Pa. Tene J culosis a ‘aber Cu ite ly gehen bendy Complex is. one. of the, 0 tebe Tt usual is a is patna CAML nf dene Wor 4 " “ise Cape Ay j = ie = Tagetler called Complex becanye they are. guncbily ruaked to call La ie J Mijcobackuriaro tubercubasit lungs [though a Organs are, ally id. Mycobautenwm bovis | Mycbacteninm a (ah reheat aFticanwmn (~_ tubercalyis ee ) Mycobapkeriam mi crobir Complex 5.) Mycabackeriam mungi, de Pa Clinical Feaburs | Pulmenay Ex trcoulimone _ Tubtrcwlosis —___Twhereulasis a lo Fever RGR thers das Lymphadenis > Se © Productive (6 ug Ti @Evening Kise: of leat Tempera hur are © Humopty sis > © Renal Tuberculosis © Tabereibosy of Fallopian Tuba = JO Tebureloss of Endemebnin OSkeldal Tuberentond ty “EBs Meningi tes & Tubureulemna, | ——ONight- Syreating — CB Spine — Pott /s.Diseate) —_ O WerghE Logs GE Theres @ Plewritic Chath p pala TB Pericarditis, Pari bites oral 1) I~ 1Tub ——— pay Perclosts | a | Lnfechin Before Achivchion of Cell Mediated Dnmeni ty +} - = Mycobacterium B SSS: SL Marose, C3; others ee. —— es Mannose receptor, CRS) Other 7 — Unchecked bacilliary Prolifendiy Phagesomel Manipbin *Maturdhin ams et Lack of aud pH Bacleenia with om | Alveolar | Matrophage ane *Inefhchi h } a | Sue ae Sead mal biple— fe mage ee a i. Lintiation and Consequat) of cull Mecliatel Lrmanity nye Macephay Adivalel Macnphaye 2 {@ ¥ —— ‘uburewin Rentivi M\achophagt Aetivation . Dae rw tnafurakion anc « Pruction ef reachive Oxyst Species oeAnn EE Oo, bene Tuberculosis Pathogenesis — Trheletin of — TLc&, TEN= Achivake Yrorncgtes, & ynaunphages anil hentt- “CaWsU—> Maurphage Actively Repre ee ake a Acbvabod macrepl TE pitaelaid cull by aero Soles _Opsonization be dacilli. by (Caa, C3b] Phayocytosis by Yaron M acto phages pryent the Artigen"Foywers of pacill bo Helper sy — Cbs Helper T=culls diffurntiade to Tat PL T,> Ty cay ae f obs TOM Granulomar argh c £ tubule bacilli pike Hitmeral Zmmuny — RY pore. \ — Plage aay wine nile ‘LEN- = peti aol sydd haf pend urgo stpechur Change Pals form diarkcel, vehich aggnydy fe Added moacrephagy Pl TL | ELLA b abt lymphocoby Rees apt pl cats me ee Awbardt: Fetmation — Rg Ugh Gest aly canbe —___ fparteund by Lyemtecghy & F pases a “ Lenbor central crllalar Zane ed Cason Ness harnriud ly bo Eabarly Lew pH ed a\ | Tapcleamlcculecsleoallinalssliashahucsh a a a0 Steroid Thempy | a ae Ory Froyplant (Delay a Hypersensitivity Readion a 5 | © Piabeta moldy] . if 2 Tuberculosis “Tissue Damaging Respone, -— When thee is Sea 1 Shake in apaticnt. © oll Aye Macopheyy, activating Pespenic Hi wale O HIV -infuchion Je Hence, the body ana the infuchn iy ge. fees ee “© Trnrmanosuppressive The caseou was becomps ligycbe [Divas oe Cay sing the-reloue of tubwde- pacill— Symptoms of Taber Lee Spral of Taberlesy Begins oe. | [Sbart appearing — Cony Seg Hem eae ak Lymphaht, | ee | hs —$neeZing oe nt ~ Spread of TB ‘Fo other pesplee Spot TH difhant organ Pulmonary Fubereuosis } ~ => Evening rise of T emperature ) Pro ductive La — dnd —ermoptysis ere Be Causative Agent ° — Mycobateriam stubereuloss Be Lab Diagnosis” ! © Specimen Collection o~ Two spuban Songs ance 4 pec a ree of Pulmonary aber tilesi = One Spot sample ——o or morning Sample. : ReaD Phe we ak time of presentation. —— | Spek Sample o = Collect at i Earl 1h Samptce= CollutkedL after Washing mouth so Chal ie feck (if Phar is any) Cannot Line : thy Staining prcedure.Pulmonay Tuberculosis trac eof Collections om *Should be collected i wal venti + Patient ak e tle 3-4 dap breaths * APtor that, Proludive. Couyh deep from chest rSpib the Sputum ino wide = mouthed Scew- Capped. container . teoy ft slioy Quality ~ . E arena show d be thick: and. Viscous = Wabury, Specimen Should: be didcanlal @Digestion Decontamination of Specimens — Before, Cultum ank Smear preparation, the. Specinn.| is-digesbed (Aigestion of pus Cells) and decontaminbin Frm the hormal Flore (commensal) i: This may be Carpied out by two methods — 1) Petrofh's Method (4% NaOH) — ae iy Mixed with 4‘, NaOH—>. Cenbrifugel—> |Newtralized with PO" buffer Saline recommended. for Lowenstein Jernen Media LNALC(N—Acety! L- Cysteine) + y/o NaOH | Best Liquefig jy the-S pba —> Nao Hills Norm. Fm __Recommendid: foe Automabed, Cults 8 y stom Direct Microseapy Pro cased Specimen suse bo prepar, ond ih is sired weit eal i Staining CAcidy Fast Sbajning) Teale ea smadeihecslcwe ese 7| Puatiiionarys Te berculass i Under Oi Tinmersion, 4 ue = Negative Reule ¢-The specimen is reported - ——megakive iF 100 oit immersion Fidds are founch — — ——— pagakive For-aicidl- Bayt —bacll lie -—— — |_____ Li) Positive Resulk s—Acid fas bacilli appear thin, long, Slender, anc Signy Curve with a beaded appearance. ata = Dip Nealon Skaning pe (ie ey ee NS a aie oe a 2 pS Sti 3 + Gradking of Smear a |__| OE AEB Seen [Pinel [Grading] Result iii NSA EB OE 100 0 Negative [= AgB/looorr | 100 [Scanty | Positive. 10—99 AFB/io0 ore | 100 {+ Positive \=10 AFB/ OIF SOMISEE Positive. > 10 AFB /OLE 200 NS | Positive ;— EF the-slender-bacilli has typical beaded. appearance, — big report as acid Fast—bacilli resembling Myvbatterinn { baberculesiy are Seen by Smear micfosepy by ZN SEain. -_ Kinyown 'S Cold Acid Fast Staining Ms Hosking is motrin > Phenol Concentrarton in carbol Fuschin is increayehRR SS Pulmonary Tuber cul asis [Eigoeeeene Staining > Using Avoramine= Ehodamine stain. seen wnder | #luoroscent micrescope _ 4 => This tediniqur 15 Pore Commonly used “new - > Acid fast bacilli can be bebtte appreiatul using Auramine — Rhodamine shan a cemparul fo | Zichl= Neeken Sbaining @Cubture t Lae a i) Lowenstein — Tensen Mahiam ¢— PG = Malachite, Gren a Corp TA AS paragine, | LEM 1 rm ae [M.— Mineral Sal Solution Ge — Fag Albumin | Spedmun (ey. spation Sele) Wihwoalakdt ors LT = ‘ruin Lrenbabds Pe abue G=3 werks-becaaye Mycbaire abroad isan fastidiong organism. andl gra cae M gain bobs — Rough » push & buf colarrul colunic) | Macobackerian bovid = Sraortth , bai d-whibt colowrud Cuniy pb) DACTEC Debeds grvth at wall af ceistance be Antibabunde @® TL dentification $~ ALC iKanee bo Asti th ay Add Pash Staining Smear is prepara, Peet 1 Caling on L-mudians or spuem Spesiman —> Tb iy Stained. wibh acids fay shain.—> LE the acid ines sail of Aire Se: then Further babs aroPu Mona} Tucbercuaosis ii) MPT C4 Sone Dabuibion— Lt pasitive far My cebacbonisn Lubsrculosis Complex ae ative for Non -Tuborcular Mycobackarin= Aes — Lit) MALDI = TOR ° mated identificahion Sy stem © Serology o- World Health Organizebin (WHO) hay — | | banned pres We of Serological bab fore TB cleagnas. ——— | => Nok recommenda ac be low sensitivity: ee = Trowel Cras— reaukiviky with other myvoballeric — =o Molecular Mabhels ¢~ Exhundy weal a | a > Give Fahour Res pet T > More Sensitive ee Culbury _ aa vrei teen a a ) Polymerase Chain Reachion PCR) Th GuneX perk (CBNAAT) — LOC es => Barly Qeration | ae —S.Ago useful in dckubng Extrpulmormy Tubsroulny ——- 5! tit) Truenat | ( Chip Bate NAAT) ee reas in In poten ie ek in Fee age as oe sili Pu Ti Smear Positive Sugar Negaive Smear Negative ee renee of CXR senate ex Caos i a £ eR ——Sympbans-ef TB pes biee J | ee TRY > Clinically) | pp Skabea BE PB TURES (hee Microbiligediy oo dere Cliniedly