pulmonary tb

5/5/2010Khorfakkan hospital1

Highlights on

Pulmonary Tuberculosis

Prof. Dr. Saad S Al-AniSenior Pediatric ConsultantHead of Pediatric departmentKhorfakkan Hospital


TB Diagnosis“The first rule of TB diagnosis: is to think of TB….”

Include TB in your differential diagnosis when history, symptoms are consistent with TB diagnosisOrder the appropriate diagnostic tests


Pulmonary infectionsPredisposing factors

1.Decreased cough reflex

2.Injury to cilia

3.Decreased function of alveolar macrophages

4.Edema or congestion

5.Retention of secretions


3.Progressive primary pneumonia Miliary dissemination (blood stream).

Pulmonary tuberculosis

Primary1.Single granuloma within parenchyma and hilar lymph nodes (Ghon complex).

2.Infection does not progress (most common).


Secondary

Pulmonary tuberculosisCont.

•Infection (mostly through reactivation) in a previously sensitized individual

Pathology

•Cavitary fibrocaseous lesions

•Bronchopneumonia

•Miliary TB


Typical Progression of Pulmonary tuberculosis

1.Pneumonia2.Granuloma formation with fibrosis

3.Caseous necrosis

4.Calcification

5.Cavity formation


Pulmonary tuberculosis


Acid-Fast (Kinyoun) Stain of Mycobacterium


Mycobacterium Tuberculosis Stained with Fluorescent Dye


Fibrocaseous


Miliary


GranulomaGranuloma


MycobacteriumMycobacterium


Not Everyone Exposed Becomes InfectedProbability of transmission depends on:

1.Infectiousness 2.Type of environment 3.Length of exposure

10% of infected persons will develop TB disease at some point in their lives

* 5% within 1-2 years* 5% at some point in their lives


Treatment of TB Disease

Include four 1st-line drugs in initial regimen1.Isoniazid (INH)2.Rifampin (RIF)3.Pyrazinamide (PZA)4.Ethambutol (EMB)Never add a single drug to a failing regimen


Barriers to Adherence

•Stigma

•Extensive duration of treatment

•Adverse reactions to medications

•Concerns of toxicity

•Lack of knowledge about TB

and its treatment


Improving Adherence

•Adherence is the responsibility of the provider,

not the patient and can be ensured by:

-Patient education

–Directly observed therapy (DOT)

–Case management–Incentives/enablers


Directly Observed Therapy (DOT)

*Health care worker watches patient swallow each dose of medication

*DOT is the best way to ensure adherence

•Should be used with all intermittent regimens

Reduces relapse of TB disease and acquired drug resistance


Remember

“A decision to test

is

a decision to treat.”

Thank you

pulmonary tb

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