1. بسم الله الرحمن الرحيم

2. بسم الله الرحمن الرحيم Student Case Presentation Tuberculosis Group B2 Community

3. Introduction to TB Case History and Physical Examination Investigations and diagnosis Management Prevention and Control of TB Tuberculosis Group B2

4. Introduction 1.What is Tuberculosis (TB) ? 2.How Tuberculosis is transmitted ? 3.What organs does it affect ? Tuberculosis Group B2

5. Introduction Between 2000 and 2010 there will be : -1,000,000,000 person newly infected -200,000,000 get sick -35,000,000 will die of TB Tuberculosis Group B2

6. Introduction to TB Case History and Physical Examination Investigations and diagnosis Management Prevention and Control of TB Tuberculosis Group B2

7. Case History and Physical Examination History of Chief complain :... continue Fever: High grade Sweating: more in the night Cough: no blood stain (no heamoptysis) Sputum with cough: mild no history of contact with T.B patient Torki Alsolami is a 23 years old Saudi male patient presented to ER with history of fever for 1 month duration, weight loss, and cough also for 1 month duration. Tuberculosis Group B2

8. History of Past illness : Medications: -ve Surgeries: previous nasal deformity caused by trauma repaired by surgery Family and social history the patient is non-smoker, no HTN, no D.M, no cholesterol or other chronic illnesses and –ve T.B contact Case History and Physical Examination... continue Tuberculosis Group B2

9. Physical Examination Blood pressure : 111/95 Pulse : 72/min General : General appearance : conscious + oriented Neck : no lymph node enlargement. Chest : resonant – equal air entry in both side – bronchial breathing. CVS : S1+S2+ O Abdomen : soft + lax + no organomegaly + and presence of bowl sounds. CNS : intact Case History and Physical Examination Temprature: 40 o C Respiratory rate: 20/min Tuberculosis Group B2

10. Introduction to TB Case History and Physical Examination Investigations and diagnosis Management Prevention and Control of TB Tuberculosis Group B2

11. Investigations and Diagnosis Differential diagnosis :Either Pneumonia or TB Investigations : 1. CBC “ complete blood count” WBC = 8.2 RBC = 4.57 Hb = 12 – 8 Hct = 36.5 MCV = 80 MCH = 28. pH = 7.3 PT = 15.4 / 13.5 PTT = 53.3 / 35.5 2. Blood Chemistry : Bun = 10 osmo = 259 crea = 0.8 Na = 180 K = 4.4 AST = 173 ALT = 222 LDH = no reagent Glucose = 90 Tuberculosis Group B2

12. Investigations and Diagnosis Investigations (continue) : 3. Chest x-ray: patchy or nodular shadows in the upper zones, with loss of volume, and fibrosis with or without cavitation. Provisional diagnosis : By examining the lung carefully … there was right side vesicular sound wich may indicate right side T.B... continue Tuberculosis Group B2

13. Investigations and Diagnosis Special investigations : 1. Acid fast stain  sputum= +ve “many acid fast bacilli” 2. Mantoux tuberculin skin test “ induration = indicates infection with M. tuberculosis Tuberculosis Group B2

14. Introduction to TB Case History and Physical Examination Investigations and diagnosis Management Prevention and Control of TB Tuberculosis Group B2

15. Management Tuberculosis Group B2 TB treatment needs long time. and it might be extended up to 12 months. but basically it needs 6 months. for the first 2 month Rifampcin Isoniazid Pyrazinamide ethambutol or streptomycin are given,and for the next 4 month the first two given. HIV patients needs 2 years of that course because of multiresistance devloped. using the 2nd line drugs (clarithromycin..azithromycin and capromycin )

16. Management Drugs 1. Anti T.B2. Klacid “ anti-biotic drug3. ceftriaxone Plus : -ve Pressure room Tuberculosis Group B2

17. Introduction to TB Case History and Physical Examination Investigations and diagnosis Management Prevention and Control of TB Tuberculosis Group B2

18. Prevention of TB Case finding & treatment. BCG( Bacille Calmette Guerin) immunization which is lived attenuated M.bovis and it’s given to the newborns in KSA. It potentiates the cellular immunity activity and tuberculin test( Mantoux) postivity. Should’ve not given to HIV patient. Tuberculosis Group B2

19. Control of TB Among the case: Reporting the case isolation concurrent disinfection follow up Among the contacts: Mantoux test + chest x-ray+ sputum for AFB Prophylaxis with rifampcin follow up and education Tuberculosis Group B2

20. Done by : Group B2 Community Hussain Morfeq Yasser Noor elahi Maher Abdulsalam Yasser AL-Qasmi Nabeel Nourah Mohammed Badawod Mohammed Abdulmajeed Motasim Jawi Meshari Bairgdar Mohammad Bukhary Hasan Al-Aidarous Hassan Moria Faisal A. Basonbul Motas Abdulraof Sait Mohammed A.Husni Amro M. Daous Ahmed A. Al-Jubali Ammar Beiary Tuberculosis Group B2