“A day is not wasted, If a

memory is made”
-Anonymous
 Challenge : HIV co infection.
 WHO declared the disease as global emergency.
 Tuberculosis : From the word “Tubercle”, Necrotizing
bacterial infection of mostly lungs and other organs .
 Transmission :Aerosolized droplet nuclei .
 Transmission depends on
intimacy & duration.
 Infection to be differentiated
from disease.
Associated risk

HIV co-infection
Chronic
Diabetes mellitus
renal failure

Chronic Endogenou
Lymphoma
lung disease s factors
Incidence
 Late Adolescence
 Early Adulthood.
 Age groups : Women are more to be infected than
men at an age 25-34 .
 Opposite is true in old age.
Classification

Primary
disease
Pulmonary
disease
Post primary
Tuberculosis disease

Extra
pulmonary Other organs
disease
 Clinical picture
Fact : Before HIV, 80 % Tb was limited to lung
Today, 2/3rd of HIV infected patient’s have both
pulmonary & extra pulmonary or extra pulmonary
alone. Why??
 Why infections of right lung are more common?

 Pulmonary tuberculosis.
 Pulmonary Tuberculosis
 Primary disease : Initial infection
 Common in children.
 Localised to middle & lower zones .
 Hilar & paratracheal lymphadenopathy : Not detectable
on chest radiograph.
 Evident ghon lesion .
 Primary pulmonary tb progresses in impaired immunity
involving …
Pulmonary tuberculosis lesion
Complications

Tuberculous
Pleural effusion
empyema
Miliary tb or
Progressive primary
tuberculous meningitis
tuberculosis
.
Hilar/mediastinal
Enlarged lymph nodes.
lymphandenopathy
Chest Radiography

Primary tuberculosis Consolidation & Pleural effusion

Primary progressive tuberculosis
 Post primary disease
 Endogenous reactivation of latent infection.
 Adult type.
 Localized to apical & posterior segments of upper lobe.
 Satellite lesions.
 Tuberculous pneumonia.
 Clinical findings
Fever With night Malaise & Intermittent &
sweats ,Weight loss, Weakness. Low grade.
Anorexia

Cough Initially non Later with purulent

productive . sputum.

Massive Erosion of fully Rasmussen’s

haemoptysis patent vessel . aneursym.

Pleuritic chest pain

Dyspnea & ARDS In extensive disease.
Chest examination Classical amphoric
breath sounds.

Haematologic study Mild anaemia . Leucocytosis.

 Pulmonary Tuberculosis in AIDS
 Person with skin test M.tb infection
who acquires HIV has 3-15 % risk
of active tuberculosis.
 HIV attaks the critical immnune mechanism

involved against tuberculosis.

Early Late

Tuberculin test Usually positive Usually negative

Adenopathy Unsual Common

Pulmonary distribution Upper lobe Middle & Lower lobe.

Cavitation Present Typically absent.

Extra pulmonary disease 10 % of cases 50 % of cases.

CT-Scan:Immuno compromised patient
Extra pulmonary tuberculosis

Lymph Bones
nodes &Joints
Pleura Meninges

Genitourinary tract Peritoneum

I. Lymph node tuberculosis
 Commonest presentation : > 25 % cases.
 Frequent in any HIV infected patients.

 Cervical & supraclavicular lymph nodes

involved with painless swelling.

 Differential diagnosis

Neoplastic disease - lymphoma.

 II. Pleural tuberculosis
 Involvement of pleura in primary tuberculosis.
 Extent of reactivity : Effusion may be small or large

enough to cause pleuritic chest pain & Dyspnea.

 Physical findings : Dullness to percussion &

Absence of breath sounds.

 Chest radiograph : Effusion & Parenchymal lesion.

 Tb of upper airways :Advanced.

 Symptoms :Hoarseness, Dysphagia

with chronic productive cough.

 III. Genitourinary tuberculosis
 Accounts for 15 % .
 Involves any portion of genitourinary tract.

 Symptoms : Urinary frequency,Dysuria,

Haematuria & Flank pain.

 Commonly diagnosed in females than males.

Females Males

Affects fallopian tubes. Affects Epididymis

Endometrium . Orchitis

Menstraul abnormalities & Prostitis .

Infertility .
 IV. Skeletal tuberculosis.
 Accounts for 8 -9 % .
 Reactivation of hematogenous foci or paravertebral
lymph nodes.
 Weight bearing joints: Spine- Hips & Knees involved.
 Pott’s disease & It’s catastrophic complication is
paraplegia.
 Advanced disease causes kyphosis.
 Tb of hip joint : Pain & Limping.
 Tb of knee : Pain & Swelling.
V. Tuberculous meningitis.
 Accounts for about 5 %
 In children & adults with HIV.
 Spread : Hematogenous spread or rupture of sub
ependymal tubercle into subarachnoid space.
 Chest radiography : Old pulmonary lesion or miliary
pattern.
 Symptoms : Head ache, Confusion,
Altered sensorium, Neck rigidity
 * Paresis of ocular nerves.
 * Cerebral arteries produce focal ischemia.
 * Hydrocephalus.
VI. Tuberculous peritonitis.
 Direct spread from ruptured lymph node or
hematogenous spread.
 Symptoms : Nonspecific abdominal pain, Fever &
Ascites.
 Coexistence of cirrhosis complicates the diagnosis.
Diagnosis
 AFB Microscopy
 Mycobacterial culture.
 Radiographic procedures.
 PPD skin testing.
 Drug susceptibility testing.
Differential Diagnosis.
 Aspiration pneumonia, Lung abscess.
 Actinomycosis & Nocardiosis.
 Mycotic infections.
 Carcinoma of lung.
 Pneumoconiosis.
 Bronchiectasis.
 Sarcoidosis.
Thank you