pulmonary tuberculosis aisha m siddiqui. pulmonary tb facts facts history history definition...
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PULMONARY TUBERCULOSIS
AISHA M SIDDIQUIAISHA M SIDDIQUI
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PULMONARY TB FACTSFACTS HISTORYHISTORY DEFINITIONDEFINITION EPIDEMIOLOGYEPIDEMIOLOGY PATHOLOGYPATHOLOGY CLINICAL FEATURESCLINICAL FEATURES DIAGNOSISDIAGNOSIS COMPLICATIONSCOMPLICATIONS PREVENTIONPREVENTION CHEMOTHERAPYCHEMOTHERAPY REFERNCESREFERNCES
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FACTS
““If you know TB, you know medicine” Sir If you know TB, you know medicine” Sir William Osler.William Osler.
1/3 world population is infected.1/3 world population is infected. 8,000 die/day, 2-3 million/year. >AIDS& 8,000 die/day, 2-3 million/year. >AIDS&
malaria.malaria. Accounts for 1/3 AIDS deathes.Accounts for 1/3 AIDS deathes. HIV patients 30 times more likely to get HIV patients 30 times more likely to get
sick with TB once infected.sick with TB once infected.
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HISTORY
1882 Robert Koch identified the tubercle bacillus.1882 Robert Koch identified the tubercle bacillus. 1895 “Roentgen” x-rays.1895 “Roentgen” x-rays. 1921 BCG vaccine (France).1921 BCG vaccine (France). 1940 PPD (USA).1940 PPD (USA). 1944 Streptomycin.1944 Streptomycin. 1946 PAS.1946 PAS. 1952 INH.1952 INH. 1966 Rifampicin.1966 Rifampicin.
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HISTORY (cont.)
Do Nothing Era.Do Nothing Era. Sanatorium Era.Sanatorium Era. Collapse therapy.Collapse therapy. Chemotherapy Era.Chemotherapy Era. Drug resistance.Drug resistance.
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Definition
Acid fast, aerobic bacilli:Acid fast, aerobic bacilli:
MycobacteriumTuberculosis.MycobacteriumTuberculosis. Granuloma, central caseation, Langhan’s Granuloma, central caseation, Langhan’s
giant cells.giant cells.
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EPIDEMIOLOGY(HIGH RISK)
Extremes of age.Extremes of age. Contacts with open TB.Contacts with open TB. Over crowded populations.Over crowded populations. Health workers.Health workers. Low immunity.Low immunity.
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PATHOLOGY
PRIMARY INFECTION: Primary complex.PRIMARY INFECTION: Primary complex. P.M.N+ macrophages->>> T- cells->>> increase P.M.N+ macrophages->>> T- cells->>> increase
cell mediated immunity (3-8/52)->>> +PPD.cell mediated immunity (3-8/52)->>> +PPD. Caseating granuloma, Langhan’s giant cells, Caseating granuloma, Langhan’s giant cells,
lymphocytes & fibrosis------ healing lymphocytes & fibrosis------ healing &calcification.&calcification.
20% contain remaining bacilli, activate if low 20% contain remaining bacilli, activate if low immunity( decr host defences)immunity( decr host defences)
POST PRIMARY T.B.POST PRIMARY T.B.
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CLINICAL FEATURES Prim TB: Symptomless usually.Prim TB: Symptomless usually. Miliary TB: Acute, diffuse, disseminated by blood. Old Miliary TB: Acute, diffuse, disseminated by blood. Old
people. Difficult diagnosis. Fatal if not treated.people. Difficult diagnosis. Fatal if not treated. Ill health, decrease wt., fever. (gradual)>>> meningitis, Ill health, decrease wt., fever. (gradual)>>> meningitis,
hepatosplenomegaly, choroidal tubercles.hepatosplenomegaly, choroidal tubercles. CXR miliary, may be normal.CXR miliary, may be normal. PPD+/-PPD+/- Transbronchial biopsy.Transbronchial biopsy. CT scan.CT scan. Liver & bone marrow biopsy& culture.Liver & bone marrow biopsy& culture.
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CLINICAL FEATURES (cont’d)
Post primary TB:Post primary TB:
Vague ill health, fever, decr. Wt., sweating, Vague ill health, fever, decr. Wt., sweating, cough, haemoptysis.cough, haemoptysis.
Pneumonia/ pleural effusion.Pneumonia/ pleural effusion.
Abnormal CXR.Abnormal CXR.
CBC, sputum, biopsy.CBC, sputum, biopsy.
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DIAGNOSIS CXR / CT.CXR / CT. PPD?PPD? Sputum: AFB( Z-N) Sputum: AFB( Z-N) FLUORESCENT 50% sensitivity.FLUORESCENT 50% sensitivity. NAA (DNA/ RNA), 6 hours, expensive, NAA (DNA/ RNA), 6 hours, expensive,
other specimens also.other specimens also..Culture: LJ.Culture: LJ BACTEC 7-10 daysBACTEC 7-10 days NIACIN test ++NIACIN test ++• BiopsyBiopsy• Bronchoscopy / LavageBronchoscopy / Lavage
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INVESTIGATIONS (other)
CBCCBC U/EU/E ESRESR LFTLFT
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COMPLICATIONS
ExtrapulmonaryExtrapulmonary AdrenalAdrenal SIADHSIADH
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PREVENTION
BCG 70% immunityBCG 70% immunity Contact tracingContact tracing INHINH
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CHEMOTHERAPY
Standard 6-9/12Standard 6-9/12 Inexpensive 12/12Inexpensive 12/12 ResistantResistant
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Treatment
Ethambutol>>Ethambutol>> Pyrazinamide>> 2/12Pyrazinamide>> 2/12 INH>>>>>>INH>>>>>> Rifampicin >>>>>> 6/12Rifampicin >>>>>> 6/12 Pyridoxine>>>>>>Pyridoxine>>>>>>
STEROIDS?????STEROIDS?????
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TREATMENT (cont’d)
Cheaper:* Streptomycin Cheaper:* Streptomycin
INHINH
2/12 daily then 2/wk……10/2/12 daily then 2/wk……10/
* INH 300* INH 300
Thiacetazone 150 Thiacetazone 150
12/12 daily.12/12 daily.
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TREATMENT(cont’d)
Resistant: PAS 15 gms 12 hrly POResistant: PAS 15 gms 12 hrly PO
Ethionamide 0.75-1 gm POEthionamide 0.75-1 gm PO
Capreomycin 0.75- 1 gm IM Capreomycin 0.75- 1 gm IM
Cycloserine 0.75-1 gm POCycloserine 0.75-1 gm PO
CiprofluxacinCiprofluxacin
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NEW
DOTSDOTS ICL enzyme.ICL enzyme.
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REFERENCES
Scientific American Medicine Scientific American Medicine Davidson’s Principles and practice of Davidson’s Principles and practice of
MedicineMedicine WHO report on TBWHO report on TB
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