INTRODUCTION
it is communicable disease
suffered by all ages.hippocrates
called this disease as phithesis.in
1882 robert koch discovered
tubercle bacillus.in 1907,von
pirquet discovered tuberculin
test .
DEFINITION:
Tuberculosis (TB) is caused by
infection with Mycobacterium
tuberculosis (MTB), which is part
of a complex of organisms
including M. bovis (reservoir
cattle) and M. africanum
PREVALENCE:
The incidence of tuberculosis {per
100,000} people in Nepal was reported
at 163.19 in 2008.
Current estimates suggest that around
one-third of the world's population has
latent tuberculosis .
The majority of these cases are likely to
occur in the world's poorest
In the United States, approximately
14000 cases of tuberculosis . The
prevalence of tuberculosis is
continuing to increase because of
the increased number of patients
infected with HIV and the growing
numbers of the homeless
ETIOLOGY:
Mycobacterium tuberculosis
IT includes 4 other TB-causing
mycobacteria:
M. bovis,
M. africanum,
M. canetti and
M. microti
RISK FACTOR
Developed countries
Immigration from high-prevalence
areas
Human immunodeficiency virus (HIV)
Increasing proportion of elderly
Social deprivation
Drug resistance
DEVELOPING COUNTRIES
Ineffective control programmed
Lack of access to health care
HIV
Drug resistance
MODE OF TRANSMISSION
TYPES:
PATHOPHYSIOLOGY
pathophysiology
DIFFERENT TYPES OF TB
Primary pulmonary TB.
(1) Spread from the primary focus to
hilar and mediastinal lymph glands
to form the 'primary complex', which
in most cases heals spontaneously.
(2) Direct extension of the primary
focus-'progressive PTB.
(3) Spread to the pleura-tuberculous
pleurisy and pleural massive spread-
miliary tuberculosis and meningitis
effusion. (4) Blood-borne spread: few
bacilli-pulmonary, skeletal, renal,
genitourinary infection often months
or years later;
FEATURES OF PRIMARY TUBERCULOSIS
Infection (4-8 weeks)
Influenza-like illness
Skin test conversion
Primary complex
DISEASE:
Collapse (especially right
middle lobe)
Consolidation (especially right
middle lobe)
Obstructive emphysema
Cavitation (rare)
CAVITATION
Pleural effusion
Miliary
Endobronchial
Meningitis
Pericarditis
CRYPTIC TB
Age over 60 years
Hypersensitivity
Erythema nodosum
Phlyctenular conjunctivitis
Dactylitis Pyrexia of unknown region
Unexplained weight loss, general
debility (hepatosplenomegaly in
25-50%) Blood dyscrasias; leukaemoid
reaction, pancytopenia
MILIARY TUBERCULOSIS:
It is due to dessemination of
tubercle bacilli via the blood
stream.it may present loss opf
weight,fever,hepatospleenomeg
aly,choroidal tubercle seen in
the eyes,
Chest x ray :miliary shadow 1-
2mm in diameter seen,the lesion
can increase size upto 5-10mm ,
CT Scan-lung parenchymal
abnormalities
ADULT POST PRIMARY TB:
gradual onset of symptoms over
weeks or months,anorexia ,
weight loss,fever,cough,sputum
may be mucoid,purulent or
blood stained,finger clubbing
). The presence of a miliary
pattern or cavitation indicates
active disease . In extensive
disease, collapse may be marked
and result in significant
displacement of the trachea and
mediastinum.
DIAGNOSTIC EVALUATION: Mantoux test:
RESULT FINDING IF POSITIVE
CHEST X RAY-
STAINING: Sputum is stained with
ziehl-neelsen stain for acid and
alcohol fast bacilli
FIBEROPTIC BRONCHOSCOPY:
Washing of the affected lobes if no
sputum is available
Biopsies of the pleura, lymphnodes
and solid lesions within the lungs
TREATMENT Direct observed therapy short course :
Special clinic are are used to supervise the
treatment regimen directly
5 COMPONENTS :
Political and administrative components
Good quality diagnosis
Good quality drug
Direct observed tx
Monitoring and accountability
DOTS programmed has so far been
introduced in 27 of the 75 district
where the anti TB programmed is
being implemented by the
government. A special programmed
called Kathmandu valley coalition
against tuberculosis has been
launched{KV-CAT}
DRUGS
FIRST LINE ANTI –TUBERCULOSIS DRUG
1} ISONIAZID
MODE OF ACTION: cell wall synthesis
MAJOR ADVERSE REACTION: Peripheral
neuropathy,hepatitis,rash.
LESS COMMON REACTION: Lupoid
reaction, seizure, psychosis
RIFAMPICIN:
Mode of action: DNA
transcription
Major adverse reaction: febrile
reaction, hepatitis and rash
Less common reaction: nephritis,
thrombocytopenia
Pyrazinamide Mode of action:
Major adverse reaction:
hepatitis,hyperuricaemia L.a.r: rash , gout
Streptomycin :
Mode of action: protein synthesis
Major adverse reaction: 8th nerve
damage and rash
Less adverse reaction:
nephrotoxicity and granulocytosis
Ethambutol:
Mode of action: cell wall synthesis
M.A.R: retrobular neuritis,antralgia
L.C.R: Peripheral neuropathy,rash
THERAPEUTIC INTERVENTION:
Multiple antituberculin drugs for 8 weeks
in the initial treatment phase, followed by
4-7 months continuation phase.
Bed rest
INH for 6-12 months to immediate contact
High carbohydrate,high protein,high
vitamin diet with supplemental vit b6 to
counter INH side effect