Pneumonia+ Tb

Pneumonia:•Pneumonia is an inflammatory process of

infectious origin (inflammation and consolidation (solidification)) affecting the

pulmonary parenchyma (alveoli and bronchioles).

•It is characterized by chill and fever, productive cough, blood-tinged or rusty

sputum, pleurutic pain, hypoxia, with shortness of breathing, and sometimes cyanosis.

•The development of pneumonia is facilitated by an exceedingly virulent organism, large

inoculum, and impaired host defenses.

2. Lobar pneumonia: Consolidation of a part or all of a lung lobe, predominantly intra-alveolar exudates resulting in consolidation. Most frequently is caused by Streptococcus Pneumoniae (Pneumococcus).

Symptoms• Common clinical symptoms include Common clinical symptoms include

cough productive large amount of cough productive large amount of sputum, fever, chills, fatigue, sputum, fever, chills, fatigue, dyspnea, rigorsdyspnea, rigors

• pleuritic chest painpleuritic chest pain• Other presentations may include Other presentations may include

headache and myalgia.headache and myalgia.

• Certain etiologies, such as Certain etiologies, such as legionella, also may produce legionella, also may produce gastrointestinal symptoms.gastrointestinal symptoms.

Clinical Signs

• Clinical signs of Pneumonia• 1. High remitted Pyrexia• 2. Profound systemic upset • 3. Digital clubbing may develop quickly(10-14 days) • 4. Chest examination usually reveals signs of

consolidation; signs of cavitations rarely found• 5. Pleural rub common• 6. Rapid deterioration in general healthy with

marked weight loss can occur if disease not adequately treated

DiagnosisDiagnosis •SymptomsSymptoms

•Physical examinationPhysical examination

•Chest x-rays Chest x-rays

•Blood testBlood test

• sputum Gram stainsputum Gram stain

•sputumsputum cultures cultures

•two sets of blood two sets of blood cultures cultures •serologic testingserologic testing

MANAGEMENTMANAGEMENT

• When managing a patient with When managing a patient with pneumonia one shouldpneumonia one should

• Assess the severity of the Assess the severity of the pneumonia pneumonia

• Decide whether it is community or Decide whether it is community or nursing home acquired nursing home acquired

• Determine if the patient is over 65 Determine if the patient is over 65 or has a comorbid illness or has a comorbid illness

• Decide whether to treat orally or Decide whether to treat orally or with IV medswith IV meds

TreatmentTreatment depends on the cause of pneumonia; Typically, oral antibiotics, rest, fluids, and home care are sufficient for complete resolution.

Tuberculosis:•In the pulmonary form, it is spread by inhalation of droplets containing the organism Mycobacterium tuberculosis (also referred to as the (tubercle bacillus).

•In the non-pulmonary form, it is most often caused by the ingestion of

infected milk.

A-Primary

B. Secondary tuberculosisIt is usually results from activation of a prior Ghon complex, with spread to a new pulmonary or extra-pulmonary site. It is characterized clinically by: progressive disability, fever, hemoptysis, pleural effusion (often bloody), and generalized wasting.

Spread of diseaseSecondary tuberculosis may be complicated by

lymphatic and hematogenous spread, resulting in miliary tuberculosis, which is seeding of distal organs with innumerable small rallied seed-like

lesions. Hematogenous spread may also result in larger lesions, which may involve almost any organ.

Prominent examples of extra-pulmonary tuberculosis include tuberculous meningitis, Pott disease of the

spine, para-vertebral abscess, or psoas abscess, Genito-urianry.

Factors increase the risk of tuberculosis1. Age(children>young adult)2. . Close contact of patients with smear positive pulmonary tuberculosis 3.Poor enviromental hygen

Symptoms include coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and fatigue. shortness of breath. If the infection spreads beyond the lungs, the symptoms will depend upon the organs involved.

DiagnosisThe main problem with tuberculosis diagnosis is the difficulty in culturing this slow-growing organism in the laboratory (it may take 4 to 12 weeks for blood or sputum culture). A complete medical evaluation for TB must include •a medical history, •a physical examination, •a chest X-ray, •microbiological smears, and cultures. •It may also include a tuberculin skin test, •a serological test.

(Dead bacteria injected subcutaneously)Tuberculin skin test

measuring the diameter of indurationTuberculin skin test

TB prevention and control takes two parallel approaches. First, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. second approach, children are vaccinated to protect them from TB. No vaccine is available that provides reliable protection for adults. However, in tropical areas where the levels of other species of mycobacteria are high, exposure to nontuberculous mycobacteria gives some protection against TB. VaccinesMany countries use Bacillus Calmette-Guérin (BCG) vaccine as part of their TB control programmes, especially for infants

Tuberculosis treatment :refers to the medical treatment of the infectious disease tuberculosis (TB). Active tuberculosis will kill about two of every three people affected if left untreated Treated tuberculosis has a mortality rate of less than 5%.The standard "short" course treatment for TB is isoniazid, rifampicin (also known as rifampin in the United States), pyrazinamide, and ethambutol for two months, then isoniazid and rifampicin alone for a further four months. The patient is considered cured at six months (although there is still a relapse rate of 2 to 3%). For latent tuberculosis, the standard treatment is six to nine months of isoniazid alone.If the organism is known to be fully sensitive, then treatment is with isoniazid, rifampicin, and pyrazinamide for two months, followed by isoniazid and rifampicin for four months. Ethambutol need not be used