TUBERCULOSIS

DEFINITION

• Tuberculosis is defined as a contagious bacterial infection caused by Mycobacterium

tuberculosis that involves the lungs.

WHO CLASSIFICATION OF TUBERCULOSIS

Anatomical site of disease
History of previous treatment
Drug Resistance
HIV Status
CLASSIFICATION BASED ON ANATOMICAL SITE OF DISEASE

1. Pulmonary Tuberculosis

TB involving the lung parenchyma or tracheobronchial tree

2. Extra pulmonary TB
TB involving organs other than lungs like pleura, lymph nodes, abdomen etc.
CLASSIFICATION BASED ON HISTORY OF PREVIOUS TREATMENT
1.New patients
No history of ever treated TB
2. Previously treated patients
Those patients who have received one month or more of anti TB drugs in the past. These are
a) Relapse patients: Treated for TB and declared cured or tx completed and
now diagnosed with recurrent episode of TB.
b) Treatment after failure patients: The pt who have previously txed for TB
and it is failed.
c) Tx after loss to follow up patients: The pts who have previously been
treated for TB and declared lost to follow up
d) Other previously treated pts: The pts who have previously treated for TB
but whose outcome after their most recent course of tx is unknown or
undocumented.
3. Pt with unknown previous TB tx history
 DRUG RESISTANCE
a)Mono resistance: pts who are resistance to one first line anti TB drug only.
b)Polydrug resistance: Pts who are resistance to more than one first line anti TB
drug.
c) Multidrug resistance: Resistance to at least both isoniazid and rifampicin.
d)Extensive drug resistance: Resistance to any fluoroquinolones and to at least
one of three second line injectable drugs in addition to multidrug resistance.
e) Rifampicin Resistance: resistance to rifampicin detected with in or without
resistance to any anti TB drug
 CLASSIFICATION BASED ON HIV STATUS

a) HIV positive TB patients: TB case who have positive result from

HIV testing conducted.
b) HIV negative TB patient: TB patients who have negative result
from HIV testing conducted at the time of TB diagnosis.
c) HIV status unknown TB patients: TB patients who have no
results of HIV testing and no other documented evidence of enrolement
in HIV care.
TYPES OF TUBERCULOSIS
1. Primary tuberculosis
2. Secondary tuberculosis
3. Miliary tuberculosis

ETIOLOGY
Agent factors
Mycobacterium tuberculosis
Source of infection
Human source: Human to human
Bovine source: Infected milk
Host factors
Age
Sex
Hereditary
Immunity

Mode of transmission
Droplet infection generated by sputum
Incubation Period
3-6 weeks
RISK FACTORS
. HIV and other conditions that impair the immune system
. Pt dependent on alcohol or other chemicals because of malnutrition,
debilitation and generally poor health
. Infants and children under the age of five years
. People with lifelong conditions such as DM or kidney diseases
. People who inject drugs
. Tobacco use
 CLINICAL MANIFESTATIONS

• 1. Initially present:
Fatigue, malaise, anorexia, unexplained weight loss, low grade fever, night sweat
2. Pulmonary manifestations
Cough, high fever, generalized flu like symptoms, pleuritic pain, productive cough
3. Breathlessness, chest pain
4. Weight loss
5. Extreme tiredness or fatigue
6. Enlargement of liver or spleen
7. Enlargement of lymphnodes
 DIAGNOSTIC EVALUATION

1 Medical history
2 Physical Examination

*Clubbing of the fingers and

Toes

*Swollen or tender lymph nodes in the neck or other areas

*Fluid around the lungs
3 Tuberculin skin test or Mantoux test
. It is a standardized test
. PPD is injected in the intradermal layer of inner aspect of forearm
 . 5 tuberculin units in a tuberculin syringe with a 26 to 27 gauge needle is used.
. Needle is inserted under the skin only. Only 0.1 of PPD is injected, created an elevation
in the skin.
. Test is considered positive, if a raised area of induration occurs within 48- 72 hours. A
positive results indicates that a person has been exposed to infection. It does not mean that
active disease is present.
. Size of induration : It denotes the significance of reaction
i) Not significant: 0 to 4 mm
ii) May be significant: 5mm or greater
iii) Significant: 10 mm or greater
• 4. Chest X ray
• 5. Sputum culture test
• 6. Quanti FERON – TB Gold test
• 7. Drug susceptibility testing
8. Other tests
*Bronchoscopy
* CT Scan & MRI
* Ultrasound scan
 MANAGEMENT

• Medical management: Essential drugs

First Line Drug Of Tuberclosis
1. Isoniazid 5-10 mg/ KG up to 300mg,(PO, IM)
2. Ethambutol 15-225 mg/kg up to 2.5g (PO)
3. Rifampicin 10- 15 mg/kg up to 600 mg (PO)
4. Steptomycin 15 mg/kg up to 1 g (IM)
5. Pyrazinamide 25 mg/ kg up to 2g(PO)
 Second Line Drug Of Tb
1 Kanamycin 12-15 mg/kg up to 1g, IM
2. Ethionamide 15mg/kg up to 1g, PO
3. Para amino salicylic acid 200-300mg/kg up to 12g, PO
4. Cycloserine 15mg /kg up to 1g, PO