TUBERCULOSIS
Presented By,
Hemalini Nagadevi
Mentor: Dr Asyraf
Supervisor: Dr Carol
INTRODUCTION
INTRODUCTION
• Tuberculosis (TB) is a potentially fatal
contagious disease that can affect almost any
part of the body but is mainly an infection of
the lungs.
MYCOBACTERIUM TUBERCULLI
-Gram Positive
-Obligate aerobe (an organism that
requires O2 to grow)
-Non spore forming
-Mesophile (an organism that grows
best in moderate temperature,
neither too hot nor too cold)
TYPES
• Pulmonary Tuberculosis
• Avian Tuberculosis (Microbacterium Avium ;
Of Birds)
• Bovine Tuberculosis (Mycobacterium Bovis ;
Of Cattle)
• Milliary Tuberculosis / Disseminated
Tuberculosis
SPREADING OF TB
TYPES
Pulmonary TB
1. Primary Tuberculosis :-
• The infection of an individual who has not been previously
infected or immunised 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.
2. Secondary Tuberculosis :
• The infection that individual who has been previously
infected or sensitized is called secondary or post primary or
reinfection or chronic tuberculosis.
Extra Pulmonary TB
- 20% of TB Patients
- Affected sites in body are :-
1) Lymph node TB ( tuberculous lymphadenitis):-
Seen frequently in HIV infected patients.
• Symptoms :- Painless swelling of lymph nodes most
commonly at cervical and Supraclavical (Scrofula)
• Systemic systems are limited to HIV infected patients.
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 that got infected.
• Symptoms : Dysuria, Hematuria.
5)Skeletal TB :-
• Involvement of weight bearing parts like spine, hip, knee.
• Symptoms : Pain in hip joints and knees, swelling of knees,
trauma.
6)Gastrointestinal TB :-
• Involvement of any part of GI Tract
•
7) TB Meningitis & Tuberculoma :-
• 5% of All Extra pulmonary TB
8)TB Pericardiatis :-
• 1- 8% of All Extra pulmonary TB cases.
• Spreads mainly in mediastinal or hilar nodes or 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.
PATHOGENESIS
SYMPTOMS OF TB
CLINICAL MANIFESTATIONS
CONSTITUTIONAL SYMPTOMS
Anorexia
Low grade fever (fever with chills)
Night sweats
Fatigue
Weight loss
PULMONARY SYMPTOMS
Dyspnea
Non resolving bronchopneumonia
Chest tightness
Unexplained cough lasting more than 2 weeks
Mucopurulent sputum with haemoptysis
Chest pain
EXTRA PULMONARY SYMPTOMS
Pain
RISK FACTORS
CLOSE CONTACT WITH SOMEONE WHO HAVE ACTIVE TB.
IMMUNO COMPROMISED PATIENTS
-Diabetes Mellitus (DM)
-Human Immunodeficiency Virus (HIV)
-Chronic Obstructive Pulmonary Disease
-End Stage Renal Disease
-Malignancy
Malnutrition
DRUG ABUSE AND ALCOHOLISM
CURRENT SMOKER
PEOPLE LIVING IN OVERCROWDED CONDITIONS
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
Tests may include:
•Sputum examination and cultures
Detection of acid fast bacilli (AFB) on smears and cultures.
When possible, at least one early morning specimen should be obtained as
sputum collected at this time has the highest yield.
•Genexpert Cepheid Test - Nuclear Acid Amplification Test (NAAT)
Provide rapid results within 24 - 48 hours and has greater PPV (>95%) with AFB
smear positive specimens. They have the ability to confirm rapidly the presence of
Mycobacterium in 50 - 80% AFB smear negative, culture positive specimens.
Thoracentesis
Tuberculin skin test (also called a PPD test)
Biopsy of the affected tissue (rare)
Bronchoscopy
Chest CT scan
Interferon-gamma release blood test such as the QFT-Gold test to test for TB
infection
Tuberculin skin test (also called a PPD test)
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.
Tuberculin Test Interpretation
LINE-PROBE ASSAY
• WHO recommends the use of LPA as a rapid
diagnostic test for detection of Rifampicin and
Isoniazid resistance. The WHO recommended
commercially available tests include GenoType
MTBDRplus VER 1 and 2 (Hain Lifescience,
Germany), Nipro NTM+MDRTB detection kit
2 (Nipro, Japan).
Chest X-Ray
TREATMENT
DOSAGE REGIME
Intensive phase + continuation phase
HRZE (2 months) + HR (4 months)
Treatment Regime According to WHO
Fixed-Dose Combinations (FDCs)
FDC drugs incorporate two or more drugs in single tablet and offer
reduction in number of pills that need to be consumed.
• Forecox-Trac Film Coated Tab: Isoniazid, Rifampicin,
Ethambutol and Pyrazinamide
• Rimactazid 300 Sugar Coated Tab: Isoniazid and Rifampicin
• Rimcure 3-FDC Film Coated Tab: Isoniazid, Rifampicin and
Pyrazinamide
• Akurit-Z Tab: Isoniazid, Rifampin (Rifampicin) and
Pyrazinamide
• Akurit Tab: Isoniazid and Rifampin (Rifampicin)
• Akurit-Z Kid Dispersible Tab: Isoniazid, Rifampin (Rifampicin)
and Pyrazinamide
• Akurit-4: Ethambutol, Isoniazid, Rifampin (Rifampicin) and
Pyrazinamide
The two FDCs available in MoH Drug Formulary
for adults are :
a. 4-Drug combination: Isoniazid 75 mg,
Rifampicin 150 mg, Pyrazinamide 400 mg and
Ethambutol 275 mg tablet
b. 3-Drug combination: Isoniazid 75 mg,
Rifampicin 150 mg and Pyrazinamide 400 mg
tablet
The Recommended Dosage
for the two FDCs
• 30 - 37 kg body weight: 2 tablets
daily
• 38 - 54 kg body weight: 3 tablets
daily
• 55 - 70 kg body weight: 4 tablets
daily
• More than 70 kg body weight: 5
tablets daily
SIDE EFFECTS
OTHER TBs
LATENT TB INFECTION (LTBI) IN ADULTS
Some of these exposed
People living in high TB
individuals will acquire the
prevalence areas, usually exposed
infection. Notwithstanding,
to infectious TB either by a direct
many infected individuals will
Patients whocontact
havewith
been a known index case
ultimately Hence, only a small
or inadvertently exposed to an develop adequate
infected but do not show activeimmunity to keep the infection
unsuspected TB patient. number will
at bay.
any clinical manifestation
of disease activity is said eventually develop
to have LTBI. active disease.
Latent TB
TB IN CHILDREN
TB IN
CHILDREN
•PTB and lymph node TB are the commonest presentations.
•Most children with PTB are sputum negative, hence high
index of clinical suspicion is required for the diagnosis.
•Contact with an active TB person is a strong factor to
suspect TB in a symptomatic child.
•Common clinical features of TB in children : prolonged
fever, failure to thrive, unresolved pneumonia, loss of
weight and persistent lymphadenopathy.
TB IN PREGNANCY AND LACTATION
Tb in Tb in Lactation
Pregnancy Period
•Isoniazid, rifampicin, ethambutol •First-line antiTB drugs are safe in
and pyrazinamide are safe to be breast feeding
used in pregnancy. •Breastfeeding mothers with TB should
•Streptomycin should be avoided in receive a full course of antiTB drugs.
•Mother and baby should stay together
pregnancy due to foetal ototoxicity.
•Pyridoxine (25 mg daily) should be for continuation of breastfeeding.
•Once active TB in the baby is ruled out,
given to all pregnant women on the baby should be given 6 months
isoniazid to prevent foetal isoniazid prophylaxis, followed by
neurotoxicity. BCG vaccination
LATENT TB INFECTION (LTBI) IN ADULTS
At least one-third
Riskof HIV-
of mortality is 2.6
positive persons worldwide
times higher in HIV-
are infected with
Mycobacterium
positive patients who
tuberculosis Treatment:
TB is one of the develop
and 8 - 10% of them developTB an
compared
initial phase of isoniazid,
leading causes of every
clinical disease to those
year. who do not. pyrazinamide
rifampicin,
death among people and ethambutol for 2 months
Followed by rifampicin and
infected with HIV isoniazid for 4 months
HIV
DOTS
•DOTS - Directly observed treatment, short-course
DOT means that a trained health care worker or other designated
individual provides the prescribed TB drugs and watches the patient
swallow every dose.
PREVENTION
1) Mask
2) BCG vaccine
3) Regular medical follow up
4) Isolation of Patient
5) Ventilation
6) Natural sunlight
THANK YOU
