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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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TuberculosisAnatomyof thelungsCauses of ProductiveCoughBased on sputumcolorLowerRespiratoryTract InfectionsAcute bronchitisadenovirus, coronavirus,parainfluenza, influenza andrhinovirusis self-limitinginfectionIt manifests as cough that sometimes could come with sputum, wheezing, fever and shortnessof breathOnly few cases are caused by bacterialinfectionBronchiolitisself-limitinginfectionRespiratory syncytialvirusUsually it infectschildrenIt manifests as cough, fever, runny nose, wheezing andcrackles.InfluenzaRNA virus3 typesType AType BType Cis the most common type of influenzavirusinfect both humans andanimalsinfect humansonlyinfect both human andpigs.Symptoms of influenza infection start 1 to4 days after infection and it include fever,headache, runny nose, sore throat,myalgia, malaise and nonproductivecough.PneumoniaPneumonia manifests as dyspnea orshortness of breath, chest pain, productivecough ( bloody sputum or yellow greensputum), fatigue, fever, tachypnea,decreased breath sound and dullness topercussion.CaustiveAgentsClassification ofmyobacteriumNon-cultivableM,lepreaTypicalM.tuberculosisM, bovisM.africanumAtypicalRunyon Group I(Photochromogens)M.kansasiiM.marinumRunyon Group II(Scotochromogens)M.szulgaiM.xenopiM.scrofulaceumRunyon Group III(Nonchromogens)M. aviumM.haemophilumM. ulceransRunyon GroupIV (RapidGrowers)M.abscessusM.chelonaeM. fortuitumEpidemiology ofTBinfects 1/3 worldpopulation – 2billion people95% casesare indevelopingworld8 millionnewcases/yr3 milliondeaths/yr80% of all TBcases occurs inSub Sharan Africaand South EastAsiaGlobally, TB incidenceis falling at about 2%per year. This needs toaccelerate to a 4–5%annual decline to reachthe 2020 milestones ofthe End TB Strategy.An estimated 54 millionlives were saved throughTB diagnosis andtreatment between 2000and 2017.TransmissionTouchIngestionAirborneRiskfactorsRecentlyinfected with TBThose with medicalconditions thatweaken the immunesystemHIV infection (the virus that causesAIDS)\ Substance abuse\ Silicosis\Diabetes mellitus\ Severe kidneydisease\ Low body weight\ Organtransplants\ Head and neckcancer\ Medical treatments suchas corticosteroids or organtransplant\ Specialized treatmentfor rheumatoid arthritis or Crohn’sdiseaseSigns andsymptomsInvestigations of Tuberculosiscollection of aspecimenEarly morning sputum in case of pulmonary TB and itrequires a minimum of two successive days sputum\Bronchoalveolar lavage (BAL) \Gastric aspirate\ CSF \Lymph node biopsy or aspirates\ Other tissue biopsiesMicroscopyZiehl Neelsen Staining /Acid Fast StainingSpecificity of 98% / Low sensitivity <50% /Qualitative and quantitativeFluorescent staining(Auramine-RhodamineFluorochrome)Rapid and more sensitive / Expensive / Dyetoxicity.Culture (The Gold Standard)SolidMediaAgar based (Middlebrook 7H10) / Egg based(Löwenstein-Jensen medium)Culture is incubated at 35 C, 5-10% CO2 andin high humidityIt takes 4-8 weeks / can bereported negative after 8 weeks.Rough, tough and buff colonies.LiquidMediaBACTEC 460 /Mycobacteria GrowthIndicator Tube (MGIT)Positive in 2-3weeks / can bereported negativeafter 6 weeksRadiometricculture hasfaster results (3-4days)MolecularMethodsPCRMolecular LineProbe Assays(LPA)It is a DNA-baseddiagnostic testthat identifiesmultidrug-resistantTB (MDR TB).XpertMTB/RIFAssaysA new NAAT that quicklyidentifies possiblemultidrug-resistant TB (MDRTB) (Rifampicin resistance).Tuberculin Test(Mantouxtuberculin skintest (TST))Delayedhypersensitivityreaction type 4.Injecting tuberculinintradermally, which containspurified protein derivative frommycobacteria tuberculosis(PPD tuberculin).Indurationmeasured after48-72 hours.It can be positive in case ofactive TB (disease), people withlatent infections, and people whohad received BCG vaccination.SerologyInterferon-GammaRelease Assays(IGRAs)Test that detectsIFN-g that isreleased by WBCwhen mixed withantigens derivedfrom M.tuberculosis.The results within 24hours.BCG vaccination does not cause a false positive IGRA testresult.Investigations of TBContactsContacts with skin test reaction of an indurationdiameter of >5 mm or with any symptoms of TBdisease should go for further examination and TBdiagnostic tests, starting with a chest radiograph.Contacts with special vulnerability or susceptibility to TB diseaseshould undergo for further examination and diagnostic testingregardless of whether they have a positive skin test result or areill.EvaluatingResponse toTreatmentClinicalevaluation(Monthly / Adversereactions tomedications and toassess adherence)BacteriologicalexaminationPositive cultures after 3months of treatment:Reevaluated for drug-resistantdisease and failure to adhereto the regimenPositive culturesafter 4 months oftherapy: Failureof the treatmentand managedaccordinglyTuberculosis(TB) Treatment &ManagementChest radiographPositive cultures at thediagnosis: Repeat chestradiograph after completing2 months of therapy mightbe useful (not essential),while chest radiograph aftercompleting the course of thetherapy gives a baselinefor comparison with anyfuture films.Negative culture in the initialdiagnosis: Chest radiograph isnecessary after 2 months oftreatment, and desirable atcompletion of treatment.DiseasenotificationPathogenesisPrimary tuberculosisgranuloma - macrophages,fibroblasts, lymphocytes, andneutrophilstubercles can become calcified – Ghoncomplexself-limitingInfants & very younghave a high mortalityfrom primary infectionsSecondaryTuberculosisTubercles can reactivate,proliferate, and causeadditional infection anddamage in the lungRe-infection fromexogenous bacteriaReactivated diseaseoccurs in areas withhigh oxygen tensionand low lymphaticdrainage such as theapices of the lungsDisseminatedtuberculosisLatent TBIs a subclinicalinfection with tuberclebacilli without clinical,bacteriological orradiological signs ofthe diseasebacilli can disseminateto the lymph nodes,kidneys, bones, genitaltract, brain, etcprognosis ispoor and theaffected sitesuffers severedamage:renal necrosis andscarring damage toreproductive organsdegeneration of spinemeningitisMechanism ofFeverPyrogenMacrophages and immune cells areactivatedIL-1, IL-6, IL-8, TNF-a, interferongammaLaminaeterminalisPre-optic regionPosterior hypothalamicregionActivatephospholipaseInduce the production of prostaglandinsE2Prostaglandins E2 will change thetemperature set pointBody will try to increase body Tempreture byPeripheralvasoconstrictionNorepinephirneincreasesthermogenesis inadipose tissueShiveringApproachConsiderationsIsolate patients withpossible (TB) in a privateroom with negativepressure\ Medical staffmust wear high-efficiencydisposable masks\Continue isolation untilsputum smears arenegative for 3 consecutivedeterminationsDrug therapyPatients who are receivingpyrazinamide should undergobaseline and periodic serum uricacid assessments, and thosewho are receiving long-termethambutol should undergobaseline and periodic visualacuity and red-green colorperception testing (Ishihara test)for color blindness.After 2 months of therapy (for a fullysusceptible isolate), pyrazinamidecan be stopped. Isoniazid plusrifampin are continued as daily orintermittent therapy for 4 moremonths. If isolated isoniazidresistance is documented,discontinue isoniazid and continuetreatment with rifampin,pyrazinamide, and ethambutol forthe entire 6 months. Therapy mustbe extended if the patient hascavitary disease and remainsculture-positive after 2 months oftreatment.MonitoringPatients diagnosed with active TBshould undergo sputum analysisfor Mycobacteriumtuberculosis weekly until sputumconversion is documented.Monitoring for toxicity includesbaseline and periodic liverenzymes, complete blood cell(CBC) count, and serum creatinine.BCGvaccineComplicationsPrognosisAirborneprecautionscontains a live butvery weakened formof a bacteriacalled Mycobacteriumbovisprevention of severeforms of TB(tuberculousmeningitis and miliarydisease)Not given toimmunocompromisedpeople and pregnantIf treated >Excellentprognosis.If not treated >mortality rate > 50%.Extreme ages\ Hodgkinlymphoma\ end-stagerenal disease \ chroniclung disease\malnutrition\ alcoholismN95RespiratorPowered Air-PurifyingRespirator (PAPR)Airborne Infection Isolation Room (AIIR)Clique duas vezes aqui para editar o textoClique e arraste este botão para criar um novo tópico