Pulmonary tuberculosis Mumps virus

Human : M.tuberculosis “Major Agent 98%” Mumps virus

1- live in dark
Causative
agents

2- destroyed by sunshine - boiling

3- resistant outside until 20 hours
Cattle : M.bovis + Birds : M.avian “rare”
Reservoi

Human : case only and not any case ! Human : Case : clinical or subclinical
Case : open active case “ alveoli granuloma formed in lung by t.b bacilli raptured and Carrier : Incubatory “transient” for last few days of
r

sputum formation” IP
Animal : open active diseased cattle
Sputum of open active case cough sprays in human or cattle Saliva , love salivary gland especially parotid
Exit

Undetectable but when no t.b bacilli in sputum examination Last few of IP especially 2 last 2 days
P.O.C

Remember meningitis was also undetectable but with nasoph.. swab
Direct droplet either man or cattle sputum
MOT
Throughout course of disease especially first 4 days
2 days before + 4 days after onset of symptoms
Direct droplet
In direct ( droplet nuclei – dust – article & fomites )

In direct(air born) ( droplet nuclei – dust– article & fomites )

Verticle : utero-infection in first trimester before
placental formation cause congenital malformation
Hardly detectable 2-3 weeks average 18 days
IP

4:12 weeks from infection to formation of granuloma ‫بيظهر بعد اسبوعين وبيبقا كويس بعد اسبوعين‬
inlet

Respiratory airway Respiratory airway

Host : 1/age : less 5y in prescence of household case + more 15 y golden age 5:15 less Environment :overcrowding, poor housing, lack of
susceptibility

susceptible due to less exposure to environment and mental stresses hygiene etc
2/Sex : male more More exposure Agent : life long immunity
3/Non genetic but attributed to social status rather hereditary Host : age : children ,young adults 5:15
4/farmers-agricultural-silica industries 5/ malnutrition Sex : both are same
6/ chronic diseases 7/ race : related to sociodemographic factors
Environment : low socioeconomic.homeless. overcrowding no prober ventilation etc
1/ night fever, night sweating, loss of weight, cough then hemoptysis Non specific symptoms : prodromal stage ( 2 days )
2/ purulent sputum FAHM followed by swelling , tenderness & enlarged
CP

one or more salivary gland usually parotid : start at

one side few days then other side . slowly over 2
weeks
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licatio • lung fibrosis
Comp
HOPAA: Hearing loss – Orchitis – Pancreatitis – Aseptic
n • may spread to other parts : cns, kidneys, etc meningitis and Abortion
CP + lab diagnosis : CP + lab diagnosis :
diagnosis

Specific: sputum smear, culture of causative organism specific : throat swap & CSF culture
Non specific : 1-tuberculin test :purified protein derivative of tb intra dermal 2d .. P : serological test for igM (recentinfection) &
immunized either past infection,vaccination . N:‫العكس‬ IgG (old infection)
2-X ray to lung : suspected shadow
Very General : Health promotion , education , environmental sanitation General : Health promotion – education –
IMP Specific : vaccines : BCG 1-M.bovis 2-Intradermal 3-live attenuated 4-become active in environmental sanitation in droplet infection
‫ﻛﻠﮭﺎ‬ 3months “segregation is preferable” Specific : Vaccine : mono or triad (with
4- Single compulsory dose in Egypt in 1st 3months then after 2-3weeks show measles,rubella)
ulceration then scarring give immunity 7-10y 2/live attenuated 3/ Compulsory in Egypt at 1 year ,
prevention

5- Tuberculin test is obligatory before BCG when giving to adults as health workers 18 months with vitamin A 4/ SC
“unless hyper sensitivity if he has past infection or reactivation if dorminant” Adverse reaction : orchitis , fever parotitis
6- CI : immune suppression, pregnant .chronic Diseases Contraindication : pregnancy , immunosuppression ,
7- SE :if given wrong or SC: necrosis,suppuration,lymphadenitis,reactivation of debilitating condition
derminant infection Seroprophylaxis ( immunoglobulin )
Chemoprophlaxis: INH for High risk contacts :1/when tuberculin + Hyperimmune serum is available.
2/when tuberculin – and giving BCG but recently converters Given to high-risk contacts post exposure as
pregnant and young adult .2 It may be given to cases
especially adults
Case: finding”most IMP ask now ”-notification-isolation in fever hospital -disinfection Case: finding-notification-isolation 9d -disinfection
concurrent, terminal- ttt: directly observed treatment of short course DOTS concurrent, terminal- treatment : symptomatic-
“supervision when swallow treatment” 1st phase 3anti tb drugs and 2drugs in 2nd release after recovering from symptoms or parotid
phase.. success 90% -release -rehabillitate swelling
Contacts: enlistment + clinical investigation Contacts: enlistment
control

surveillance to maximum IP +tuberculin +xray + sputum analysis:: ‫خايف منه‬ high ‫ عشان اتجنب فترة ال‬segregation for 9d : ‫خايف منه‬
specific : high risk contacts chemoprophlaxis : ‫خايف عليه‬ infectivity
If tuberculin - /Give BCG or combined with INH if recently converts … If tuberculin + specific : ‫خايف عليه‬
/Give INH protection by serooprophylaxis to high risk contact (
Case Finding /Most imp measure 1/ risk group as contacts,occupational no imp )
workers,chronic dis.. Community control
2/dangerous g:food handlers,teachers,baby sitter ‫مصيبة لو اتعدوا‬
NB / tuberculin then xray then sputum examination”most cost-effective”

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