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Pulmonary tuberculosis

Pulmonary tuberculosis. L de Man Dept. of Physiotherapy University of the Free State 2012 . Definition. Tuberculosis is an active infection with the bacterium Mycobacterium tuberculosis. History. Tuberculosis has been present in humans since antquity

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Pulmonary tuberculosis

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  1. Pulmonary tuberculosis L de Man Dept. of Physiotherapy University of the Free State 2012

  2. Definition • Tuberculosis is an active infection with the bacterium Mycobacterium tuberculosis

  3. History • Tuberculosis has been present in humans since antquity • Tubercular decay in the spines of Egyptian mummies dating from 3000 – 2400 BC • 460 BC Hippocrates identified phtisis as the most widespread disease of the times involving coughing up blood and fever, which was almost always fatal.

  4. History • Robert Koch discovered the tuberculosis bacili in 1882 and received the Nobel Prize in medicine in 1905 • In 1946 the development of the antibiotic streptomycin made effective treatment and cure possible

  5. History • Prior to that the only treatment besides going to a sanatorium, were surgical treatment – collapsing an infected lung to “rest” it and allow lesion to heal

  6. History • Surgery discontinued in 1950’s • Postoperative problem was postural due to lack of structural support • Due to overcompensation the patient developed posture of leaning away from the incision side

  7. Thoracoplasty • Left lung collapse secondary to thoracoplasty

  8. Epidemiology • Current estimates: around ⅓ of world’s population has latentTB • Between 2002 and 2020 1000 million will become newly infected 150 million will contract TB 36 million will die

  9. Reasons for increase in incidence • Developed countries • Immigration from high prevalence areas • HIV • Social deprivation (homelessness, poverty) • Increased proportion of elderly • Drug resistance • Developing countries • Ineffective control programmes • Lack of access to health care • Poverty, civil unrest • HIV • Increased population • Drug resistance

  10. Epidemiology • The 22 countries account for 80% of the TB cases in the world

  11. Alphabetical list of countries 1.Afghanistan 2. Bangladesh 3. Brazil 4. Cambodia 5. China 6. Democratic Republic of Congo 7. Ethiopia 8. India 9. Indonesia 10 Kenya 11. Mozambique 12. Myanmar 13. Nigeria 14. Pakistan 15. Philippines 16. Russia 17. South Africa 18. Tanzania 19. Thailand 20. Uganda 21. Viet Nam 22. Zimbabwe

  12. Epidemiology In 2007, the country with the highest incidence rate was Swaziland, with 1200 cases per 100,000 people versus 15 cases per 100,000 people in United Kingdom

  13. Pathology • Spreads through cough, sneeze, any other way of transmitting saliva – a single sneeze can release up to 40,000 droplets (0,5 – 5µm in diameter) • Primary TB = active disease on first exposure • Most infections result in a asymptomatic,latent infection

  14. Pathology • Combination of primary lesion and regional lymph node involvement = Ghon focus

  15. Pathology • Post-primary TB = active TB • Earliest chest x-ray = an ill defined opacity situated in one of the upper lobes

  16. Pathology • As disease progress consolidation, collapse, caseation,fibrosis and cavitation • On chest x-ray – significant displacement trachea and mediastinum

  17. Pathology

  18. Symptoms of active TB • Chronic cough • Hemoptises • Fever • Night sweats • Appetite loss • Weigt loss • Fatigue

  19. Miliary TB • Blood borne dissemination gives rise to miliary TB • Classic appearance on chest x-ray = fine, 1 – 2 mm lesions distributed throughout the lung fields

  20. Diagnosis • Ussually confirmed by direct microscopy = Ziel-Neelsen staining • Culture of samples is sputum

  21. Management • Rifampicic and Isoniazid for 3 months • Or Isoniazid for 6 months • Chemotherapy • Were drug resistance is not expected, a patient can be assumed to be non-infectious after 2 weeks of appropriate therapy. • Directly observed therapy (DOT)

  22. Extra pulmonary TB • Lymphadenitis Lymph nodes of cervical and mediastinal glands

  23. Extra pulmonary TB 2. Gastrointestinal TB • Any part of bowel can be infected • Acute abdomen • Narrowing, shortening, distortion of bowel • TB peritonitis 3. Pericardial disease • Pericardial effusion • Constrictive percarditis

  24. Extra pulmonary TB 4. CNS disease • Most important form and when unrecgonised and untreated = fatal • Recovery rate = 60% or less with permanent neurological deficit • Usual local source = caseous focus in meninges or brain

  25. TB meningitis

  26. Extra pulmonary TB 5. Bone and joint disease • Spine is common site = Pott’s disease • Vertebral collapse resulting in kyphosis • Spinal cord compression • Sinus formation • Paraplegia (so called Pott's paraplegia) • Prevention = Controlling the spread of tuberculosis infection • Therapy = Stabilisation and decompression with\ spinal involvement

  27. Physiotherapy • Physio per se is not indicated • Treat associated conditions or complications that may have arisen through reactions to drugs

  28. References • Boon NA, Colledge NR, Walker BR, Hunter JAA. 2006. Davidson’s Principles and Practise of Medicine. 20th Ed. Edinburgh London, Elsierivier Limited. p 695-703.

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