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1. PULMONARY
TUBERCULOSIS (TB)
Presented by
ASER MOHAMED KAMAL

2. Pulmonary tuberculosis (TB)
 DEF:Tuberculosis is the infectious disease primarily
affecting lung parenchyma is most often caused by
mycobacterium tuberculosis.it may spread to any part
of the body including meninges,kidney,bones and
lymphnodes.
 It’s the one of the most prevalent infections of
human beings and cotnributes considerably to
illness and death around the world . It is spread by
inhealing tiny droplets of salaiva from the coughs
or sneezes of an infected person . It is slowly
spreading ,chronic , granulomatus bacterial
infection charactarized by gradual wieght loss

3. MYCOBACTERIUM
TUBERCULI

4. TYPES
 PULMONARY TUBERCULOSIS
 AVIAN TUBERCULOSIS( MICROBACTERIUM AVIUM
;OF BIRDS)
 BOVINE TUBERCULOSIS(MYCOBACTERIUM BOVIS
;OF CATTLE)
 MILIARY TUBERCULOSIS / DISSEMINATED
TUBERCULOSIS

5. CLASSIFICATION
 Class I (TB exposure)
 (+) exposure
 (-) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) chest radiograph

6. CLASSIFICATION
 Class II (TB infection)
 (±) exposure
 (+) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) chest radiograph

7. CLASSIFICATION
 Class III (TB disease)
 Has three or more of the ff. criteria
 (+) history of exposure to an adult/adolescent with active TB
disease
 (+) Mantoux tuberculin test
 (+) signs and symptoms suggestive of TB
 Cough/wheezing > 2 weeks; fever > 2 weeks
 Painless cervical and/or other lymphadenopathy
 Poor weight gain; failure to make a quick return to normal after
an infection (measles, tonsillitis, whooping cough) or failure to
respond to approriate antibiotic therapy (pneumonia, otitis media)
 Abnormal Chest radiograph
 Laboratory findings suggestive of TB (histological, cytological,
biochemical, immunological or molecular)

8. CLASSIFICATION
 Class IV (TB inactive)
 A child/adolescent with or without history of
previous TB and any of the ff:
 (±) previous chemotherapy
 (+) radiographic evidence of healed/calcified TB
 (+) Mantoux tuberculin test
 (-) signs and symptoms suggestive of TB
 (-) smear/culture for M. tuberculosis

9. INCIDENCE
 With the increased incidence of AIDS, TB has
become more a problem in the U.S., and the world.
 It is currently estimated that 1/2 of the world's
population (3.1 billion) is infected with
Mycobacterium tuberculosis
 Global Emergency Tuberculosis kills 5,000 people
a day
 2.3 million die each year

10. ETIOLOGY
 Mycobacterium tuberculosis
 Droplet nuclei(coughing,sneezing,laughing)
 Exposure to TB

11. Risk Factors
1. Age: infants and adolescents are at highest risk
of disease
2. Close contact with an untreated sputum positive
patient
3. Impaired host defenses: immunodeficiency
states, particularly that associated with HIV
infection; immunosuppression related to
accompanying viral infection, or drug induced;
malnutrition.
4. Other disease staes: Hodgkin’s lymphomas,
diabetes mellitus, leukemia, malignancy (head
and neck) severe kidney disease, silicosis,
prolonged treatment with corticosteroids

12. Risk Factors
5. Persons whose tuberculin skin test results
converted to (+) In the past 1-2 years.
6. Persons who have CXR suggestive of old TB.
7. IMMUNO COMPROMISED STATUS
(ELDERLY,CANCER).
8. DRUG ABUSE AND ALCOHOLISM.
9. PEOPLE LACKING ADEQUATE HEALTH CARE.
10. IMMIGRANTS FROM COUNTRIES WITH HIGHER
INCIDENCE OF TB.
11. INSTITUTIONALISATION(LONG TERM CARE
FACILITIES).

13. PATHOPHYSIOLOGY
 (INITIAL INFECTION OR PRIMARY INFECTION)
 ENTRY OF MICRO ORGANISM THROUGH DROPLET NUCLEI
 BACTERIA IS TRANSMITTED TO ALVEOLI THROUGH AIRWAYS
 DEPOSITION AND MULTIPLICATION OF BACTERIA
 BACILLI ARE ALSO TRANSPORTED TO OTHER PARTS OF THE BODY THROUGH
BLOOD STREAM AND LYMPHNODE
INFLAMMATION

14. PATHOPHYSIOLOGY
 PHAGOCYTOSIS BY NEUTROPHILS AND MACROPHAGES
 ACCUMULATION OF EXUDATE IN ALVEOLI
 BRONCHO PNEMONIA
 NEW TISSUE MASSES OF LIVE AND DEAD BACILLI ARE SURROUNDED BY
MACROPHAGES WHICH FORM A PROTECTIVE MASS AROUND GRANULOMAS
 GRANULOMAS THEN TRANSFORMS TO FIBROUS TISSUE MASS AND CENTRAL
PORTION OF WHICH IS CALLED GHON TUBERCLE

15. PATHOPHYSIOLOGY
 THE MATERIAL (BACTERIA AND MACROPHAGES
BECOMES NECROTIC FORMING CHEESY MASS
 MASS BECOMES CALCIFIED AND BECOMES COLAGENOUS SCAR
 BACTERIA BECOME DORMANT AND NO
FURTHER PROGRESSION OF ACTIVE DISEASE
 (ACTIVE DISEASE OR RE INFECTION)
 INADEQUATE IMMUNE RESPONSE
 ACTIVATION OF DORMANT BACTERIA

16. PATHOPHYSIOLOGY
 GHON TUBERCLE ULCERATES AND RELEASING CHEESY MATERIAL INTO BRONCHI
 BACTERIA THEN BECOME AIRBORNE RESULTING IN FURTHER SPREAD OF INFECTION
 ULCERATED TUBERCLE HEALS AND BECOMES SCAR TISSUE
 INFECTED LUNG BECOME INFLAMMED
 FURTHER DEVOLOPMENT OF PNEUMONIA AND TUBERCLE FORMATION
 UNLESS THE PROCESS IS ARRESTED IT SPREADS DOWNWARDS TO THE HILUM OF LUNGS
AND LATER EXTENDS TO ADJASCENT LOBES

17. CLINICAL MANIFESTATIONS
CONSTITUTIONAL SYMPTOMS
 Anorexia
 Low grade fever
 Night sweats
 Fatique
 Weight loss
PULMONARY SYMPTOMS
 Dyspnea
 Non resolving bronchopneumonia
 Chest tightness
 Non productive cough
 Mucopurulent sputum with hemoptpysis
 Chest pain
EXTRA PULMONARY SYMPTOMS
 Pain
 Inflammation

18. ASSESSMENT AND DIAGNOSTIC
FINDINGS
 HISTORY COLLECTION
 PHYSICAL EXAMINATION
 Clubbing of the fingers or toes (in people with advanced disease)
 Swollen or tender lymph nodes in the neck or other areas
 Fluid around a lung (pleural effusion)
 Unusual breath sounds (crackles)
 IF MILIARY TB;
 A physical exam may show:
 Swollen liver
 Swollen lymph nodes
 Swollen spleen

19. ASSESSMENT AND DIAGNOSTIC
FINDINGS
Tests may include:
 Biopsy of the affected tissue (rare)
 Bronchoscopy
 Chest CT scan
 Chest x-ray
 Interferon-gamma release blood
test such as the QFT-Gold test
to test for TB infection
 Sputum examination and cultures
 Thoracentesis
 Tuberculin skin test (also called a PPD test)

20. QUANTIFERON GOLD TEST
 QFT-Gold test measures interferon-gamma in
the testee's blood after incubating the blood
with specific antigens from M. Tuberculosis
proteins

21. COMPLICATIONS
 Bones. Spinal pain and joint destruction may result
from TB that infects your bones(TB spine or potss
spine)
 Brain(meningitis)
 Liver or kidneys
 Heart(cardiac tamponade)
 Pleural effusion
 Tb pneumonia
 Serious reactions to drug therapy(hepato
toxicity;hypersentivity)

22. MEDICAL MANAGEMENT
 PULMONARY TB is treated primarily with antituberculosis agents
for 6 to 12 months.
 Pharmacological management
 Streptomycin 15mg/kg
 Isoniazid or INH(Nydrazid) 5 mg/kg(300 mg max perday)
 Rifampin 10 mg/kg
 Pyrazinamide 15 – 30 mg/kg
 Ethambutol(Myambutol) 15 -25 mg/kg daily for 8 weeks and
continuing for up to 4 to 7 months

23. MEDICAL MANAGEMENT
 Capreomycin 12 -15 mg/kg
 Ethionamide 15mg/kg
 Paraaminosalycilate sodium 200 -300 mg/kg
 Cycloserine 15 mg/kg
 Vitamin b(pyridoxine) usually adminstered with INH


24.  Other drugs that may be useful, but are not on the
WHO list of SLDs:
 Rifabutin
 Macrolides:e.g.,clarithromycin (CLR)
 Linezolid(LZD)
 Thioacetazone(T)
 Thioridazine
 Arginine

25. MULTIDRUG THERAPY
 Multiple-drug therapy to treat TB means taking
several different antitubercular drugs at the same
time.
 The standard treatment is to take isoniazid,
rifampin, ethambutol, and pyrazinamide for 2
months. Treatment is then continued for at least
4months with fewer medicines

26. Prevention
 ISOLATION
 Ventilate the room
 Cover the mouth
 Wear mask
 Finish entire course of medication
 vaccinations

27. CONCLUSION