Tuberculosis

Pathology
inhalation of aerosols

recruitment of macrophages and lymphocytes

langerhans and epitheloid cells which gives the typical tuberculous

granuloma

ghon focus

clinical features
pulmonary

primary pulmonary tb

miliary tb

post primary tb

person who has been sensitized earlier

extrapulmonary

lymphadenitis

matting and formation of collar stud abscess

pleural tb

pleural fluid analysis reveals - lymphatic exudate with low glucose and
ph

gastrointestinal

right iliac fossa mass

pericardial

central nervous system

bone and joint disease

pott disease

genitourinary

Investigations
chest xray

direct sputum smear

 2 samples

early morning

on spot

light emiting diode fluoroscent microscopy

zheil neelson

culture

naat

Cephid GeneXpert MTB/Rif

drug sensitivity testing

diagnosis
pulmonary

sputum

brochoscopy w/ washings or BAL

gastric washing (mainly for children)

extrapulmonary

fluid examination (csf, ascitis, pleural, pericardial, joint)

tissue biopsy - bone marrow or liver may be used as diagnositic in

disseminated disease

diagnostic tests done

stain - auramine fluoresence, zn staining

nucleic acid amplification

culture - solid (loweninstein jensen, middlebrook), liquid (MGIT)

pleural fluid - adenosine deaminase

respomse to empirecal anti tubercular drugs

Baseline blood tests

cbc

crp

urea and electrolytes

lft

Management
 chemotherapy
6 months of treatment is sufficient for all pulmonary and extrapulmonary tb

but 12 months of treatment is needed in cns tb

ethambutol must be used with caution

intensive

HRZE- 2

daily

continuous phase

HR -4

HRE - 4

in countries w/ high level of resisance to isoniazid

control and prevention

latent tb infection

drug moa and adr

H

cell wall synthesis

peripheral neuropathy, hepatitis, rash

DNA transcription

febrile reactions, hepatitis, rash, gastrointestinal disturbance

unknown

hepatitis, gi disturbance, hyperuracemia

cell wall synthesis

rash, photosensitization, gout