tuberculosis (tb)
TRANSCRIPT
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Why TB
One third of the world is reported to be infected.
8.2 million cases were active.
1.2-1.4 million death were reported( World Health Organization. 2013.).
Tuberculosis is more common in developing countries.
Tuberculosis (TB)
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37 million lives were saved through diagnosis and treatment between 2000 and 2013.
In 2013 an estimated 480,000 people developed multidrug resistant tuberculosis (MDR-TB).
Tuberculosis is the leading killer of HIV positive people.
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What cause it
Mycobacterium tuberculosis complex
It includes:
Mycobacterium tuberculosis
Mycobacterium africanum
Mycobacterium bovis
Mycobacterium microti
M. tuberculosis divides every 15–20 hours
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MOTT
M. kansasii, M. simiae and M. marinum
M. Scrofulaceum
M. avium
M. Ulcerans
M. abscessus, M. fortuitum
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Microscopy
M. tuberculosis is characterized by caseating granulomas containing Langhans giant cells, which have a "horseshoe" pattern of nuclei.Organisms are identified by their red color on acid-fast staining.
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• granuloma that provides a protection and enable the bacilli to sustain a long-term persistent infection.
• Protective granulomas are formed by cytokines.
• Granulotomatous lesions are important in both regulating the immune response and minimizing tissue damage.
• T cells help maintain Mycobacterium within the granulomas.
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DiagnosisDiagnosis of active tuberculosis depend on
signs of lung disease for more than two weeks .
Abnormal chest x-ray. Multiple sputum samples for smear
culture and PCR. (PPD) test. (QFT) test All tests are initial evaluation for
tuberculosis.
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Latent tuberculosis infection (LTBI)
is the presence of M. tuberculosisorganisms without symptoms or radiographic or bacteriologic evidence of TB disease.Approximately 90%–95% of those infected will not progress from LTBI to TB disease (CDC).Diagnosis is made be positive PPD or QFT
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Treatmentactive tuberculosis
isoniazidRifampicinPyrazinamideEthambutol
The four drugs are used for the first two months.rifampicin and isoniazid for the last four months.
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For latent TB treatment only rifampicin and isoniazid are used both together or one of them.WHO recommend directly observed therapy (DOT), the nurse or health care worker watch the patient while taking the medicine.
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Anatomy
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where
• Right upper lobe:
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• Right middle lobe:
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• Left upper lobe
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TB granuloma
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TB fibrosis of lung
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Miliary TB. Multiple tiny nodules scattered throughout both lungs
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TB
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TB
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TB or Not TB?
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Lung abscess
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Alveolar microlithiasis.
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Right heart failure. Well-defined masses seen with the right mid andlower zones. These ‘pseudotumours’ represent encysted pleural fluid
within the horizontal and oblique fissures (arrows).Heart failure
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interstitial pneumonitis (UIP) formerly
cryptogenic fibrosing alveolitis.
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Kartagener syndrome Triad of featuresSitus inversus (50%).
Nasal polyposis and chronic sinusitis.Bronchiectasis.
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Mesothelioma. In this case, there are more extensive lobulatedpleural masses
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‘Cannon ball’ metastases
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Miliary metastases.
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Pneumoconiosis –Multiple small dense bilateralpulmonary nodules.
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PneumoconiosisSarcoid.
organising pneumonia.Lymphoma.
Metastatic disease.
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Sarcoidosis. Egg shell calcification of both hila
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Silicosis. Egg shell calcification of both hila.
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Previous varicella pneumonia
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Wegner’s granulomatosis. Large cavitating lung lesion
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Squamous cell carcinoma
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Aspergillomas
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Sources and refrencesAbout 35,300,000 results (0.26 seconds)A–Z of Chest RadiologyBy Rakesh R. Misra is a Consultant Radiologist in the Departmentof Radiology at Wycombe Hospital, Buckinghamshire Hospitals UK.WHO site.CDC- USAPresentation prepared by: Dr. Mohamed ElafizGeneral practitioner – Medical commission
March 4,2015
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