INTRODUCTION

it is communicable disease

suffered by all ages.hippocrates

called this disease as phithesis.in

1882 robert koch discovered

tubercle bacillus.in 1907,von

pirquet discovered tuberculin

test .

DEFINITION:

Tuberculosis (TB) is caused by

infection with Mycobacterium

tuberculosis (MTB), which is part

of a complex of organisms

including M. bovis (reservoir

cattle) and M. africanum

PREVALENCE:

The incidence of tuberculosis {per

100,000} people in Nepal was reported

at 163.19 in 2008.

Current estimates suggest that around

one-third of the world's population has

latent tuberculosis .

The majority of these cases are likely to

occur in the world's poorest

In the United States, approximately

14000 cases of tuberculosis . The

prevalence of tuberculosis is

continuing to increase because of

the increased number of patients

infected with HIV and the growing

numbers of the homeless

ETIOLOGY:

Mycobacterium tuberculosis

IT includes 4 other TB-causing

mycobacteria:

M. bovis,

M. africanum,

M. canetti and

M. microti

RISK FACTOR

Developed countries

 Immigration from high-prevalence

areas

Human immunodeficiency virus (HIV)

Increasing proportion of elderly

Social deprivation

Drug resistance

DEVELOPING COUNTRIES

Ineffective control programmed

Lack of access to health care

HIV

Drug resistance

MODE OF TRANSMISSION

TYPES:

PATHOPHYSIOLOGY

pathophysiology

DIFFERENT TYPES OF TB

Primary pulmonary TB.

(1) Spread from the primary focus to

hilar and mediastinal lymph glands

to form the 'primary complex', which

in most cases heals spontaneously.

(2) Direct extension of the primary

focus-'progressive PTB.

(3) Spread to the pleura-tuberculous

pleurisy and pleural massive spread-

miliary tuberculosis and meningitis

effusion. (4) Blood-borne spread: few

bacilli-pulmonary, skeletal, renal,

genitourinary infection often months

or years later;

FEATURES OF PRIMARY TUBERCULOSIS

Infection (4-8 weeks)

Influenza-like illness

Skin test conversion

Primary complex

DISEASE:

Collapse (especially right

middle lobe)

Consolidation (especially right

middle lobe)

Obstructive emphysema

Cavitation (rare)

CAVITATION

Pleural effusion

Miliary

Endobronchial

Meningitis

Pericarditis

CRYPTIC TB

Age over 60 years

Hypersensitivity

Erythema nodosum

Phlyctenular conjunctivitis

Dactylitis Pyrexia of unknown region

Unexplained weight loss, general

debility (hepatosplenomegaly in

25-50%) Blood dyscrasias; leukaemoid

reaction, pancytopenia

MILIARY TUBERCULOSIS:

It is due to dessemination of

tubercle bacilli via the blood

stream.it may present loss opf

weight,fever,hepatospleenomeg

aly,choroidal tubercle seen in

the eyes,

Chest x ray :miliary shadow 1-

2mm in diameter seen,the lesion

can increase size upto 5-10mm ,

CT Scan-lung parenchymal

abnormalities

ADULT POST PRIMARY TB:

gradual onset of symptoms over

weeks or months,anorexia ,

weight loss,fever,cough,sputum

may be mucoid,purulent or

blood stained,finger clubbing

). The presence of a miliary

pattern or cavitation indicates

active disease . In extensive

disease, collapse may be marked

and result in significant

displacement of the trachea and

mediastinum.

DIAGNOSTIC EVALUATION: Mantoux test:

RESULT FINDING IF POSITIVE

CHEST X RAY-

STAINING: Sputum is stained with

ziehl-neelsen stain for acid and

alcohol fast bacilli

FIBEROPTIC BRONCHOSCOPY:

Washing of the affected lobes if no

sputum is available

Biopsies of the pleura, lymphnodes

and solid lesions within the lungs

TREATMENT Direct observed therapy short course :

Special clinic are are used to supervise the

treatment regimen directly

5 COMPONENTS :

Political and administrative components

Good quality diagnosis

Good quality drug

Direct observed tx

Monitoring and accountability

DOTS programmed has so far been

introduced in 27 of the 75 district

where the anti TB programmed is

being implemented by the

government. A special programmed

called Kathmandu valley coalition

against tuberculosis has been

launched{KV-CAT}

DRUGS

FIRST LINE ANTI –TUBERCULOSIS DRUG

1} ISONIAZID

MODE OF ACTION: cell wall synthesis

MAJOR ADVERSE REACTION: Peripheral

neuropathy,hepatitis,rash.

LESS COMMON REACTION: Lupoid

reaction, seizure, psychosis

RIFAMPICIN:

Mode of action: DNA

transcription

Major adverse reaction: febrile

reaction, hepatitis and rash

Less common reaction: nephritis,

thrombocytopenia

Pyrazinamide Mode of action:

Major adverse reaction:

hepatitis,hyperuricaemia L.a.r: rash , gout

Streptomycin :

Mode of action: protein synthesis

Major adverse reaction: 8th nerve

damage and rash

Less adverse reaction:

nephrotoxicity and granulocytosis

Ethambutol:

Mode of action: cell wall synthesis

M.A.R: retrobular neuritis,antralgia

L.C.R: Peripheral neuropathy,rash

THERAPEUTIC INTERVENTION:

Multiple antituberculin drugs for 8 weeks

in the initial treatment phase, followed by

4-7 months continuation phase.

Bed rest

INH for 6-12 months to immediate contact

High carbohydrate,high protein,high

vitamin diet with supplemental vit b6 to

counter INH side effect