16631529
Descrição
Mapa Mental por Moza Almualla, atualizado more than 1 year ago
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Criado por Moza Almualla
quase 6 anos atrás
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Tuberculosis
- Affect the lungs
- Normal structure
- The right lung consists of three lobes: the
superior, middle, and inferior lobes
- Blood Supply
- Pulmonary artery that arises from the pulmonary trunk and
carries deoxygenated, arterial blood to the alveoli
- Once the blood is oxygenated, it drains from the alveoli by way of
multiple pulmonary veins, which exit the lungs through the hilum
- Pulmonary artery that arises from the pulmonary trunk and
carries deoxygenated, arterial blood to the alveoli
- The left lung consists of two lobes: the
superior and inferior lobes
- Pyramid-shaped, paired organs that are connected to
the trachea by the right and left bronchi
- Nervous Innervation
- The parasympathetic system causes bronchoconstriction, whereas the
sympathetic nervous system stimulates bronchodilation
- Sensory nerve fibers arise from the vagus nerve,
and from the second to fifth thoracic ganglia
- The pulmonary plexus is a region on the lung root
formed by the entrance of the nerves at the hilum
- The parasympathetic system causes bronchoconstriction, whereas the
sympathetic nervous system stimulates bronchodilation
- The right lung consists of three lobes: the
superior, middle, and inferior lobes
- Normal structure
- Caused by
- Mycobacterium tuberculosis
- Types of Mycobacteria
- Types of Mycobacteria
- Mycobacterium tuberculosis
- Epidemiology
- In 2017, 10 million people fell ill with TB, and 1.6 million died from
the disease (including 0.3 million among people with HIV)
- Globally, TB incidence is falling at about 2% per year. This needs to accelerate to
a 4–5% annual decline to reach the 2020 milestones of the End TB Strategy
- An estimated 54 million lives were saved through TB
diagnosis and treatment between 2000 and 2017
- In 2017, 10 million people fell ill with TB, and 1.6 million died from
the disease (including 0.3 million among people with HIV)
- Transmission
- Airborne, ingestion, touch
- Airborne, ingestion, touch
- Risk factors
- Recently infected with TB
- Medical conditions that weaken
the immune system
- HIV infection / Substance abuse / Silicosis /
Diabetes mellitus / Severe kidney disease /
Low body weight / Organ transplants / Head
and neck cancer / Corticosteroids or organ
transplant / Crohn’s disease
- HIV infection / Substance abuse / Silicosis /
Diabetes mellitus / Severe kidney disease /
Low body weight / Organ transplants / Head
and neck cancer / Corticosteroids or organ
transplant / Crohn’s disease
- Recently infected with TB
- Signs and symptoms
- Cough
- Causes of productive cough
- Causes of productive cough
- Fever
- Mechanism of fever
- Pyrogen > Macrophages and immune cells are activated > IL-1, IL-6, IL-8, TNF-a,
interferon gamma > Laminae terminalis > Pre-optic region > Posterior hypothalamic
region > Activate phospholipase > Induce the production of prostaglandins E2 >
Prostaglandins E2 will change the temperature set point > Peripheral vasoconstriction >
Norepinephirne increases thermogenesis in adipose tissue > Shivering
- Pyrogen > Macrophages and immune cells are activated > IL-1, IL-6, IL-8, TNF-a,
interferon gamma > Laminae terminalis > Pre-optic region > Posterior hypothalamic
region > Activate phospholipase > Induce the production of prostaglandins E2 >
Prostaglandins E2 will change the temperature set point > Peripheral vasoconstriction >
Norepinephirne increases thermogenesis in adipose tissue > Shivering
- Mechanism of fever
- Weight loss
- Blood stained sputum
- Night sweats
- Cough
- Investigations
- History and
physical
examinations
- CBC
- Kidney and liver function tests
- Inflammatory markers and (ESR)
- CSF
- Biopsies or mediastinoscopy
- Histological examinations
- Chest X-rays, CT scan, MRI
- X-ray
- Typical Post-Primary)
- Atypical (Primary)
- Typical Post-Primary)
- X-ray
- Laboratory diagnosis
- Starts with the collection of a specimen
- Early morning sputum / Bronchoalveolar lavage
/ Gastric aspirate / CSF / Lymph node biopsy or
aspirates / Other tissue biopsies
- Early morning sputum / Bronchoalveolar lavage
/ Gastric aspirate / CSF / Lymph node biopsy or
aspirates / Other tissue biopsies
- Microscopy
- Ziehl Neelsen Staining / Acid Fast Staining (Specificity of 98% /
Low sensitivity < 50% / Qualitative and quantitative)
- Fluorescent staining (Auramine-Rhodamine Fluorochrome)
(Rapid and more sensitive / Expensive / Dye toxicity)
- Ziehl Neelsen Staining / Acid Fast Staining (Specificity of 98% /
Low sensitivity < 50% / Qualitative and quantitative)
- Culture (The Gold Standard)
- Solid Media: Agar based (Middlebrook 7H10) / Egg based (Löwenstein-Jensen medium)
/ Culture is incubated at 35 C, 5-10%, CO2 and in high humidity. It takes 4-8 weeks / can
be reported negative after 8 weeks / Rough, tough and buff colonies
- Liquid Media: BACTEC 460 / Mycobacteria Growth Indicator Tube
(MGIT) / Positive in 2-3 weeks / can be reported negative after 6 weeks
- Radiometric culture has
faster results (3-4 days)
- Solid Media: Agar based (Middlebrook 7H10) / Egg based (Löwenstein-Jensen medium)
/ Culture is incubated at 35 C, 5-10%, CO2 and in high humidity. It takes 4-8 weeks / can
be reported negative after 8 weeks / Rough, tough and buff colonies
- Molecular Methods
- PCR / Molecular Line Probe Assays (LPA): DNA-based diagnostic test that
identifies multidrug-resistant TB (MDR TB) / Xpert MTB/RIF Assays: new
NAAT that quickly identifies possible rifampicin resistance
- PCR / Molecular Line Probe Assays (LPA): DNA-based diagnostic test that
identifies multidrug-resistant TB (MDR TB) / Xpert MTB/RIF Assays: new
NAAT that quickly identifies possible rifampicin resistance
- Tuberculin Test (Mantoux tuberculin skin test)
- Injecting tuberculin intradermally, which contains purified protein derivative from
mycobacteria tuberculosis (PPD tuberculin) / Induration measured after 48-72 hours
- A positive test indicates the exposer to a mycobacterium /
It can be positive in case of active TB (disease), people with
latent infections, and people who had received BCG
vaccination / A positive test in people with normal immune
system will be a 10 mm induration after 48-72 hours
- A positive test indicates the exposer to a mycobacterium /
It can be positive in case of active TB (disease), people with
latent infections, and people who had received BCG
vaccination / A positive test in people with normal immune
system will be a 10 mm induration after 48-72 hours
- Injecting tuberculin intradermally, which contains purified protein derivative from
mycobacteria tuberculosis (PPD tuberculin) / Induration measured after 48-72 hours
- Serology
- Interferon-Gamma Release Assays (IGRAs)
- Measures the person’s immune reactivity to mycobacteria tuberculosis / Test that detects IFN-g
that is released by WBC when mixed with antigens derived from M. tuberculosis / The results
within 24 hours / BCG vaccination does not cause a false positive IGRA test result
- Measures the person’s immune reactivity to mycobacteria tuberculosis / Test that detects IFN-g
that is released by WBC when mixed with antigens derived from M. tuberculosis / The results
within 24 hours / BCG vaccination does not cause a false positive IGRA test result
- Interferon-Gamma Release Assays (IGRAs)
- Starts with the collection of a specimen
- Of TB Contacts
- Assessment of the person's health / skin test /
Contacts with skin test reaction of an induration
diameter of >5 mm or with any symptoms of TB
disease > diagnostic tests > chest radiograph /
Specimen collection from sputum depends on the
case and not recommended for healthy contacts with
normal chest radiographs / Contacts with
susceptibility to TB > examination and diagnostic
testing > regardless of whether they have a positive
skin test result or are ill
- Assessment of the person's health / skin test /
Contacts with skin test reaction of an induration
diameter of >5 mm or with any symptoms of TB
disease > diagnostic tests > chest radiograph /
Specimen collection from sputum depends on the
case and not recommended for healthy contacts with
normal chest radiographs / Contacts with
susceptibility to TB > examination and diagnostic
testing > regardless of whether they have a positive
skin test result or are ill
- History and
physical
examinations
- A Notifiable disease
- Other notifiable diseases (UAE)
- Other notifiable diseases (UAE)
- Pathogenesis
- Histology
- Management
- Approach Considerations
- Isolate / Negative pressure / Masks / Continue
isolation until sputum smears are negative for
3 consecutive determinations
- Airborne precautions
- Masks and Respirators
- N95 Respirator / Powered
Air-Purifying Respirator (PAPR)
- N95 Respirator / Powered
Air-Purifying Respirator (PAPR)
- Masks and Respirators
- Airborne precautions
- Isolate / Negative pressure / Masks / Continue
isolation until sputum smears are negative for
3 consecutive determinations
- Drugs
- Isoniazid, rifampin, pyrazinamide, and ethambutol
for 2 months ( Initial phase) / Isoniazid and rifampin
for 4 more months (Continuation phase)
- Pyrazinamide > Serum uric acid
assessments / Ethambutol > Visual acuity
and red-green color perception testing
(Ishihara test) for color blindness
- Pyrazinamide > Serum uric acid
assessments / Ethambutol > Visual acuity
and red-green color perception testing
(Ishihara test) for color blindness
- Isoniazid, rifampin, pyrazinamide, and ethambutol
for 2 months ( Initial phase) / Isoniazid and rifampin
for 4 more months (Continuation phase)
- Evaluating response
to treatment
- Clinical evaluation / Bacteriological
examination / Chest radiograph
- Clinical evaluation / Bacteriological
examination / Chest radiograph
- Approach Considerations
- BCG vaccine
- Bacille Calmette-Guerin vaccine contains a live but very
weakened form of a bacteria called Mycobacterium bovis
- Not given to immunocompromised
people and pregnant
- Not given to immunocompromised
people and pregnant
- Bacille Calmette-Guerin vaccine contains a live but very
weakened form of a bacteria called Mycobacterium bovis
- Complications
- Extra pulmonary TB
- CNS (Meningitis) / Lymphatics (Scrofula / Pleura (Tuberculosis
pleurisy) / Disseminated (Miliary TB) / Bones and joints of spine
(Pott’s disease) / Genitourinary ( Urogenital TB)
- CNS (Meningitis) / Lymphatics (Scrofula / Pleura (Tuberculosis
pleurisy) / Disseminated (Miliary TB) / Bones and joints of spine
(Pott’s disease) / Genitourinary ( Urogenital TB)
- Extra pulmonary TB
- Prognosis
- If treated (Excellent prognosis) / If not treated (Mortality rate > 50%)
- If treated (Excellent prognosis) / If not treated (Mortality rate > 50%)
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