TB

Tuberculosis
According to the World Health Organization
(WHO)Trusted Source, 1.5 million people died from
the disease in 2020. Tuberculosis is also the 13th
leading cause of death globally. Currently, it’s the
second main infectious cause of death, after COVID-
19.
Tubercoloses

•, once called
consumption, is a
highly infectious
disease that primarily
affects the lungs
What causes
tuberculosis?
•Mycobacterium tuberculosis
is an obligate aerobe; this
•explains why ?!
• its couse disesa in highaly
oxygenated tissu like upper
lobe of the lung and kideny
some of these have
become resistant to
medication called
multidrugresistant
or MDR strains.
transmitted from
person to person
by respiratory
aerosols produced
by coughing.
Symptoms
1. a bad, lingering
cough
2. coughing up
blood
3. pain in the chest
4. fever
5. fatigue
6. night sweats
7. weight loss
How is it diagnosed!?
🤨🤔
• Mantoux tuberculin skin
test (TST)
• Blood test
TB and HIV
💔👀
People living with HIV are at higher risk of
contracting the infection and dying from TB. In
fact, TB is the leading cause of death of HIV-
positive
people, according to the WHOTrusted Source.

Untreated latent TB is more likely to progress to

active TB in a person living with HIV. That makes
testing for TB essential for anyone with a HIV-
positive status
clinical guidlines for the
management of
tuberculodis
tuberculosis patients are
divided in to 4
categories
category 1:
• apatients who has never had treatment for
tuberculosis or has taken anti tuberculosis
drugs for less than 1 month
• this group include:
• -new sputum + pulmonary TB
• -new sputum — pulmonary TB with
extensine parenchymal involvement
• -new cases of severe form extrapulmonary
TB
category 2:

• in this category those patients are

included who have taken anti
tuberculosis therapy in the past such AS
the following
• -relapse
• -treatment failure
• -interrupted or defult treatment
category 3:

•-sputum — pulmonary TB
with limited parenchymal
involvement
category 4 :

-extrapulmonary TB

-Chronic cases
management of category
1 and 3 :
treatment duration (6
monthes)
divided in to two
phases:
initial intensive phase: continuation phase:

• extend for 2 monthes • extend for 4

and include the monthes and
following drugs: include the following
• isoniazid, rifpampicin, drugs :
ethambutol and • isoniazid and
• pyrazinamide. ethambutol or
rifpampicin
management of category 2 :

• management duration( 8 monthes).

• divided in to two phases :
• Initial intensive phase
• Extend for 2 monthes and include the
following 5 drugs :
• isoniazid, ethambutol,
pyrazinamide,rifpampicin and
streptomycin
• one more month :
• the above, but no streptomycin.

• check sputum smear after 5 monthes

• if smear negative continue isoniazid,

rifpampicin, and ethambutol for 5
monthes.
• if positive give 5 drugs again for one
month
management of category4

•multi drug resistance(MDR)

•treatment is given by (DOT)
direct observation therapy
TB and HIV

• TB is febrile. Fever increase replication of the virus

and make the disease worse.
• HIV decrease the immunity and cause severe
tuberculosis.
• any patient with TB or kalazar should be treated for
HIV
special problems

in tuberculosis
• 1-pregnant ladies streptomycin is
contraindicated

• 2-in patient with renal failure avoid

streptomycin and ethambutol or given in
small dose with regular monitoring
• 3- if patient develop hepatotoxicity stop all
drugs untill there is no jaundice,bilirubin normal
and enzymes normal then you have 2 choices:
• either itroduce all drugs at full doses or itroduce
by one
• 4- hypersensetivity reactions of the drugs like
erythema multiforme, steven johnson
syndrome and toxic epidermal necrolysis
• stop all drugs untill the patient is normal and
then itroduce one by one gradually to see which
one is causing hypersensetivity (don, t itroduce
all of them together)
Drug side effects😢💔
 • Ethambutol side
Some effects:
pyrazinamide • Chills • Painful or
side effects :• swollen joints Belly
• Lack of energy pain, optic neuritis
• Nausea and • Headache •
vomiting • Loss Confusion
of appetite •
Muscle or joint
pain
• Common rifampin • Common
side effects : • isoniazid side
• Skin rash . Upset effects :
stomach , • • Numbness
nausea , and
vomiting • and tingling in
Diarrhea • Loss of your hands and
appetite • hepatic enzyme
Inflamed elevation
pancreas
macrolides :
• GIT intolerance
Ethionamide, PAS cysloserine:
CNS toxicity
(para-
aminosalicylicacid)
• hepatotoxicity
• hypothyroidism
• GIT intolerance