens y pas ays

C/0 Pain increased on walking & decreased on

rest


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PAST MEDICAL HX :

She got admitted in a private hospital , diagnosed

assynovitis of left ankle and joint debridement

Synovial biopsy was done. Biopsy showed

possibility of TB for which she was started on Anti-

rugs rom pas mon w c s e s oppetaking from 2 weeks


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PROVISIONAL DIAGNOSIS

? TUBERCULOSIS OF ANKLE JOINT


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DAY1 (25/7/13)

BP:130/80mmHg Pulse:80bpm

Patient has no fresh complaints

General condition fair and vital stable

ADV: Hb , TC , DLC, ESR, RBS , Uric acid , CRP,RA

Test , Synovial Biopsy.

Drug Dose Route frequency

T. Aceclofenac 100mg Po 1-0-1

T. Ranitidine 150mg Po 1-0-1

Inj.Diclofenac 50mg iv Sos


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LAB DATA

Hb :11.7g/dl

TC :9,000cells/cumm

DLC:N:54%

RBS:96mg/dl

Uric acid: 5.0 mg/dl

CRP: 0.00 mg/dl

B:00%

L:40%

M:00%

ESR:70mm/hrPCV:35.7%

es : nega ve


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DAY 2 (26/7/13)



General condition fair and vital stable

Adv: Treatment as per chart.

T. AKT4 from today

Chest X-Ray

Pulmonologist opinion


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DAY3(27/7/13)


Patient c/o chills and rigors and gastric irritation

after taking AKT4.

ADV: syp.aluminium hydroxide 1tsp 1-0-1

Stopped AKT4 drugs

Pulmonologist reference


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DAY4 (28/7/13)


No fresh complaints

Toe movements present

Distal pulses- present

ADV: CST

Patient will be shifted to pulmonology


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DAY5,6 (29,30/7/13)


O/E:


General condition fair, vitals stable

Adv: CST


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DAY7 (31/8/13)


O/E:

vitals stable

stopped AKT4 since 3 days

Adv : CST


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DAY9,10 (2 & 3/8/13)


o/e:


Patient conscious oriented

Adv : CST


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TREATMENT CHART

Drug Dose Route frequency Day of

Start

Day of

Stop

T. Aceclofenac 100mg Po 1-0-1 D1 Cont

T. Ranitidine 150mg Po 1-0-1 D1 Cont

Inj.Diclofenac 50mg Po Sos D1 Cont

Tab.INH+RFM+PYR

+ETH

300+450

+750+80

0mg

Po 1-0-0 D2 D3


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RECHALLENGE THERAPHYDRUG DOSE frequency day 11

(4/8/13)

Day 12

(5/8/13)

Day 13

(6/8/13)

Day 14

(7/8/13)

T.Ethambutol 800mg 1-0-0 -0-0

-0-0

1-0-0

+ + +

T.Pyrazinamide 750mg 1-0-0 -0-0

-0-0 + +

- -

T.Isoniazid

300mg 1-0-0 -0-0

-0-0

1-0-0

_

T.levofloxicin 500mg 1-0-0 -0-0

-0-0

1-0-0

T.Rabeprazole 20mg

1-0-0)

1-0-0 + + + +

T.silybin

phospholipid

120mg 0-1-0 + + + +


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PHARMACEUTICAL CARE PLAN


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SUBJECTIVE OBJECTIVE

Swelling of joints Synovial biopsy

Pain in the joints X-ray


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FINAL DIAGNOSIS

Based subjective and objective evidence of

patient she was diagnosed as tuberculosis of

ankle joint


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GOALS OF TREATMENT

To reduce the signs and symptoms.

To prevent further progression of the disease

To reduce the complications of the disease

To improve the health related quality of life


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TREATMENT OPTIONS

Anti TB drugs

Isoniazid

Rifampicin

Pyrazinamide

Ethambutal

Non pharmacological treatment

Orthosis

Below knee plaster cast


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GOALS ACHIEVED

Nil


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MONITORING PARAMETERS

Disease specific Drug specific

Chest x-ray Potts-cozart test

o a oo coun p a m c exam na onPLT Liver function tests

ESR

synovial biopsy

AFB culture sensitivity


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PROBLEMS IDENTIFIED

ADR-Drug induced chills & rigors and gastric

irritation.

yri oxine was not prescri e .


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PATIENT COUNSELLING

About the disease:

Tuberculosis (TB) is an infectious disease that iscaused by a bacteria.

It spreads from person to person through airborneparticles.

Symptoms include unexplained weightloss , tiredness,fatigue, shortness of breath, fever, night sweats , chills,

and a loss of appetite. Symptoms specific to the lungsinclude coughing that lasts for 3 or more weeks,coughing up blood, chest pain, and pain with breathingor coughing


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ABOUT THE MEDICATION

Isoniazid :

Advice the patient about the signs/symptoms ofhepatotoxicity.

If taking antacids, patient should take antacid at least1h before oral INH.

Patient should take medication on empty stomach 1hbefore or 2h after food.

Patient should report sign/symptoms of peripheralneuropathy and thrombocytopenia.


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RIFAMPICIN

It decreases the effectiveness of oral

contraceptives.

Drug causes red-orange discolouration of urine,

eces, sa va ,swea ears.

It causes flu-like symptoms.

Advice patient to take this drug 1h before & 1hafter a meal with a full glass of water.


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PYRAZINAMIDE

This drug may cause nausea,vomiting.

Advice the patient to report signs/symptoms of

hepatotoxicity.

Instruct the patient to promptly report any visual

changes.


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LIFESTYLE MODIFICATIONS

Dietary Tips for Tuberculosis Patients

Eat a variety of fruit and vegetables each day. (darkgreen, orange, legumes, starchy vegetables) severaltimes a week.

Drink pasteurized milk and warm water.

Bake, broil, or grill food should be consumed.

Eat a variety of protein rich foods, with more fish,beans, peas, nuts and Choose low-sodium foods, anddo not add salt when cooking.


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LIFESTYLE MODIFICATIONS Hand hygiene :

Cleaning hands with soap and wateror an alcohol-based hand rub toprevent transmission of germs to others.

Personal protective equipment :

Use a mouthpiece, resuscitation bag, or other ventilation devices to

prevent contact wit mout an ora secretions.

Respiratory hygiene :

Cover mouth/nose when coughing/sneezing.

Use tissues and promptly dispose of them in trash.

Perform hand hygiene after soiling hands with respiratory secretions.

Environmental cleaning :

Develop procedures for routine care, cleaning, and disinfection of environmentalsurfaces, especially frequently touched surfaces in patient/resident-care areas.


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DOTS

TB DOT providers should document reasons for both refusal of DOT

and discontinuation of DOT by TB clients who are or have beenoffered this treatment option.

It ensures that the patient completes an adequate regimen.

It lets the health care worker monitor the patient regularly for side

.

By ensuring that patient takes every dose of medicine, it helps thepatient become non-infectious sooner and adherent to medication.

Health-care providers of TB services will take the time to explainto patients, in simple language .

DOT should take place anywhere the patient and health careworker agree upon provided the location is convenient and safe forboth parties


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BCGVACCINATION

The live attenuated strain ofMycobacterium

bovis known as bacillus Calmette-Gurin (BCG)

uses shared antigens to stimulate the

-tuberculosis.

1mL percutaneous.


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VACCINE ADMINISTRATION

The single dose of BCG vaccine is administered intradermally, intothe lateral aspect of the abducted left upper arm.

Patients should be advised not to cover the site with tight clothing orsealed dressings.

The BCG can be given simultaneously with other live vaccines but, ifnot given at the same time, further immunisations should be delayedfor at least 4 weeks. No other immunisations should be given in the

..

CONTRA-INDICATIONS

A past history of TB.

A positive pre-immunisation tuberculin test.

A previous anaphylactic reaction to vaccine component.

Compromised immunity due to treatment or disease.

Generalised septic skin conditions.

Acute illnesses with fever or systemic upset.


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Tuberculosis of Ankle Joint

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