TuBerculosis

pathogenesis and types
1. inhalation of mycobacterum tuberculosis
  1. primary TB
    1. charecterized by Ghon complex
      1. ghon focus
        localized fibrosis
      2. lymphadenitis
        hilar lymph nodes
      3. if remains dormant
        latent TB
        in reactivation due to immunocompression
        secondary TB
        in lungs
        cavitations
        bronchopneumonia
        caseating necrosis
        if it spread via blood
        miliary Tb
        vertebra
        pott's disease
        intestine
        ulcerations
        kidney
        sterile pyuria
        menengis
        tuberculous menengitis
epidemiology of Tb
1. highest burden
  1. southeast asia followed by africa
2. prevalance in UAE
  1. adult expatriates subjected to screening is about 39 per 100,000
3. goal
  1. increase annual decline to 4-5%
positive signs in history taking
1. hemoptysis
  1. differentials
    1. vascular
      1. pulmonary embolism
    2. autoimmune
      1. goodpasture syndrome
    3. neoplastic
      1. lung cancer
    4. infective
      1. TB
2. cough
  1. differentials
    1. acute or chronic ?
    2. productive or dry?
    3. with hemoptysis or not?
    4. how to diagnose
      1. common causes
        pneumonia
        lung cancer
        tb
        COPD
        Ace inhibitors induced
        heart failure
3. weigh loss
4. night sweats
5. fatigue
positive signs in physical examination
1. crackles
  1. description
    1. Sound when sudden “popping” reopening of collapsed alveoli as air passes through fluid
    2. During expiration alveoli stick together. During inspiration the alveolar walls separate with difficult and only at the end of inspiratory movement.
2. decrease lung sounds
3. pleural effusion
  1. accumulation of fluid in pleural cavity (>500ml) restricting lung expansion
4. decrease resonance
  1. less air in consolidation
5. decrease tactile fermitus
  1. more voice transmission in consolidation
1. microbiology
  1. acid fast bacilli
    1. Ziehl-Neelson stain
      1. cell wall with high lipid content (mycolic acid)
        Lowenstein-Jensen medium
        virullence factors
        Sulfatides
        prevent phagolysosome fusion
        allow mycobacterium tuberculosis to survive
        grow in
2. inestigations
  1. chest X-ray
    1. tuberculin skin test
      1. IGRA
3. TREATMENT
  1. DOT: the patient takes treatment for 6 monthes undersupervision
    1. isoniazid
      1. rifampin
        pyrazinamide
        ethambutol
4. prevention
  1. vaccine
    1. BCG vaccine at birth
      1. prophylaxis
        Isoniazid
        airborne isolation
        types of precuations

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TuBerculosis

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	Criado por group C year 3 mais de 7 anos atrás