1. PULMONARY TUBERCULOSIS
AISHA M SIDDIQUI

2. PULMONARY TB FACTS HISTORY DEFINITION EPIDEMIOLOGY PATHOLOGY
CLINICAL FEATURES
DIAGNOSIS
COMPLICATIONS
PREVENTION
CHEMOTHERAPY
REFERNCES

3. FACTS “If you know TB, you know medicine” Sir William Osler.
1/3 world population is infected.
8,000 die/day, 2-3 million/year. >AIDS& malaria.
Accounts for 1/3 AIDS deathes.
HIV patients 30 times more likely to get sick with TB once infected.

4. HISTORY 1882 Robert Koch identified the tubercle bacillus.
1895 “Roentgen” x-rays.
1921 BCG vaccine (France).
1940 PPD (USA).
1944 Streptomycin.
1946 PAS.
1952 INH.
1966 Rifampicin.

5. HISTORY (cont.) Do Nothing Era. Sanatorium Era. Collapse therapy.
Chemotherapy Era.
Drug resistance.

6. Definition Acid fast, aerobic bacilli: MycobacteriumTuberculosis.
Granuloma, central caseation, Langhan’s giant cells.

7. EPIDEMIOLOGY(HIGH RISK)
Extremes of age.
Contacts with open TB.
Over crowded populations.
Health workers.
Low immunity.

8. PATHOLOGY PRIMARY INFECTION: Primary complex.
P.M.N+ macrophages->>> T- cells->>> increase cell mediated immunity (3-8/52)->>> +PPD.
Caseating granuloma, Langhan’s giant cells, lymphocytes & fibrosis healing &calcification.
20% contain remaining bacilli, activate if low immunity( decr host defences)
POST PRIMARY T.B.

9. CLINICAL FEATURES Prim TB: Symptomless usually.
Miliary TB: Acute, diffuse, disseminated by blood. Old people. Difficult diagnosis. Fatal if not treated.
Ill health, decrease wt., fever. (gradual)>>> meningitis, hepatosplenomegaly, choroidal tubercles.
CXR miliary, may be normal.
PPD+/-
Transbronchial biopsy.
CT scan.
Liver & bone marrow biopsy& culture.

10. CLINICAL FEATURES (cont’d)
Post primary TB:
Vague ill health, fever, decr. Wt., sweating, cough, haemoptysis.
Pneumonia/ pleural effusion.
Abnormal CXR.
CBC, sputum, biopsy.

11. DIAGNOSIS CXR / CT. PPD? Sputum: AFB( Z-N)
FLUORESCENT 50% sensitivity.
NAA (DNA/ RNA), 6 hours, expensive, other specimens also.
.Culture: LJ
BACTEC 7-10 days
NIACIN test ++
Biopsy
Bronchoscopy / Lavage

12. INVESTIGATIONS (other)
CBC
U/E
ESR
LFT

13. COMPLICATIONS
Extrapulmonary
Adrenal
SIADH

14. PREVENTION
BCG 70% immunity
Contact tracing
INH

15. CHEMOTHERAPY
Standard 6-9/12
Inexpensive 12/12
Resistant

16. Treatment Ethambutol>> Pyrazinamide>> 2/12
INH>>>>>>
Rifampicin >>>>>> /12
Pyridoxine>>>>>>
STEROIDS?????

17. TREATMENT (cont’d) Cheaper:* Streptomycin INH
2/12 daily then 2/wk……10/
* INH 300
Thiacetazone 150
12/12 daily.

18. TREATMENT(cont’d) Resistant: PAS 15 gms 12 hrly PO
Ethionamide gm PO
Capreomycin gm IM
Cycloserine gm PO
Ciprofluxacin

19. NEW
DOTS
ICL enzyme.

20. REFERENCES Scientific American Medicine
Davidson’s Principles and practice of Medicine
WHO report on TB