The document provides information about tuberculosis (TB), including its definition, etiology, risk factors, classification, pathophysiology, diagnosis, and treatment. TB is caused by the bacterium Mycobacterium tuberculosis and usually affects the lungs. It can spread to other parts of the body. Risk factors include low socioeconomic status, crowded living conditions, HIV/AIDS, and malnutrition. Diagnosis involves examining symptoms, chest x-rays, and testing sputum samples for acid-fast bacilli. Treatment consists of a two-month intensive initial phase followed by a four-month continuation phase using multiple antibiotic drugs.
5. Definition
Cough is physiological protective
mechanism which is characterized
by explosive expectoration
following a deep inspiration. Its
function is to clear the
tracheobronchial tree of excessive
secretions and foreign body.
8. Cough History
● Acute
○ Less than 3 wk
○ Aspiration, Inhalation of noxious chemical or smoke
● Sub-acute
○ 3-8 wk
○ Tracheobronchiti-spertussis
○ post viral tussive syndrome
● Chronic
○ More than 8 wk
○ Cardiopulmonary d’s
○ Inflammatory
○ Infectious
○ neoplastic and cardiovascular etiology
9. Cough History
● Acute cough occurring in context of more serious disease such as
pneumonia, aspiration, CHF, pulmonary embolism is usually easy
to diagnose due to the presence of other clinical features.
● Cough of less than 8 wk duration may be the early manifestation of
a disease causing chronic cough.
● Chronic cough with a normal chest radiograph
○ Cough variant asthma
○ Gastro-esophageal reflux
○ Post-nasal drainage
○ Medication (ACE inhibitor)
13. TUBERCULOSIS
● Is the most prevalent communicable infectious disease
on earth and remains out of control in many developing
nations
● It is a chronic specific inflammatory infectious disease
caused by Mycobacterium tuberculosis in humans
● Usually attacks the lungs but it can also affect any parts
of the body
● Also Known as “ KOCH’s Disease”, “wasting disease”
and the “white plague.”
14. ETIOLOGY
● MYCOBACTERIUM TUBERCULOSIS
○ It presents either
■ as latent TB infection (LTBI) or
■ as progressive active disease.
○ typically causes progressive destruction of the lungs,
death in most patients (do not receive treatment)
15. CHARACTERISTICS OF M. TUBERCULOSIS
● Rod shaped,
● 0.2-0.5 µ in D, 2-4 µ in L
● Mycolic acid present in its cell
wall,
● makes it acid fast
● It resists decolourization with
acid & alcohol
● Aerobic and non motile
● It multiplies slowly, can
remain
● dormant for decades
16. Main species of mycobacterium causing tuberculosis:
TYPICAL MYCOBACTERIA
Mycobacterium
tuberculosis
Mycobacterium hominis
Mycobacterium bovine
ATYPICAL MYCOBACTERIA
Saprophytic mycobacteria
Mycobacterium avium
18. RISK FACTORS OF TUBERCULOSIS
Low socioeconomic status
Crowded living conditions
Diseases that weakens immune
system like HIV
Person on immunosuppressant like steroid
Health care workers
Migration from a country with a high number
of cases
Alcoholism
Recent Tubercular infection
(within last 2 years)
19. CO-INFECTIONWITH
HUMAN IMMUNODEFICIENCYVIRUS (HIV)
● HIV is the most important risk factor for active TB,
because the immune deficit prevents patients from
containing the initial infection
● Coinfection with HIV
○ Accelerates the progression of both diseases
○ Requiring rapid diagnosis and treatment of both
diseases
21. Classification of TB
TB
Pulmonary (85-90%) Extra-pulmonary (10-15%)
Sputum
PositiveTB
(Those who
have bacteria
in sputum)
Sputum
NegativeTB
(Those who do
not have
bacteria in
sputum)
Lymph Nodes
Bones & Joints
Genitourinary tract
Meninges
Intestines
Skin
22. Typeof tuberculosis infection
Pulmonary TB :
1. PRIMARY TUBERCULOSIS :
The infection of an individual who has not been previously infected or
sensitized is called Primary tuberculosis or Ghon’s complex or childhood
tuberculosis.
2. SECONDARY TUBERCULOSIS :
The infection that individual who has been previously infected or
sensitized is called secondary or post primary or reinfection or chronic
tuberculosis.
23. Typeof tuberculosis infection
Pulmonary TB :
1. PRIMARY TUBERCULOSIS :
The infection of an individual who has not been previously infected or
sensitized is called Primary tuberculosis or Ghon’s complex or childhood
tuberculosis.
2. SECONDARY TUBERCULOSIS :
The infection that individual who has been previously infected or
sensitized is called secondary or post primary or reinfection or chronic
tuberculosis.
28. SYMPTOMSOFTB
Most common symptom of TB
• Cough for 2 weeks or more Other
symptoms of TB are:
• Fever, especially evening rise
• Pain in the chest
• Loss of weight
• Loss of appetite
• Coughing up blood-stained sputum
• Shortness of breath,
• Tiredness
31. History and Symptoms
Pulmonary Tuberculosis
In case of active tuberculosis, 75% of the
cases present with lung involvement.
Suspect Pulmonary tuberculosis in any
individual who has the following
symptoms:
● Cough (most common symptom)
○ Initially dry cough which
progresses to productive.
○ Persistent cough, often for more
than three weeks.
● Fever
● Night sweats
● Unexplained weight loss
● Hemoptysis
● Chest pain
● Anorexia
● Malaise
● Chills
● Fatigue
● Dyspnea
● Lymphadenopathy
39. SPUTUM EXAMINATION
● Essential to confirm TB
● Best collected in morning before any meal
● Stained with ziehl-neelson technique
40. Acid Fast Bacilli “AFB” Smear Test
Specimen examined for acid fast bacilli by staining:
Ziehl-neelsonAcidFast
Staining
41. Tuberculin skin Test / Mantoux test / PPD test
● Standard method for screening & measuring of a person’s Cellular
response.
● Measuring the size of induration 48-72 hours
42. Tuberculin skin Test / Mantoux test / PPD test
● Positive If ≥ 10 mm Induration Size.
43. Positive Reaction
● Person infected in the past or latent TB infection.
● After BCG vaccination, but this may last for only 3-7 years
45. Tahapan pengobatan TB
Tahap awal
● Pengobatan tahap awal pada semua pasien baru, harus diberikan
selama 2 bulan
● Secara efektif menurunkan jumlah kuman yang ada dalam tubuh
pasien
Tahap lanjutan
● membunuh sisa-sisa kuman yang masih ada dalam tubuh,
khususnya kuman persisten
● Durasi tahap lanjutan selama 4 bulan
47. ● Pasien tinggal di daerah dengan prevalensi tinggi resisten
isoniazid
● Terdapat riwayat kontak dengan pasien TB resistan obat >
cenderung memiliki pola resistensi obat yang sama dengan kasus
sumber
48. ● Paduan obat standar pasien TB kasus baru (dengan asumsi atau
diketahui peka OAT)
57. References
1. Kementerian Kesehatan Republik Indonesia.Strategi Nasional Penanggulangan Tuberkulosis di Indonesia
2020- 2024
2. Terracciano E, Amadori F, Zaratti L, Franco E. [Tuberculosis: an ever present disease but difficult to
prevent]. Ig Sanita Pubbl. 2020 Jan-Feb;76(1):59-66. [PubMed]
3. Adler Y, Charron P, Imazio M, et al. 2015 ESC Guidelines for the diagnosis and management of pericardial
diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European
Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS).
Eur Heart J 2015; 36: 2921-64.
4. Ahmad S. Pathogenesis, Immunology, and Diagnosis of LatentMycobacterium tuberculosisInfection. Clinical
and Developmental Immunology 2011; 2011: 1-17.
