pulmonary tb
DESCRIPTION
What are the highlights on TB ,what to do to prevent or treatTRANSCRIPT
5/5/2010Khorfakkan hospital1
Highlights on
Pulmonary Tuberculosis
Prof. Dr. Saad S Al-AniSenior Pediatric ConsultantHead of Pediatric departmentKhorfakkan Hospital
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TB Diagnosis“The first rule of TB diagnosis: is to think of TB….”
Include TB in your differential diagnosis when history, symptoms are consistent with TB diagnosisOrder the appropriate diagnostic tests
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Pulmonary infectionsPredisposing factors
1.Decreased cough reflex
2.Injury to cilia
3.Decreased function of alveolar macrophages
4.Edema or congestion
5.Retention of secretions
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3.Progressive primary pneumonia Miliary dissemination (blood stream).
Pulmonary tuberculosis
Primary1.Single granuloma within parenchyma and hilar lymph nodes (Ghon complex).
2.Infection does not progress (most common).
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Secondary
Pulmonary tuberculosisCont.
•Infection (mostly through reactivation) in a previously sensitized individual
Pathology
•Cavitary fibrocaseous lesions
•Bronchopneumonia
•Miliary TB
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Typical Progression of Pulmonary tuberculosis
1.Pneumonia2.Granuloma formation with fibrosis
3.Caseous necrosis
4.Calcification
5.Cavity formation
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Pulmonary tuberculosis
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Acid-Fast (Kinyoun) Stain of Mycobacterium
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Mycobacterium Tuberculosis Stained with Fluorescent Dye
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Fibrocaseous
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Miliary
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GranulomaGranuloma
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MycobacteriumMycobacterium
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Not Everyone Exposed Becomes InfectedProbability of transmission depends on:
1.Infectiousness 2.Type of environment 3.Length of exposure
10% of infected persons will develop TB disease at some point in their lives
* 5% within 1-2 years* 5% at some point in their lives
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Treatment of TB Disease
Include four 1st-line drugs in initial regimen1.Isoniazid (INH)2.Rifampin (RIF)3.Pyrazinamide (PZA)4.Ethambutol (EMB)Never add a single drug to a failing regimen
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Barriers to Adherence
•Stigma
•Extensive duration of treatment
•Adverse reactions to medications
•Concerns of toxicity
•Lack of knowledge about TB
and its treatment
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Improving Adherence
•Adherence is the responsibility of the provider,
not the patient and can be ensured by:
-Patient education
–Directly observed therapy (DOT)
–Case management–Incentives/enablers
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Directly Observed Therapy (DOT)
*Health care worker watches patient swallow each dose of medication
*DOT is the best way to ensure adherence
•Should be used with all intermittent regimens
Reduces relapse of TB disease and acquired drug resistance
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Remember
“A decision to test
is
a decision to treat.”
Thank you