Tuberculosis:

case detecting

Lecturer: Ph.D.
M.G.Dolynska
 Main ways of the new cases
revealing
 Passive
Obligate diagnostical minimum (clinical,
radiological examination, direct smear
microscopy)
 Active

Screening X-ray examination for adults

Screening Mantoux test for children
Ziehl - Nielsen staining
 ZN-staining
Advantages Disadvantages
 Cheapness  Low sensitivity
 Simplicity  Lack of viability and
 Quickness drug sensitivity
evaluation
 Inability to detect
mycobacteria types
 Cultural test
 Lewenstein-Yensen
 Middlebrook set
 BACTEC set
Culture
 Cultural methods
Advantages Disadvantages
 High sensitivity  Taking time
 Drug resistance  Expensiveness
evaluation  Hazard to the
 Possibility of typing personnel
 Mantoux skin test with 5TU (Seibert) interpretation
Induration 5 mm
 Children in close contact with known or suspected contagious cases
of tuberculosis disease
 Children suspected to have tuberculosis disease because of findings
on chest radiograph consistent with active or previously active
tuberculosis
 Clinical evidence of tuberculosis disease
 Children receiving immunosuppressive therapy or with
immunosuppressive conditions, including HIV infection
Induration 10 mm
 Children at increased risk of disseminated disease:
 Those younger than 4 years of age
 Those with other medical conditions, including Hodgkin’s disease,
lymphoma, diabetes mellitus, chronic renal failure, or malnutrition
From American Academy of Pediatrics. Tuberculosis.
In: Red book: 2003 report of the committee on infectious diseases. 25th edition. Elk Grove (IL): Pickering
LK; 2003.
Mantoux skin test with 5TU (Seibert) interpretation
(continuation)

 Children with increased exposure to tuberculosis disease:

 Those born, or whose parents were born, in high-prevalence
regions of the world
 Those frequently exposed to adults who are HIV-infected,
homeless, users of illicit drugs, residents of nursing homes,
incarcerated or institutionalized, or migrant farm workers
 Those who travel to high-prevalence regions of the world

Induration 15 mm
Children 4 years of age or older without any risk factors

From American Academy of Pediatrics. Tuberculosis.

In: Red book: 2003 report of the committee on infectious diseases. 25th edition. Elk
Grove (IL): Pickering LK; 2003
Mantoux skin test procedure
Result appreciation
Result appreciation
Hyperergic tuberculin reaction
 PCR-test
1. Probe processing
(DNA purification)
2. DNA melting
3. Primers hybridization
4. Complement DNA
chains building
 Radiological examination:
purposes
 Case detecting
 Differential diagnosis
 Treatment control
 Radiological examination:
main approaches
 Screening (fluoroscopy, roentgenoscopy)
 Additional examination – tomography
 Movement observing - radioscopy
 Routine clinical examination
Complaints:
General:
 Fatigue, malaise, weakness, sweating, fever

Local:
 Cough with mucous sputum, hemophtysis

 Chest pain

 Dyspnoe
 Routine clinical examination

Anamnesis:
Diseases onset:
 Sudden

 Insidious

 Wavy
 Respiratory tract examination
 Percussion: dull sound, tympanic sound
 Auscultation: weakened breathing, dry or
moisture rales
 Routine clinical examination

Anamnesis:
 Social and professional history
At risk:
 Low income
 Profession: industry workers, miners, health

care workers
 Family history: TB contact
 Personal history: diseases, substances abusing
 Routine blood test
Normal Tuberculosis
Hb 120-160g/l ↓
Leukocytes 4,0 - 9,0 ↑ (up to 15)
eosinophil 0,5 - 5% ↑
band neutrophil 1 - 6% ↑
segm. Neutrophil 47 - 72% ↑
lymphocyte 19 - 37% ↑↓
monocyte 3 - 11% ↑
ESR 2 - 15 mm/hour ↑(up to 30
mm/hour)