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TUBERCULOSIS
Tuberculosis (TB) is one of the most
prevalent infections of human beings and
contributes considerably to illness and
death around the world. It is spread by
inhaling tiny droplets of saliva from the
coughs or sneezes of an infected person.it
is a slowly
granulomatous
spreading,
bacterial
chronic,
infection,
characterized by gradual weight loss
2
the infectious
Tuberculosis is
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.
3
4
PULMONARYTUBERCULOSIS
AVIAN TUBERCULOSIS
(MICROBACTERIUM AVIUM ; OF BIRDS)
BOVINE TUBERCULOSIS
(MYCOBACTERIUM BOVIS ; OF
CATTLE)
MILIARY TUBERCULOSIS /
DISSEMINATED TUBERCULOSIS
5
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
6
world's
infected
population (3.1 billion) is
with Mycobacterium
tuberculosis
Global Emergency Tuberculosis
5,000 people a day
2.3 million die each year
kills
Mycobacterium tuberculosis
Droplet Nuclei
(coughing,sneezing,laughing)
Exposure to TB
7
❑ CLOSE CONTACT WITH SOME ONE WHO HAVE
ACTIVE TB.
❑ IMMUNO COMPROMISED STATUS
(ELDERLY,CANCER)
❑ DRUG ABUSE ANDALCOHOLISM
❑ PEOPLE LACKING ADEQUATE HEALTH CARE
❑ PRE EXISTING MEDICAL CONDITIONS (DIABETES
MELLITUS,CHRONIC RENAL FAILURE)
❑ IMMIGRANTS FROM COUNTRIES WITH HIGHER
INCIDENCE OF TB.
❑ INSTITUTIONALISATION(LONG TERM CARE
FACILITIES)
8
❑ LIVING IN SUBSTANDARD CONDITIONS
❑ OCCUPATION(HEALTH CARE WORKERS)
9
(INITIAL INFECTION OR PRIMARYINFECTION)
ENTRY OF MICRO ORGANISM THROUGH DROPLET
NUCLEI
BACTERIA IS TRANSMITTED TO ALVEOLI THROUGH
AIRWAYS
DEPOSITION AND MULTIPLICATION OFBACTERIA
BACILLI ARE ALSO TRANSPORTED TO OTHERPARTS
OF THEF
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STREAMAND10
PHAGOCYTOSIS BY NEUTROPHILS AND
11
MACROPHAGES
ACCUMULATION OF EXUDATE INALVEOLI
BRONCHO PNEMONIA
NEW TISSUE MASSES OF LIVE AND DEADBACILLI
ARE SURROUNDED BY MACROPHAGES WHICHFORM
A PROTECTIVE MASS AROUND GRANULOMAS
GRANULOMAS THEN TRANSFORMS TO FIBROUS
TISSUE MASSAND CENTRALPORTION OFWHICH IS
CALLED GHON TUBERCLE
THE MATERIAL (BACTERIAANDMACROPHAGES
BECOMES NECROTIC FORMING CHEESYMASS
MASS BECOMES CALCIFIED AND BECOMES
COLAGENOUS SCAR
BACTERIA BECOME DORMANT AND NO FURTHER
PROGRESSION OF ACTIVEDISEASE
(ACTIVE DISEASE OR RE INFECTION)
INADEQUATE IMMUNE RESPONSE
ACTIVATION OF DORMANT BACTERIA
12
GHON TUBERCLE ULCERATES AND RELEASING CHEESY
MATERIAL INTO BRONCHI
BACTERIATHEN BECOME AIRBORNE RESULTING INFURTHER
SPREAD OF INFECTION
ULCERATED TUBERCLE HEALS AND BECOMES SCARTISSUE
INFECTED LUNG BECOME INFLAMMED
FURTHER DEVOLOPMENT OF PNEUMONIAANDTUBERCLE
FORMATION
UNLESS THE PROCESS IS ARRESTED IT SPREADS DOWNWARDSTO
THE HILUM OF LUNGS AND LATER EXTENDS TO ADJACENT LOBES
13
CONSTITUTIONAL SYMPTOMS
Anorexia
Low grade fever
Night sweats
Fatique
Weight loss
14
PULMONARYSYMPTOMS
Dyspnea
Non resolving bronchopneumonia
Chest tightness
Non productive cough
Mucopurulent sputum with hemoptpysis
Chest pain
EXTRA PULMONARYSYMPTOMS
Pain
Inflammation
15
HISTORYCOLLECTION
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)
16
IF MILIARYTB;
A physical exam may show:
Swollen liver
Swollen lymph nodes
Swollen spleen
17
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)
18
QFT-Gold test measures interferon-gamma in
the testee's blood after incubating the blood
with specific antigens from M. Tuberculosis
proteins
19
0.1 ML OF PPD IS INJECTEDFOREARM(SC)
AFTER 48-72 HRS CHECK FOR INDURATION A
T
THE SITE
IF INDURATION IS EQUAL TO AND MORE THAN
10MM
POSITIVE
20
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)
21
PULMONARY TB is treated primarily with
antituberculosis agents for 6 to 12 months.
Pharmacological management
First line antitubercular medications
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
22
Second line medications
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

23
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
24
DOTS (directly observed treatment, short-course), is the name given to the
World Health Organization-recommended tuberculosis control strategy that
combines five components:
25
1. Government commitment (including both political will at all levels, and
establishing a centralized and prioritized system of TB monitoring,
recording and training)
2. Case detection by sputum smear microscopy
3. Standardized treatment regimen directly observed by a healthcare worker
or community health worker for at least the first two months
4. A regular drugsupply
5. A standardized recording and reporting system that allows assessment of
treatment results
DOT is especially critical for patients with drug-
resistant TB, HIV-infected patients, and those on
intermittent treatment regimens (i.e., 2 or 3 times
weekly).
26
Multiple-drug therapy to treat TB means
taking several different antitubercular
drugs at the same time.
27
The standard treatment
isoniazid, rifampin, ethambutol,
is to take
and
pyrazinamide for 2 months. Treatment is
then continued for at least 4months with
fewer medicines
Assessment
Obtain history of exposure to TB
Assess for symptoms of active disease
Auscultate lungs for crackles
During drug therapy assess for liver
function
28
Ineffective breathing pattern related to pulmonary
infection and potential for long term scarring with
decreased lung capacity
Interventions
Administer and teach self administration of medications
ordered
Encourage rest and avoidance of exertion
Moniter breath sounds respiratory rates ,sputum
production and dyspnoea
Provide supplymental oxygen as ordered
Encourage increased fluid intake
Instruct about best position to facilitate drainage
29
Risk for spreading infection related to nature of
disease and patients symptoms
Be aware that TB is transmitted by respiratory
droplets
Use high efficiency particulate masks for high risk
procedures including endoscopy
Educate patient to control the spread of infection by
covering mouth and nose while coughing and
sneezing
Isolation of patient
Instruct about risk of drug resistance if drug
regimen is not strictly and continuosly followed
Carefully moniter vital signs and observe for
temperature changes
30
Imbalanced nutrition less than body
requirement related to poor appetite ,fatique
and productive cough
Explain the importance of eating nutritious diet to
promote healing and defense against infection
Provide small frequent meals
Moniter weight of the patient
Administer vitamin supplyments as ordered
31
Non compliance related to lack of motivation
and lack of treatment
Educate patient about etiology transmission and
effects of TB
Review adverse effects of drug therapy
Participate in observation of medicine
taking,weekly pill counts or programmes designed
to increase compliance with the treatment for TB
Explain that TB is a communicable disease and
that taking medications is most effective way of
preventing transmission
Instruct about medications schecule and side
effects
32
❑ ISOLATION
❑ Ventilate the room
❑ Cover the mouth
❑ Wear mask
❑ Finish entire course of medication
❑ vaccinations
33

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Pulmonary tuberculosis (1).pdf

  • 2. Tuberculosis (TB) is one of the most prevalent infections of human beings and contributes considerably to illness and death around the world. It is spread by inhaling tiny droplets of saliva from the coughs or sneezes of an infected person.it is a slowly granulomatous spreading, bacterial chronic, infection, characterized by gradual weight loss 2
  • 3. the infectious Tuberculosis is 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. 3
  • 4. 4
  • 5. PULMONARYTUBERCULOSIS AVIAN TUBERCULOSIS (MICROBACTERIUM AVIUM ; OF BIRDS) BOVINE TUBERCULOSIS (MYCOBACTERIUM BOVIS ; OF CATTLE) MILIARY TUBERCULOSIS / DISSEMINATED TUBERCULOSIS 5
  • 6. 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 6 world's infected population (3.1 billion) is with Mycobacterium tuberculosis Global Emergency Tuberculosis 5,000 people a day 2.3 million die each year kills
  • 8. ❑ CLOSE CONTACT WITH SOME ONE WHO HAVE ACTIVE TB. ❑ IMMUNO COMPROMISED STATUS (ELDERLY,CANCER) ❑ DRUG ABUSE ANDALCOHOLISM ❑ PEOPLE LACKING ADEQUATE HEALTH CARE ❑ PRE EXISTING MEDICAL CONDITIONS (DIABETES MELLITUS,CHRONIC RENAL FAILURE) ❑ IMMIGRANTS FROM COUNTRIES WITH HIGHER INCIDENCE OF TB. ❑ INSTITUTIONALISATION(LONG TERM CARE FACILITIES) 8
  • 9. ❑ LIVING IN SUBSTANDARD CONDITIONS ❑ OCCUPATION(HEALTH CARE WORKERS) 9
  • 10. (INITIAL INFECTION OR PRIMARYINFECTION) ENTRY OF MICRO ORGANISM THROUGH DROPLET NUCLEI BACTERIA IS TRANSMITTED TO ALVEOLI THROUGH AIRWAYS DEPOSITION AND MULTIPLICATION OFBACTERIA BACILLI ARE ALSO TRANSPORTED TO OTHERPARTS OF THEF r Be e Ot e m Dp l a Yt ef r To m Hw w Rw . b Or a i n Uy b e Gt t y . c Ho m BLO1 1 / 2 O2 / 2 D0 1 3 STREAMAND10
  • 11. PHAGOCYTOSIS BY NEUTROPHILS AND 11 MACROPHAGES ACCUMULATION OF EXUDATE INALVEOLI BRONCHO PNEMONIA NEW TISSUE MASSES OF LIVE AND DEADBACILLI ARE SURROUNDED BY MACROPHAGES WHICHFORM A PROTECTIVE MASS AROUND GRANULOMAS GRANULOMAS THEN TRANSFORMS TO FIBROUS TISSUE MASSAND CENTRALPORTION OFWHICH IS CALLED GHON TUBERCLE
  • 12. THE MATERIAL (BACTERIAANDMACROPHAGES BECOMES NECROTIC FORMING CHEESYMASS MASS BECOMES CALCIFIED AND BECOMES COLAGENOUS SCAR BACTERIA BECOME DORMANT AND NO FURTHER PROGRESSION OF ACTIVEDISEASE (ACTIVE DISEASE OR RE INFECTION) INADEQUATE IMMUNE RESPONSE ACTIVATION OF DORMANT BACTERIA 12
  • 13. GHON TUBERCLE ULCERATES AND RELEASING CHEESY MATERIAL INTO BRONCHI BACTERIATHEN BECOME AIRBORNE RESULTING INFURTHER SPREAD OF INFECTION ULCERATED TUBERCLE HEALS AND BECOMES SCARTISSUE INFECTED LUNG BECOME INFLAMMED FURTHER DEVOLOPMENT OF PNEUMONIAANDTUBERCLE FORMATION UNLESS THE PROCESS IS ARRESTED IT SPREADS DOWNWARDSTO THE HILUM OF LUNGS AND LATER EXTENDS TO ADJACENT LOBES 13
  • 14. CONSTITUTIONAL SYMPTOMS Anorexia Low grade fever Night sweats Fatique Weight loss 14
  • 15. PULMONARYSYMPTOMS Dyspnea Non resolving bronchopneumonia Chest tightness Non productive cough Mucopurulent sputum with hemoptpysis Chest pain EXTRA PULMONARYSYMPTOMS Pain Inflammation 15
  • 16. HISTORYCOLLECTION 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) 16
  • 17. IF MILIARYTB; A physical exam may show: Swollen liver Swollen lymph nodes Swollen spleen 17
  • 18. 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) 18
  • 19. QFT-Gold test measures interferon-gamma in the testee's blood after incubating the blood with specific antigens from M. Tuberculosis proteins 19
  • 20. 0.1 ML OF PPD IS INJECTEDFOREARM(SC) AFTER 48-72 HRS CHECK FOR INDURATION A T THE SITE IF INDURATION IS EQUAL TO AND MORE THAN 10MM POSITIVE 20
  • 21. 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) 21
  • 22. PULMONARY TB is treated primarily with antituberculosis agents for 6 to 12 months. Pharmacological management First line antitubercular medications 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 22
  • 23. Second line medications 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  23
  • 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 24
  • 25. DOTS (directly observed treatment, short-course), is the name given to the World Health Organization-recommended tuberculosis control strategy that combines five components: 25 1. Government commitment (including both political will at all levels, and establishing a centralized and prioritized system of TB monitoring, recording and training) 2. Case detection by sputum smear microscopy 3. Standardized treatment regimen directly observed by a healthcare worker or community health worker for at least the first two months 4. A regular drugsupply 5. A standardized recording and reporting system that allows assessment of treatment results
  • 26. DOT is especially critical for patients with drug- resistant TB, HIV-infected patients, and those on intermittent treatment regimens (i.e., 2 or 3 times weekly). 26
  • 27. Multiple-drug therapy to treat TB means taking several different antitubercular drugs at the same time. 27 The standard treatment isoniazid, rifampin, ethambutol, is to take and pyrazinamide for 2 months. Treatment is then continued for at least 4months with fewer medicines
  • 28. Assessment Obtain history of exposure to TB Assess for symptoms of active disease Auscultate lungs for crackles During drug therapy assess for liver function 28
  • 29. Ineffective breathing pattern related to pulmonary infection and potential for long term scarring with decreased lung capacity Interventions Administer and teach self administration of medications ordered Encourage rest and avoidance of exertion Moniter breath sounds respiratory rates ,sputum production and dyspnoea Provide supplymental oxygen as ordered Encourage increased fluid intake Instruct about best position to facilitate drainage 29
  • 30. Risk for spreading infection related to nature of disease and patients symptoms Be aware that TB is transmitted by respiratory droplets Use high efficiency particulate masks for high risk procedures including endoscopy Educate patient to control the spread of infection by covering mouth and nose while coughing and sneezing Isolation of patient Instruct about risk of drug resistance if drug regimen is not strictly and continuosly followed Carefully moniter vital signs and observe for temperature changes 30
  • 31. Imbalanced nutrition less than body requirement related to poor appetite ,fatique and productive cough Explain the importance of eating nutritious diet to promote healing and defense against infection Provide small frequent meals Moniter weight of the patient Administer vitamin supplyments as ordered 31
  • 32. Non compliance related to lack of motivation and lack of treatment Educate patient about etiology transmission and effects of TB Review adverse effects of drug therapy Participate in observation of medicine taking,weekly pill counts or programmes designed to increase compliance with the treatment for TB Explain that TB is a communicable disease and that taking medications is most effective way of preventing transmission Instruct about medications schecule and side effects 32
  • 33. ❑ ISOLATION ❑ Ventilate the room ❑ Cover the mouth ❑ Wear mask ❑ Finish entire course of medication ❑ vaccinations 33