TUBERCULOS

IS
Muhannad Alharbi
201607242
Introduction
• The decline in the incidence and mortality from TB in developed
countries was hailed as an example of how public health measures
and antimicrobial therapy can dramatically modify a disease.
• TB is again becoming a public health problem through:
• – its increased incidence in patients with HIV infection, and
• – with the emergence of multidrug-resistant Mycobacterium
tuberculosis strains (MDR-TB).
Primary TB infection
• Primary TB infection -Acquiring TB directly after exposure to someone with active disease.
• Most of the bacilli are killed, but some survive within macrophages, which carry them to the
regional lymph nodes.
• Primary complex?
• Inhaled TB bacilli penetrate into lungs:
• Infection is contained in a small area without spread or replication (latent TB infection or LTBI)

• Infection spreads to nearby lymph nodes and the lung tissue itself TB pneumonia primary
active TB
• – Risk of spread chiefly depends on age and immune status
• (Very young children, immune compromised eg HIV, cancer,immunosuppressive meds eg
steroids).
• TB infection and disease
extrapulmonary
tuberculosis
Diagnosis
• Sputum samples are generally unobtainable from children under
about 8 years of age, unless special induction techniques are used.
• Children usually swallow sputum, so gastric washings on three
consecutive mornings can be used to identify M. tuberculosis
originating from the lung, using special staining techniques for acid–
fast bacilli (Ziehl–Neelsen stains or auramine stains) and
mycobacterial cultures.
• If TB is suspected, a tuberculin skin test (TST; also called Mantoux
test) is performed by injecting purified protein derivative of tuberculin
into the forearm (0.1 ml intradermal injection, read after 48 hours to
72 hours as induration measured in millimetres).

• After initial infection, it takes 3 wks – 3 months (median 4 – 8 wks) to

develop hypersensitivity to the PPD test.
•
• False-negative: very young age, malnutrition, immunosuppression ,
viral infections (e.g., measles, mumps, varicella, influenza), and
overwhelming tuberculosis.
• False – positive: non-tuberculous mycobacteria infection, BCG
vaccination

• The new guideline states that an induration of 5 mm or more should

be considered to be positive, regardless of prior BCG vaccination.
• Other countries use different cut-offs (typically 10 mm).
• Interferon-gamma release assays (IGRAs) are newer, blood-based
tests for TB.
• They assess the response of T cells to in vitro stimulation, with a small
number of antigens expressed by M. tuberculosis but not by BCG.
• Positive results therefore indicate TB infection rather than BCG
vaccination.
• However, a negative IGRA result does not reliably rule out TB
infection.
Treatment
• Triple or quadruple therapy (rifampicin, isoniazid, pyrazinamide,
ethambutol) is the recommended initial combination, unless MDR-TB is
strongly suspected.
• Treatment for uncomplicated pulmonary TB or TB lymphadenitis is
usually for 6 months; longer treatment courses are required for
osteoarticular TB, TB meningitis, or disseminated disease.
• Asymptomatic children who are Mantoux or IGRA positive and therefore
latently infected should also be treated (e.g. with rifampicin and isoniazid
for 3 months or isoniazid alone for 6 months) as this will decrease the
risk of reactivation (i.e. conversion to active TB) later in life.