Caso, Chavda, Cortez, Cuaresma,

Dalumpines, Dimapanat, Edejer,

Ezhilmaran, Gautam, Gavino,
Ghising,Gilera, Gonzales,Guevarra, Hao
 •32 y/o
K.P.
•Male
 History of
• 4 Weeks PTC – Productive cough w/
Present fever, sweats and weight loss
Illness

Past Medical • No history of any medical illness

History • No BCG vaccination
Personal & • Unremarkable
Social Hx

Family Hx • Unremarkable
Review of Systems
• Sweats
• Unremarkable

Vital Signs
• BP - 100/60 mmHg, HR - 88 bpm
• RR - 22 cpm, Temp – 38.2°C, Wt. – 55 kg
EENT
§ Dry skin and oral lips, Flat neck veins
Respiratory
§ Symmetrical chest expansion, No retractions,
§ (+) crackles mid lung, (-)wheezes
CVS
§ Normal Rate, Regular rhythm
§ (-) murmur
Abdomen
§ Soft abdomen, non tender normoactive BS
 Salient Features based on
PE and History
• Productive cough x 4 weeks
• Fever
• Sweats
• Weight loss
 Productive Night Weight
Differentials Fever
cough Sweats loss

PTB + + + +

Bacterial
+ + - -
Pneumonia

Neoplasm - +/- +/- +

COPD + (mucoid) - - +

Pulmonary
+ (frothy) - - -
Edema
Presumptive
Tuberculosis
 Direct Sputum Smear Microscopy
(DSSM)
• 2 sputum smear positive

Mantoux (PPD) Test

• Positive
§ Is a communicable chronic granulomatous disease
caused by Mycobacterium tuberculosis. It usually involves
the lungs but may affect any organ or tissue in the body.

§ Separated into two important pathophysiologic types:

“primary” tuberculosis, which occurs in the
nonimmune host, and “secondary” tuberculosis, which
occurs in the host who is immune to M. tuberculosis
§ Lungs
§ Pleura
§ CNS
§ Lymphatic system
§ Genito-urinary system
§ Bones and joints
§ Disseminated (military TB)
1. Persons who have been recently infected
§ Close contacts with an infectious TB disease
§ Persons who have immigrated from areas of the world with
high rates of TB
§ Children less than 5 years of age who have a positive TB test
§ Groups with high rates of TB transmission, such as homeless
persons, injection drug users, and persons with HIV infection
§ Persons who work or reside with people who are at high risk
for TB in facilities or institutions.
2. Persons w/ medical conditions that weaken the immune system
§ HIV infection
§ Substance abuse
§ Diabetes mellitus
§ Severe kidney disease
§ Low body weight (BMI <20)
§ Organ transplants
§ Head and neck cancer
§ Medical treatments such as corticosteroids or organ transplant
§ Specialized treatment for rheumatoid arthritis or Crohn’s disease
§ Cough ≥2 weeks
§ Pain in the chest
§ Hemoptysis
§ Others
§ Weakness or fatigue
§ Weight loss
§ No appetite
§ Chills
§ Fever
§ Sweating at night
§ Thorough history and physical examination should be done on
all patients with TB disease. History should include past medical
history (previous TB treatment, risk factors for hepatic, renal and
ocular toxicity), sexual history, personal and social history, and
occupation.
§ The liver risk factors that should be identified include chronic
alcohol consumption, viral hepatitis, pre-existing liver diseases,
exposure to hepatotoxic agents, previous abnormal results of
ALT/AST/bilirubin and HIV infection.
§ Baseline testing of visual acuity using Snellen and color
perception charts are advised when Ethambutol is to be used.
§ Baseline testing for serum alanine aminotransferase (ALT) and
serum creatinine.
§ In resource-limited settings, baseline ALT and serum creatinine, at
the least, should be requested for patients ≥ 60 years old, and those
w/RF for liver or kidney disease.
§ Patients w/ TB w/ history of high-risk behavior for HIV and coming
from areas with high prevalence of HIV should be offered PICT for
HIV.
§ Screening for diabetes mellitus.
§ Serum uric acid testing is NOT recommended before starting anti- TB
treatment.
§ New Case
§ Retreatment Case
§ Relapse
§ Treatment after failure
§ Treatment after lost to follow-up (TALF)
§ Previous Treatment Outcome Unknown (PTOU)
§ Other - patients who do not fit into any of the categories
listed above.
 Therapeutic Objective
• To eliminate the offending agent.
• Prevent development of resistance
• Prevent development of relapse of
disease due to dormant bacilli
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§The various drugs target different forms of
bacilli i.e. rapidly growing and dormant forms

§Prevent development of resistance

§Prevent development of relapse of disease

due to dormant bacilli
§ Clinical Practice Guidelines for the Diagnosis, Treatment,
Prevention and Control of Tuberculosis in Adult Filipinos
2016 UPDATE
§ Harrison’s Principle of Internal Medicine, 19th edition
§ Robbin and Cotran Pathologic Basis of Disease, 9th edition
§ Katzung Basic and Clinical Pharmacology, 12th edition
§ Center for Disease Control and Prevention
§ WHO- Global tuberculosis Report 2016