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Mapa Mental
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hamda ali
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Mapa Mental sobre Tuberculosis, criado por hamda ali em 03-02-2019.
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16629351
mind_map
2019-02-04T10:59:01Z
Tuberculosis
Anatomy
of the
lungs
Causes of Productive
Cough
Based on sputum
color
Lower
Respiratory
Tract Infections
Acute bronchitis
adenovirus, coronavirus,
parainfluenza, influenza and
rhinovirus
is self-limiting
infection
It manifests as cough that sometimes could come with sputum, wheezing, fever and shortness
of breath
Only few cases are caused by bacterial
infection
Bronchiolitis
self-limiting
infection
Respiratory syncytial
virus
Usually it infects
children
It manifests as cough, fever, runny nose, wheezing and
crackles.
Influenza
RNA virus
3 types
Type A
Type B
Type C
is the most common type of influenza
virus
infect both humans and
animals
infect humans
only
infect both human and
pigs.
Symptoms of influenza infection start 1 to
4 days after infection and it include fever,
headache, runny nose, sore throat,
myalgia, malaise and nonproductive
cough.
Pneumonia
Pneumonia manifests as dyspnea or
shortness of breath, chest pain, productive
cough ( bloody sputum or yellow green
sputum), fatigue, fever, tachypnea,
decreased breath sound and dullness to
percussion.
Caustive
Agents
Classification of
myobacterium
Non-
cultivable
M,leprea
Typical
M.
tuberculosis
M, bovis
M.
africanum
Atypical
Runyon Group I
(Photochromogens)
M.
kansasii
M.
marinum
Runyon Group II
(Scotochromogens)
M.
szulgai
M.
xenopi
M.
scrofulaceum
Runyon Group III
(Nonchromogens)
M. avium
M.
haemophilum
M. ulcerans
Runyon Group
IV (Rapid
Growers)
M.
abscessus
M.
chelonae
M. fortuitum
Epidemiology of
TB
infects 1/3 world
population – 2
billion people
95% cases
are in
developing
world
8 million
new
cases/yr
3 million
deaths/yr
80% of all TB
cases occurs in
Sub Sharan Africa
and South East
Asia
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.
Transmission
Touch
Ingestion
Airborne
Risk
factors
Recently
infected with TB
Those with medical
conditions that
weaken the immune
system
HIV infection (the virus that causes
AIDS)\ Substance abuse\ Silicosis\
Diabetes mellitus\ Severe kidney
disease\ Low body weight\ Organ
transplants\ Head and neck
cancer\ Medical treatments such
as corticosteroids or organ
transplant\ Specialized treatment
for rheumatoid arthritis or Crohn’s
disease
Signs and
symptoms
Investigations of Tuberculosis
collection of a
specimen
Early morning sputum in case of pulmonary TB and it
requires a minimum of two successive days sputum\
Bronchoalveolar lavage (BAL) \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.
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)
Molecular
Methods
PCR
Molecular Line
Probe Assays
(LPA)
It is a DNA-based
diagnostic test
that identifies
multidrug-resistant
TB (MDR TB).
Xpert
MTB/RIF
Assays
A new NAAT that quickly
identifies possible
multidrug-resistant TB (MDR
TB) (Rifampicin resistance).
Tuberculin Test
(Mantoux
tuberculin skin
test (TST))
Delayed
hypersensitivity
reaction type 4.
Injecting tuberculin
intradermally, which contains
purified protein derivative from
mycobacteria tuberculosis
(PPD tuberculin).
Induration
measured after
48-72 hours.
It can be positive in case of
active TB (disease), people with
latent infections, and people who
had received BCG vaccination.
Serology
Interferon-Gamma
Release Assays
(IGRAs)
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.
Investigations of TB
Contacts
Contacts with skin test reaction of an induration
diameter of >5 mm or with any symptoms of TB
disease should go for further examination and TB
diagnostic tests, starting with a chest radiograph.
Contacts with special vulnerability or susceptibility to TB disease
should undergo for further examination and diagnostic testing
regardless of whether they have a positive skin test result or are
ill.
Evaluating
Response to
Treatment
Clinical
evaluation
(Monthly / Adverse
reactions to
medications and to
assess adherence)
Bacteriological
examination
Positive cultures after 3
months of treatment:
Reevaluated for drug-resistant
disease and failure to adhere
to the regimen
Positive cultures
after 4 months of
therapy: Failure
of the treatment
and managed
accordingly
Tuberculosis
(TB) Treatment &
Management
Chest radiograph
Positive cultures at the
diagnosis: Repeat chest
radiograph after completing
2 months of therapy might
be useful (not essential),
while chest radiograph after
completing the course of the
therapy gives a baseline
for comparison with any
future films.
Negative culture in the initial
diagnosis: Chest radiograph is
necessary after 2 months of
treatment, and desirable at
completion of treatment.
Disease
notification
Pathogenesis
Primary tuberculosis
granuloma - macrophages,
fibroblasts, lymphocytes, and
neutrophils
tubercles can become calcified – Ghon
complex
self-limiting
Infants & very young
have a high mortality
from primary infections
Secondary
Tuberculosis
Tubercles can reactivate,
proliferate, and cause
additional infection and
damage in the lung
Re-infection from
exogenous bacteria
Reactivated disease
occurs in areas with
high oxygen tension
and low lymphatic
drainage such as the
apices of the lungs
Disseminated
tuberculosis
Latent TB
Is a subclinical
infection with tubercle
bacilli without clinical,
bacteriological or
radiological signs of
the disease
bacilli can disseminate
to the lymph nodes,
kidneys, bones, genital
tract, brain, etc
prognosis is
poor and the
affected site
suffers severe
damage:
renal necrosis and
scarring damage to
reproductive organs
degeneration of spine
meningitis
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
Body will try to increase body Tempreture by
Peripheral
vasoconstriction
Norepinephirne
increases
thermogenesis in
adipose tissue
Shivering
Approach
Considerations
Isolate patients with
possible (TB) in a private
room with negative
pressure\ Medical staff
must wear high-efficiency
disposable masks\
Continue isolation until
sputum smears are
negative for 3 consecutive
determinations
Drug therapy
Patients who are receiving
pyrazinamide should undergo
baseline and periodic serum uric
acid assessments, and those
who are receiving long-term
ethambutol should undergo
baseline and periodic visual
acuity and red-green color
perception testing (Ishihara test)
for color blindness.
After 2 months of therapy (for a fully
susceptible isolate), pyrazinamide
can be stopped. Isoniazid plus
rifampin are continued as daily or
intermittent therapy for 4 more
months. If isolated isoniazid
resistance is documented,
discontinue isoniazid and continue
treatment with rifampin,
pyrazinamide, and ethambutol for
the entire 6 months. Therapy must
be extended if the patient has
cavitary disease and remains
culture-positive after 2 months of
treatment.
Monitoring
Patients diagnosed with active TB
should undergo sputum analysis
for Mycobacterium
tuberculosis weekly until sputum
conversion is documented.
Monitoring for toxicity includes
baseline and periodic liver
enzymes, complete blood cell
(CBC) count, and serum creatinine.
BCG
vaccine
Complications
Prognosis
Airborne
precautions
contains a live but
very weakened form
of a bacteria
called Mycobacterium
bovis
prevention of severe
forms of TB
(tuberculous
meningitis and miliary
disease)
Not given to
immunocompromised
people and pregnant
If treated >
Excellent
prognosis.
If not treated >
mortality rate > 50%.
Extreme ages\ Hodgkin
lymphoma\ end-stage
renal disease \ chronic
lung disease\
malnutrition\ alcoholism
N95
Respirator
Powered Air-Purifying
Respirator (PAPR)
Airborne Infection Isolation Room (AIIR)
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16629351
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