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Tuberculosis(TB)

Presented By

Out-patient department

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Outline

  • Definition
  • Incidence
  • Pathogenesis
  • Etiology
  • Risk factors
  • Signs and Symptoms
  • Diagnostic Investigation
  • Management
  • Prognosis
  • Complication

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Definition

  • A multisystemic disease
  • Has multiple presentations and manifestations
  • Caused by Mycobacterium tuberculosis
  • The lung is the most common site for the development of TB.
  • 85% of TB patients will have pulmonary complaints
  • Extrapulmonary TB occurs as part of primary or late generalized infection

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Incidence

  • 1/3 of the world’s population is thought to have been infected with M. Tuberculosis, with new infection occurring in about 1% of the population each year.
  • About 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5-10% of the united states population tests positive.
  • More people in the developing world contract tuberculosis because of a poor immune system, largely due to high rates of HIV infection and the corresponding development of AIDS.

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Incidence Cont.

  • About 90% of those infected with M. Tuberculosis have asymptomatic, latent TB infections with only 10% lifetime chance that the latent infection will progress to active tuberculosis disease.

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Pathogenesis

  • Infection occurs through exposure of the lungs or mucous membranes to infected aerosols having the M. tuberculosis.
  • The infection can be cleared by the host immune system
  • Suppressed into an inactive form(latent tuberculosis infection)

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Pathogenesis cont’d

  • Pulmonary TB occur in the lungs.
  • Extrapulmonary TB occur most commonly at:
  • Mediastinal, retroperitoneal and cervical lymph nodes
  • Vertebral bodies
  • Adrenals
  • Meninges
  • GI tract
  • The cause of tissue destruction is due to the ability of the organism to incite intense host immune reactions to the antigenic cell wall proteins
  • Large numbers of bacilli and weak host defences lead to exudative lesions which progress and spread if treatment is not given

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Etiology

  • Caused by Mycobacterium tuberculosis, a slow growing obligate aerobe
  • Humans are the only known reservoir and is spread by air borne aerosols
  • Mycobacteria invade local lymph nodes and spread to extrapulmonary sites

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Risk factors

  • Risk for developing TB is increased in (due to low immunity):
  • HIV patients
  • IV drug users
  • Alcoholism
  • Diabetes mellitus
  • Cancer patients
  • End stage kidney disease
  • Smokers
  • Malabsorption syndrome
  • Under 5 year old

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Symptoms

  • Pulmonary TB
  • Cough
  • Fever
  • weight loss/anorexia
  • Night sweats
  • Hemoptysis
  • Chestpain
  • fatigue

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Symptoms cont’d

  • Tuberculous meningitis
  • Headache
  • Altered mental state
  • Coma
  • Fever

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Symptoms cont’d

  • Skeletal TB( most common site is involvement of the spine known as Potts disease)
  • Backpain/stiffness
  • Lower extremity paralysis
  • Joint pain

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Symptoms cont’d

  • Genitourinary TB
  • Flank pain
  • Dysuria
  • Frequent urination
  • Painful scrotal mass
  • Prostatitis
  • Orchitis
  • Epididymitis
  • Pelvic inflammatory disease

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Symptoms cont’d

  • Gastrointestinal TB:
  • Non healing ulcer of the mouth
  • Difficulty swallowing
  • Abdominal pain
  • Malabsorption
  • Diarrhea
  • hematochezia

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Signs

  • Bronchial breath sounds
  • Crackles/rales
  • Confusion
  • Coma
  • Neurologic deficit
  • Lymphadenopathy
  • Cutaneous lesions

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Diagnostic Investigation

  • Screening with Mantoux tuberculin skin test
  • Sputum for Acid fast bacilli(AFB) and culture
  • HIV serology
  • Chest radiograph
  • CT scan of chest
  • Lumbar puncture in TB meningitis
  • Tissue biopsy

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Management

  • Combination of 4 drugs:
  • Isoniazid
  • Rifampicin
  • Pyrazinamide
  • Ethambutol
  • All 4 given for 2 months then isoniazid and rifampicin continued for 4 months in pulmonary tuberculosis.
  • Extrapulmonary tuberculosis is treated for 6-12 months depending on the clinical presentation.

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Management cont.

  • Admit severely ill patients.
  • Barrier nursing and isolation.
  • Counselling.
  • Encourage good nutrition.
  • Encourage adequate rest.

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Prevention

  • BCG immunization at birth.
  • Educate the people on the disease and the need for treatment compliance.
  • Prompt treatment of infected individuals.
  • Regular drug supply to ensure continuous treatment.
  • Avoid drinking raw or unpasteurized milk.
  • The mouth and nose should be covered when coughing or sneezing.

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Complication

  • Pneumothorax
  • Septic shock
  • Bronchiectasis
  • Respiratory failure
  • Lung cancer
  • Haemoptysis
  • Meningitis
  • Death

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References

  • Standard Treatment Guidelines, 2017 – MOH.
  • Dr. Esther Brako-Kwakye, Family Physician, Sunyani Regional Hospital.
  • https://wikipedia.com
  • National TB control programme.