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Sathaporn Kunnathum 13 Jun 2010
Infection Tumor Bleeding disorder FB Medicine Destructive lung
Hemoptysis or Hematemesis
Tuberculosis (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.
Fever Hemoptysis Loss of appetite Weight loss Fatique Night sweats Chest pain
transmitted by airborne droplet nuclei(containin g tubercle bacilli )
droplet nuclei are capable of floating in the immediate environment for several hours Large particles may be inhaled by a person breathing the same air and impact on the trachea or wall of the upper airway
Laboratory and physical examinations
Chest radiography Sputum examination Tuberculin testing PCR test to detect
TB TB antibody testing bronchoscopy
Usually Dx from clinical, CXY and Sputum AFB
Chest radiography is the most important method to detect TB TB’s characteristics of a chest radiograph favor the diagnosis of tuberculosis as following :
(1) (2) (3) (4) (5) (6)
Involve mainly in the upper zone patchy or nodular infiltration cavity lesion. calcification. bilateral infiltration, especially if these are in the upper zones the persistence of the abnormal shadows without alteration in an x-ray repeated after several weeks this helps to exclude a diagnosis of pneumonia or other acute infection
acute milliary tuberculosis
Upper lung infiltrate
Chronic fibro-cavitary pulmonary tuberculosis
There are direct smear and culture Direct smear examination is only positive when large numbers of bacilli begin to be excreted
negative smear by no means excludes tuberculosis A negative smear in the presence of extensive disease and cavitation makes the diagnosis less likely. Particularly if the negatives are frequently repeated
A positive tuberculin test although it is of great use in children, but it has limited diagnostic significance in older age groups
A reaction of less than 5 mm is negative
5-9 mm is considered positive (+) 10-19 mm is considered positive (+ more than 20 mm is considered (+++)
Differential Diagnosis 34
Bronchiectasis may confused with chronic fibrocavenous pulmonary tuberculosis. They also have chronic cough, sputum production and hemoptysis. Usually we can use chest x-ray examination and CT scan to distinguish them.
Differential Diagnosis 34 Cavitary lung abscess often involves the
dorsal segments of the lower lobes and posterior segments of the upper lobes. Typically lung abscess causes litt1e in the way of physical findings, may have a air-fluid level, and is not associated with patchy bronchogenic infiltrates. In contrast, physical findings are prominent over tuberculous cavities, fluid levels are rare. And patchy infiltrates elsewhere are the rule.
Acute bacterial pneumonias may resemble florid tuberculosis in all particulars except for the sputum examination and response to antimicrobial drugs.
Neoplasm may resemble tuberculosis. As in an isolated coin lesion. ( An irregular cavity wall suggests necorotic neoplasm. )
Differential Diagnosis 45
Fever caused by some other diseases
Pneumothorax Bronchiectasis Empyema Extrapulmonary expansion Hemoptysis Chronic pulmonary heart disease
The critical issue in TB control is
adopting the DOTS (1995) ( Directly Observed Treatment, Short-course therapy; DOTS Strategy is recommended by the WHO TB Program.
WHO Category of treatment I 2IRZE + 4IR in general case II 2IRZES + IRZE + 5IRE in relapse and default
INH : hepatotoxicity
neuropathy Rifampicin : gastrointestinal upset, hepatitis Ethambutol : optic neuritis PZA : hepatotoxity Streptomycin : Ototoxicity, Renal toxicity
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
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