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PULMONARY TUBERCULOSIS (TB) Presented by ASER MOHAMED KAMAL

Pulmonary tuberculosis (tb)

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Page 1: Pulmonary tuberculosis (tb)

PULMONARY TUBERCULOSIS (TB)Presented by ASER MOHAMED KAMAL

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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

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MYCOBACTERIUM TUBERCULI

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TYPES PULMONARY TUBERCULOSIS AVIAN TUBERCULOSIS( MICROBACTERIUM

AVIUM ;OF BIRDS) BOVINE TUBERCULOSIS(MYCOBACTERIUM

BOVIS ;OF CATTLE) MILIARY TUBERCULOSIS / DISSEMINATED

TUBERCULOSIS

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CLASSIFICATION Class I (TB exposure)

(+) exposure (-) Mantoux tuberculin test (-) signs and symptoms suggestive of TB (-) chest radiograph

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CLASSIFICATION Class II (TB infection)

(±) exposure (+) Mantoux tuberculin test (-) signs and symptoms suggestive of TB (-) chest radiograph

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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)

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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

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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

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ETIOLOGY Mycobacterium tuberculosis Droplet

nuclei(coughing,sneezing,laughing) Exposure to TB

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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

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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).

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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

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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

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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

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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 

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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

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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

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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)

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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

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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)

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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

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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  

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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

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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

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Prevention

ISOLATION

Ventilate the room

Cover the mouth

Wear mask

Finish entire course of medication

vaccinations

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CONCLUSION