pulmonary tuberculosis
DESCRIPTION
Dr.Sathaporn Kunnathum 13 Jun 2010HemoptysisInfection Tumor Bleeding disorder FB Medicine Destructive lungHemoptysis or HematemesisEpidemiologyTuberculosis (TB) remains the leading cause of deathworldwide from a single infectious disease agent. Indeed up to 1/2 of the world's population is infected with TB. The registered number of new cases of TB worldwide roughly correlates with economic conditions the highest incidences are seen in those countries of Africa, Asia, and LaTRANSCRIPT
Dr.Sathaporn Kunnathum13 Jun 2010
HemoptysisInfectionTumorBleeding disorderFBMedicineDestructive lung
Hemoptysis or Hematemesis
EpidemiologyTuberculosis (TB) remains the leading cause of
death worldwide from a single infectious disease agent. Indeed up to 1/2 of the world's population is infected with TB. The registered number of new cases of TB worldwide roughly correlates with economic conditions
the highest incidences are seen in those countries of Africa, Asia, and Latin America .
WHO estimates that eight million people get TB every year, of whom 95% live in developing countries. An estimated 2 million people die from TB every year.
Clinical featuresFeverHemoptysisLoss of appetiteWeight lossFatiqueNight sweatsChest pain
Cause
Mycobacterium tuberculosis
Tuberculosis is Tuberculosis is transmitted by transmitted by airborne droplet airborne droplet nuclei(containinnuclei(containing tubercle g tubercle bacilli )bacilli )
Many droplet nuclei Many droplet nuclei are capable of floating are capable of floating in the immediate in the immediate environment for environment for several hoursseveral hours
Large particles may Large particles may be inhaled by a be inhaled by a personperson
breathing the breathing the same air and impact same air and impact on theon the
trachea or wall of trachea or wall of the upper airwaythe upper airway
Laboratory and physical examinations
Chest radiography Chest radiography Sputum examinationSputum examinationTuberculin testingTuberculin testingPCR test to detect PCR test to detect
TBTBTB antibody testingTB antibody testingbronchoscopybronchoscopy
DiagnosisUsually Dx from clinical, CXY and Sputum
AFB
Radiology Chest radiography is the most Chest radiography is the most
important method to detect TB important method to detect TB TB’s characteristics of a chest TB’s characteristics of a chest
radiograph favor the diagnosis of radiograph favor the diagnosis of tuberculosis as following :tuberculosis as following :
(1)(1) Involve mainly in the upper zone Involve mainly in the upper zone(2)(2) patchy or nodular infiltration patchy or nodular infiltration(3)(3) cavity lesion. cavity lesion.(4)(4) calcification. calcification. (5)(5) bilateral infiltration, especially if these are in the bilateral infiltration, especially if these are in the upper zonesupper zones(6)(6) the persistence of the abnormal shadows without the persistence of the abnormal shadows without alteration in an x-ray repeated after several weeks alteration in an x-ray repeated after several weeks this helps to exclude a diagnosis of pneumonia this helps to exclude a diagnosis of pneumonia
or or other acute infectionother acute infection
Milliary TuberculosisMilliary Tuberculosis
acute milliary tuberculosis
Upper lung infiltrate
infiltrate
Tuberculoma
Chronic fibro-cavitary pulmonary tuberculosis
cavity
Tuberculous effusion
Sputum examinationSputum examination There are direct smear and There are direct smear and
culture culture
Direct smear examination Direct smear examination is only positive when large is only positive when large numbers of bacilli begin to numbers of bacilli begin to be excreted be excreted
Sputum examinationA negative smear by no means A negative smear by no means
excludes tuberculosisexcludes tuberculosisA negative smear in the presence A negative smear in the presence
of extensive disease and cavitation of extensive disease and cavitation makes the diagnosis less likely.makes the diagnosis less likely.
Particularly if the negatives are Particularly if the negatives are frequently repeated frequently repeated
Tuberculin Tuberculin testingtesting
A positive tuberculin test A positive tuberculin test although it is of great although it is of great use in children, but it use in children, but it has limited diagnostic has limited diagnostic significance in older significance in older age groupsage groups
•• A reaction of less than 5 mm is A reaction of less than 5 mm is
considered considered
negative negative
• • 5-9 mm is considered positive (+)5-9 mm is considered positive (+)
•• 10-19 mm is considered positive (+10-19 mm is considered positive (+
+) +)
•• more than 20 mm is considered more than 20 mm is considered
positive positive
(+++)(+++)
A positive tuberculin skin test A positive tuberculin skin test
indicates indicates
tuberculous infection, with or tuberculous infection, with or
without diseasewithout disease
Differential Diagnosis 1 2 3 4
BronchiectasisBronchiectasis may confused with may confused with chronic fibrocavenous pulmonary chronic fibrocavenous pulmonary tuberculosis. They also have chronic tuberculosis. They also have chronic cough, sputum production and cough, sputum production and hemoptysis. Usually we can use chest x-hemoptysis. Usually we can use chest x-ray examination and CT scan to ray examination and CT scan to distinguish them. distinguish them.
Cavitary lung abscessCavitary lung abscess often involves the often involves the dorsal segments of the lower lobes and posteriordorsal segments of the lower lobes and posteriorsegments of the upper lobes. Typically lungsegments of the upper lobes. Typically lung abscess causes litt1e in the way of physical abscess causes litt1e in the way of physical findings, may have a air-fluid level, and is findings, may have a air-fluid level, and is
notnot associated with patchy bronchogenic infiltrates.associated with patchy bronchogenic infiltrates. In contrast, physical findings are prominentIn contrast, physical findings are prominent over tuberculous cavities, fluid levels are rare.over tuberculous cavities, fluid levels are rare. And patchy infiltrates elsewhere are the rule.And patchy infiltrates elsewhere are the rule.
Differential DiagnosisDifferential Diagnosis 1 2 3 4
Acute bacterial pneumoniasAcute bacterial pneumonias may may resembleresemble
florid tuberculosis in all particulars florid tuberculosis in all particulars except forexcept for
the sputum examination and the sputum examination and response toresponse to
antimicrobial drugs.antimicrobial drugs.
Differential DiagnosisDifferential Diagnosis 1 2 3 4
Neoplasm Neoplasm may resemble tuberculosis. may resemble tuberculosis. As inAs in
an isolated coin lesion. ( An irregular an isolated coin lesion. ( An irregular cavity wallcavity wall
suggests necorotic neoplasm. )suggests necorotic neoplasm. )
Differential DiagnosisDifferential Diagnosis 1 2 3 4
Differential Diagnosis 1 2 3 4 5Fever caused by some other diseases
complicationsPneumothoraxBronchiectasisEmpyemaExtrapulmonary expansionHemoptysisChronic pulmonary heart disease
TreatmentThe critical issue in TB control is The critical issue in TB control is
adopting the DOTS (1995) adopting the DOTS (1995) ( Directly Observed Treatment, ( Directly Observed Treatment,
Short-course therapy; DOTS Strategy Short-course therapy; DOTS Strategy is recommended by the WHO TB is recommended by the WHO TB Program.Program.
TreatmentWHO Category of treatmentI 2IRZE + 4IR in general caseII 2IRZES + IRZE + 5IRE in relapse and
default case
Adverse effectsINH : hepatotoxicity and periphral hepatotoxicity and periphral
neuropathy neuropathy Rifampicin : gastrointestinal upset, gastrointestinal upset,
hepatitishepatitisEthambutol : optic neuritis optic neuritis PZA : hepatotoxityhepatotoxityStreptomycin : Ototoxicity, Renal toxicityOtotoxicity, Renal toxicity
Resources WHO Tuberculosis Resources (Columbia Medical School)
http://www.cpmc.columbia.edu/tbcpp Tuberculosis, NIAID Fact Sheet
http://www.niaid.nih.gov/factsheets/tb.htm Positive Skin Tests for Tuberculosis (American Family Physician)
http://www.aafp.org/afp/961101ap/pat_1991.html National Tuberculosis Center
http://www.umdnj.edu/~ntbcweb/ntbchome.htm CDC; Division of Tuberculosis Elimination
http://www.cdc.gov/nchstp/tb/structure.htm Treatment of Tuberculosis and Tuberculosis Infection in Adults
and Children American Thoracic Society Medical Section of the American Lung Association American Journal of Respiratory and Critical Care Medicine Vol 149 1994 http://aepo-xdv-www.epo.cdc.gov/wonder/PrevGuid/p0000413/p0000413.htm
Brief History of Tuberculosis http://www.umdnj.edu/~ntbcweb/history.htm
Thank you for your attention