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Tuberculosis The greatest killer in the history of mankind

Tuberculosis The greatest killer in the history of mankind

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Tuberculosis The greatest killer in the history of mankind

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  1. TuberculosisThe greatest killer in the history of mankind Brig Jawad AnsariFCPS,FCCP,FRCPE Professor of Medicine & Pulmonologist

  2. EPIDEMIOLOGY • 1/3rd of world population is infected • TB contribute 25% of avoidable deaths • 95% cases in developing world • 98% of TB deaths in developing world • 75% of TB cases in productive age group • Pakistan is 7th in ranking with reported cases 0f 361000 per annum and prevalence of 1810/100,000

  3. What are these ?

  4. Acid Fast Bacilli

  5. What is this ?

  6. TubeculousGranuloma

  7. Mycobacterium TB Complex (Tubercle bacilli) (Acid Fast bacilli:AFB) • M.tuberculosis (majority) • M. bovis • M.africanum • Can remain dormant / persist for many years • Atypical Mycobacterium/ Opportunistic

  8. Transmission of Infection • Coughing patient of pulmonary TB • Single cough: 3000 droplets nuclei • Also spread by talking, sneezing, spitting , singing • Direct sunlight kill AFB in 5 minutes • Transmission is mostly indoor • Risks of exposure; concentration of droplet nuclei and the time spent in contaminated air • Bovine TB: cervical lymph node/ intestinal TB

  9. Is TB transmitted by following? • Food • Water • Sexual intercourse • Blood transfusion • mosquitoes

  10. Is TB transmitted by following? • Food • Water • Sexual intercourse • Blood transfusion • mosquitoes NO

  11. Infection to disease • 90% of infected individuals do not develop disease • Only evidence of infection is positive tuberculin test • Chances of disease are higher soon after infection • Higher in infants and children • Emotional and physical stress • HIV infection

  12. Natural History of TB If Untreated: then by 5 years • 50%: will be dead • 25%: cured by their immune system • 25%: become chronic

  13. WHO/CDS/TB/2003.313TREATMENT OF TUBERCULOSIS:GUIDELINESFOR NATIONAL PROGRAMMESTHIRD EDITION 2003

  14. Pulmonary TB is much more common than Extra-pulmonary TB ( 80% v 20%)

  15. Meningitis Miliary Pericarditis Peritonitis Bilateral/ Extensive pleural effusion Spinal Intestinal Genitourinary EXTRA-PULMONARY TB (WHO Categorization) SEVERE FORMS: Cat 1

  16. Meningitis Miliary Pericarditis Peritonitis Bilateral/ Extensive pleural effusion Spinal Intestinal Genitourinary Lymph nodes Unilateral pleural effusion Bones ( excluding spine Peripheral joints Adrenal glands EXTRA-PULMONARY TB (WHO Categorization) SEVERE FORMS: Cat 1 LESS SEVERE FORMS: Cat 3

  17. First year MBBS Teacher to student “Be good You will be fine”

  18. In 3rd year Must Work Hard Man

  19. In fourth year Must Work Very Hard You Know

  20. In final year Can You hear me ? You must work hard

  21. Diagnosing Tuberculosis

  22. Diagnosis: Clinical Suspicion • Cough for more than 2-3 weeks • Sputum production • Weight loss • Night sweats • Fatigue & tiredness • No sign is specific

  23. Diagnosis: Lab Tests • Detection of AFBs in sputum smears • Culturing of AFB & sensitivity • Chest X-ray • Tuberculin Skin Test ? • ESR ??? • PCR

  24. SPUTUM SAMPLING • At least three isolated samples • Sputum and not saliva • Early morning samples preferable • If no cough: • Assisted cough • Induced Sputum • Alternate to sputum • Gastric washings • Bronchial washings

  25. Slide reportingUsing 1000x magnification

  26. Interpretation • Smear positive • At least 2 smears examined and both positive for AFB • Smear Negative • At least 02 smears reported as negative • Indeterminate • Only one smear examined • 03 smears examined and only one reported as positive

  27. MYCOBACTERIAL CULTURES • Growing AFB on culture confirms diagnosis • AFB grown can be tested for their sensitivity against various drugs • Methods • Lowenstein Jensen • Liquid media • Bactec • Limitations: 6-8 weeks, skilled lab,

  28. Tuberculin Skin Test • In population with high prevalence of TB, skin test is of little diagnostic value • Does not distinguish disease from infection

  29. Positive Tuberculin Test • Active TB • Previous TB • Previous BCG vaccination • Atypical mycobacteria • Sarcoidosis ( in less than 30%)

  30. False Negative Tuberculin Test • HIV infection • Malnuitrition • Immunosupressive drugs like steroids • Severe bacterial infection • Milliary TB/ Fulminant TB • Viral infections like measles, chicken pox, glandular fever • Cancer • Incorrect injection of PPD

  31. ESR AND TB • It can not be relied upon for the diagnosis of Tuberculosis and should not be advised in routine. • Not recommended by WHO and by local guidelines

  32. Role of Raidiology There is no radiological findings which can be diagnostic of Pulmonary Tuberculosis But There are certain typical patterns, where TB can be strongly suspected

  33. GHON’S COMPLEX PRIMARY TB