Work sheet of respiratory module (about Tuberculosis)

Tuberculosis

Definition:- Tuberculosis (TB) is an infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria.

Tuberculosis generally affects the lungs. 

Presentation:-

 1-Tuberculous pleural effusion (TPE) is one of the most common forms of extrapulmonary tuberculosis. TPE usually presents as an acute illness with fever, cough and pleuritic chest pain. The pleural fluid is an exudate that usually has predominantly lymphocytes.

2-Tuberculous ascites, one of the clinical signs of abdominal TB, implies accumulation of fluid in the abdomen, a swollen abdomen, and slightly raised tubercles of 1–2 mm all over the peritoneum.It’s often misdiagnosed in elderly patients.

Diagnosis:-

1-Quantiferon TB test: highly specific and sensitive, a positive result is strongly predictive of true infection with M. tuberculosis. However, like the TST and other IGRAs cannot distinguish between active tuberculosis disease and latent tuberculosis infection and cannot replace clinical judgment. 

2-Adenosine Deaminase test is done to measure the level of ADA or Adenosine Deaminase in one's pleural fluid in order to assist in the diagnosis of tuberculosis.

3-The genexpert test is a molecular TB test which detects the DNA in TB bacteria. It uses a sputum sample and can give a result in less than 2 hours.

4- Tuberculin test:Intradermal skin test used for detection of susceptibility and previous infection for TB.The material used for injection is PPD and the time needed for skin examination is after 72 

hours.

Treatment:-It splits into 2 steps or lines

First line: More effective & Less toxic are 4 drugs:

1-Isoniazid
2-Rifampin.
3-Pyrazinamide
4-Ethambutol

Drug combination:

to decrease resistance, decrease toxicity& Synergistic effect

Second line: are 8 drugs 

a)less effective and more toxic

b) used in pts whocan t tolerate 1 st line drugs

c) used in pts who are infected with resistant TB 

1. Ethionamide (analogue of isoniazid
2. Streptomycin, Kanamycin & Amikacin (aminoglycosides )
3. Capromycin
4. Para aminosalicylic acid[PASA]
5. Cyclserine
6.  Floroquinolones
7. Clofazemine
8. Lineozolid

Thank you