PTB

PULMONARY TUBERCULOSIS S/sx: Wt loss night sweats low fever, non productive to productive cough anorexia, Pleural effusion and hypoxemia cervical lymphadenopathy The worlds deadliest disease and remains as a major public health problem. Badly nourished, neglected and fatigued individuals are more prone Susceptibility is highest in children under 3 years AKA: Kochs disease: Galloping consumption

PPD ID macrophages in skin take up Ag and deliver it to T cells T cells move to skin site, release lymphokines activate macrophages and in 48-72 hrs, skin becomes indurated > 10 mm is (+) Chest xray - cavitary lesion Sputum exam sputum culture

Dx:

The National Tuberculosis Control Program Targets: 1. 2. Mgmt: short course 6-9 months long course 9-12 months Follow-up 2 wks after medications non communicable o 3 successive (-) sputum - non communicable o rifampicin - prophylactic To cure at least 85% of the sputum smear positive TB patient discovered. Detect at least 70% of the estimated new sputum smear positive TB cases. Vision: A country where TB is no longer a public health problem. Mission: Ensure that TB DOTS services are available to the communities. Goal: To reduce the prevalence and mortality from TB by half by the year 2015

MDT side effects r-orange urine i-neuritis and hepatitis p-hyperuricemia e-impairment of vision s-8th cranial nerve damage Methods of Control Prompt treatment and diagnosis BCG vaccination Educate the public in mode of transmission and importance of early diagnosid Improve social condition

TUBERCULOSIS
a highly communicable disease caused by Mycobacterium tuberculosis Mycobacterium tuberculosis is a slender, rod-shaped aerobic bacteria, acid-fast that does not produce sporm. - Mycobacterium tuberculosis primarily affects the pulmonary system, especially the upper lobes, where the oxygen content is greatest, but can also affect other areas of the body, such as the brain, intestines, peritoneum, kidney, joints, and liver, - Tuberculosis (TB) has an insidious onset, and many client are not aware of the symptoms until the disease is well advanced - A multidrug-resistant strain (MDR-TB) of TB can exist as a result of improper or noncompliant use of treatment programs and the development of mutations in the tubercle bacilli - The goal of the treatment is to prevent transmission, control symptoms, and prevent progression of the disease TRANSMISSION Via airborne route by droplet infection After the infected individual has received TB medication for 2 to 3 weeks, the risk of transmission is greatly reduced PATHOPHYSIOLOGY

droplets enter the lungs

2-12 weeks

Ghons focus: tubercle bacilli, macrophages,

Caseous necrosis 2-3 weeks PPD (+) Lypmph node (+)

Reactivation TB

Scar tissue

Ghons complex: Primary lung lesion Lymph node granuloma

CLINICAL MANIFESTATIONS may be asymptomatic in primary infection fatigue, lethargy, anorexia, weight loss low-grade fever chills night sweats persistent cough and the production of mucoid and mucopurulent sputum, which is occasionally streaked with blood

CHEST ASSESSMENT chest x-ray is not definitive, but the presence of multinodular infiltrates with calcification in the upper lobes suggests TB if the disease is active, caseation and inflammation may be seen on the chest x-ray SPUTUM CULTURES sputum specimens are obtained for an acid-fast smear a sputum culture identifying Mycobacterium Tuberculosis confirms the diagnosis after medications are started, sputum samples are obtained again to determine the effectiveness of therapy most clients have negative cultures after 3 months of compliance with medication therapy

MANTOUX TEST the most reliable determinant of infection with TB a positive reaction does not mean that active disease is present but indicates exposure to TB or the presence of inactive (dormant) disease once the test result is positive, it will be positive in ant future tests a small amount (0.1mL) of intermediate-strength purified protein derivative (PPD) containing 5 tuberculin units is administered intradermally in the forearm an area of induration measuring 10mm or more in diameter, 48 to 72 hours after injection, indicates that the individual has been exposed to TB for individuals with HIV infection or who are immuno-suppressed, a reaction of 5mm or greater is considered positive once an individuals skin test is positive, a chest x-ray is necessary to rule out active TB or to detect old, healed lesions