By
Sardar Ali
Assistant Professor -KMU
Tuberculosis is one of the oldest disease known to affect
humans, is a major cause of death worldwide
It is a chronic bacterial infection caused by Mycobacterium
Tuberculosis, that is characterized by the formation of
granulomas in infected tissues and by cell mediated
hypersensitivity. The usual site of the disease is the lungs,
but other organs maybe involved (Meninges, Kidney, Bones
and Lymphnode).
Latin Word : - “Tubercle” -Round nodule/Swelling - “Osis”:
Condition
Causative Organisms
Human: Mycobacterium Tuberculosis
Animal: Mycobacterium Bovis
Classification
Pulmonary TB
Primary Disease
Secondary Disease
Extra Pulmonary
Lymph Node TB
Pleural TB
Upper Airways TB
Skeletal TB
Genitourinary TB
Miliary TB
TYPES
A. PULMONARY TB
Primary Tuberculosis
The infection of an individual who has not been
previously infected or immunized is called Primary
tuberculosis or Ghon’s complex or childhood
tuberculosis.
Lesions forming after infection is peripheral and
accompanied by hilar which may not be detectable on
chest radiography.
Secondary Tuberculosis
The infection that individual who has been previously
infected or sensitized is called secondary or post primary
or reinfection or chronic tuberculosis
B-EXTRA PULMONARY TB
20% of patients of TB Patient . Affected sites in body are:
1. Lymph Node TB ( Tuberculuous Lymphadenitis)
Seen frequently in HIV infected patients
Symptoms: Painless swelling of lymph nodes most
commonly at cervical and Supraclavical (Scrofula)
2. Pleural TB
Involvement of pleura is common in Primary TB and
results from penetration of tubercle bacilli into pleural
space.
3. TB of Upper Airways
Involvement of larynx, pharynx and epiglottis
Symptoms :- Dysphagia, chronic productive cough
4. Genitourinary TB
15% of all Extra pulmonary cases
Any part of the genitourinary tract get infected
Symptoms :- Urinary Frequency, Dysuria, Hematuria
5. Skeletal TB
Involvement of weight bearing parts like spine, hip, knee
Symptoms :- Pain in hip joints n knees, swelling of
knees, trauma
6. Gastrointestinal TB
Involvement of any part of GI Tract
Symptoms :- Abdominal pain, diarrhea, weight loss
7. TB Meningitis & Tuberculoma
05% of All Extra pulmonary TB
Results from Hematogenous spread of 10 & 20 TB
8. TB Pericarditis
1- 8% of All Extra pulmonary TB cases
Spreads mainly in mediastinal/hilar nodes/from lungs
9. Miliary or Disseminated TB
Results from Hematogenous spread of Tubercle Bacilli
Spread is due to entry of infection into pulmonary vein
producing lesions in different extra pulmonary sites
10. Less Common Extra Pulmonary TB
Uveitis, Panophthalmitis, Painful Hypersensitivity related
Phlyctenular Conjuctivis
GHON FOCCI
A Ghon Focus is a primary lesion
usually sub pleural, often in the mid to
lower zones, caused by
Mycobacterium bacilli (tuberculosis)
developed in the lung of a nonimmune
PATHOPHYSIOLOGY
host (usually a child). It is named for
Anton Ghon (1866–1936), an Austrian
pathologist. When a Ghon's
complex undergoes fibrosis and
calcification it is called a
Ranke complex
DIAGNOSIS
Bacteriological Test
Zeihl-Neelsen Stain
b. Auramine Stain(Fluorescence Microscopy)
Sputum Culture Test : (AFB smear and culture are two
separate tests)
Lowenstein –Jensen(LJ)-Solid Medium 4-18 Weeks
Liquid Medium 8-14 days
Agar Medium 7 to 14 days
Radiography
Chest X-Ray (CXR)
DIAGNOSIS
Nucleic Acid Amplification
Species Identification: Several Hours
Low Sensitivity, High Cost
Most Useful for the Rapid Confirmation of Tuberculosis
in Persons with AFB-Positive Sputum
Utility
AFB-Negative Pulmonary Tuberculosis
Extra Pulmonary Tuberculosis
Quantiferon Gold Test: QFT-Gold Test: Measures
interferon-gamma in the blood
after incubating the blood with
specific antigens from M.
Tuberculosis proteins
PREVENTION
PREVENTION
Tuberculin Skin Test (PPD)
Injection of fluid into the skin of the lower arm.
48-72 hours later – checked for a reaction
Diagnosis is based on the size of the wheal
1-Dose = 0.1 ml contains 0.04µg Tuberculin PPD
BCG VACCINE
Bacille Calmette Guerin (BCG)
First used in 1921
Only vaccine available today for protection against tuberculosis
It is most effective in protecting children from the disease
Given 0.1 ml intradermally
Duration of Protection 15 to 20 years
Efficacy 0 to 80%
Should be given to all healthy infants as soon as possible after
birth unless the child presented with symptomatic HIV infection
TREATMENT
DOT Therapy: Directly Observed Treatment
MDR and XDR
Multi-Drug Resistance TB
TB caused by strains of Mycobacterium tuberculosis
that are resistant to at least Isoniazid and Rifampicin,
the most effective anti- TB drug.
Globally, 3.6% are estimated to have MDR-TB
Almost 50% of MDR-TB cases worldwide are
estimated to occur in China and India
Extensively Drug Resistance TB
Extensively drug-resistant TB (XDR-TB) is a form of TB
caused by bacteria that are resistant to Isoniazid and
Rifampicin (i.e. MDR-TB) as well as any Fluoroquinolone
and any of the second-line anti-TB injectable drugs
(Amikacin, Kanamycin or Capreomycin).
MDR and XDR
Epidemiological Impact
Reactivation of latent infection- People who are infected
with both HIV and TB are 25 to 30 times more likely to
develop TB again than people only infected with TB.
Primary Infection- New tubercular infection in people with
HIV can progress to active disease very quickly
Recurring Infection-In people who were cured of TB
NURSING MANAGEMENT
Administer and teach self administration of medications
Encourage rest and avoidance of exertion
Monitor breath sounds respiratory rates ,sputum
production & dyspnea
Provide supplemental oxygen as ordered
Encourage increased fluid intake
Instruct about best position to facilitate drainage
Educate patient to control spread of infection by covering
mouth and nose while coughing and sneezing
NURSING MANAGEMENT
Isolation of patient
Instruct about risk of drug resistance if drug regimen is not
strictly and continuously followed
Carefully monitor vital signs and observe for temperature
changes
Monitor weight of the patient
Instruct about medications schedule and side effects
Educate about the transmission of the disease
