PULMONARY TUBERCULOSIS

Incidence

 6% of annually reported tuberculosis cases are in

children younger than 15 years of age .

 Risk factors :
- Age younger than 5 years
- Black race or ethnic groups
- Living in urban area
- Immunocompromised or having chronic illness
 Etiology & pathogenesis

 Mycobacterium tuberculosis
 Transmitted via mucous droplets from symptomatic patient .
 Following infection , all children have an asymptomatic IP
( 3-4 weeks ) .

 The primary lesion occur in the lung , involving the parenchyma &
regional lymph nodes .
 If immunocompromised ; hematogenous spread of bacilli leads to

extrapulmonary disease ( TB meningitis & miliary TB )

** TB meningitis may lead to brainstem abscess .
 Clinical features

Latent TB Active TB

TB bacteria are asleep in your body - TB bacteria are awake -

Asymptomatic -
You cannot pass TB to others -
Only +ve ( tuberculin skin test or -
blood test “IGRA” )
Treated with one drug -
 You will have symptoms -
You can pass TB to others -
It shows up on a chest x-ray if you -
have TB in the lungs
Treated with four or more medicines -
over at least six months
 Active tuberculosis disease

 Pulmonary disease :
- Clinical & radiographical evidence of infection
- Cough > 4 weeks , intermittent fever , weight loss
- Parenchymal or Ghon focus with enlarged regional lymph nodes
on x-ray

 Extrathoracic disease :
- Meningitis ( the most sever form , more in young children )
- Scrofula ( the most common form , lymphadenitis of superficial LN with
nonhealing ulcers above the LN )

* The M.C cranial nerves affected in TB meningitis are 3rd , 6th , 7th
 Diagnosis

 Clinical features ( cough >4 weeks , fever , wt loss ) with 3 of

the following :

* Positive tuberculin skin test

* X-ray findings
* Positive acid-fast bacilli smear
* IGRA (Interferon Gamma Release Assay )
* History of contact with the disease
* Live in area endemic with TB
 Tuberculin skin test
(Mantoux tuberculin test)
 Is done to see if you have ever been exposed to TB ( screening
test )
* The test is done by putting a small amount of purified protein derivative (PPD)
under the top layer of skin on your inner forearm. If you have ever been
exposed to the TB bacteria your skin will react to the antigens by developing
a firm red bump at the site within 2 days.
• +ve test if :
Induration 15mm or more (in child > 4 years with no risk factors)
Induration 10 mm or more ( in child < 4 years with chronic
medical condition or at risk for exposure )
Induration 5mm or more ( immunocompromised , contact , or
has clinical evidence of infection including x-ray findings )
 Tuberculin skin test

 False positive test :

- Vaccination with BCG
- Infection with mycobacteria other than M.tuberculosis
- Improper technique

 False negative test :

- Immunodeficiency , HIV
- Disseminated TB ( miliary TB )
 IGRA ( TB blood test ) is the gold standard for TB Dx .
 Contact : means contact with any person taking anti-TB drugs
through out the last 2 years .
 Acid fast bacilli smear : ( sputum , bronchoalveolar lavage
or gastric lavage )

** BCG vaccine does not prevent pulmonary TB , it will decrease the risk
of developing TB meningitis and miliary TB .
 Treatment

 Latent TB : ( single drug )

 Isoniazid ( INH ) for 9 months , rifampin used when there is
contraindications for INH .

 Tuberculosis disease :
INH , rifampin , ethambutol and pyrazinamide for at least 6
months .
 TB drugs side effects
, Hepatotoxicity , peripheral neuropathy INH
GI Intolerance ( nausea , abdominal pain )

Hepatotoxicity Rifampin

Hepatotoxicity , hyperuricemia pyrazinamide

Optic neuritis Ethambutol