TuBerculosis

TuBerculosis

1. pathogenesis and types

   • inhalation of mycobacterum tuberculosis
     • primary TB
       • charecterized by Ghon complex
         • ghon focus
           • localized fibrosis
         • lymphadenitis
           • hilar lymph nodes
         • 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

2. epidemiology of Tb

   • highest burden
     • southeast asia followed by africa
   • prevalance in UAE
     • adult expatriates subjected to screening is about 39 per 100,000
   • goal
     • increase annual decline to 4-5%

3. positive signs in history taking

   • hemoptysis
     • differentials
       • vascular
         • pulmonary embolism
       • autoimmune
         • goodpasture syndrome
       • neoplastic
         • lung cancer
       • infective
         • TB
   • cough
     • differentials
       • acute or chronic ?
       • productive or dry?
       • with hemoptysis or not?
       • how to diagnose
         • common causes
           • pneumonia
             • lung cancer
               • tb
           • COPD
             • Ace inhibitors induced
               • heart failure
   • weigh loss
   • night sweats
   • fatigue

4. positive signs in physical examination

   • crackles
     • description
       • Sound when sudden “popping” reopening of collapsed alveoli as air passes through fluid
       • During expiration alveoli stick together. During inspiration the alveolar walls separate with difficult and only at the end of inspiratory movement.
   • decrease lung sounds
   • pleural effusion
     • accumulation of fluid in pleural cavity (>500ml) restricting lung expansion
   • decrease resonance
     • less air in consolidation
   • decrease tactile fermitus
     • more voice transmission in consolidation

5. ·

   • microbiology
     • acid fast bacilli
       • Ziehl-Neelson stain
         • cell wall with high lipid content (mycolic acid)
           • Lowenstein-Jensen medium
             • virullence factors
               • Sulfatides
                 • prevent phagolysosome fusion
                   • allow mycobacterium tuberculosis to survive
           • grow in
   • inestigations
     • chest X-ray
       • tuberculin skin test
         • • IGRA
   • TREATMENT
     • DOT: the patient takes treatment for 6 monthes undersupervision
       • isoniazid
         • rifampin
           • pyrazinamide
             • ethambutol
   • prevention
     • vaccine
       • BCG vaccine at birth
         • prophylaxis
           • Isoniazid
             • airborne isolation
               • types of precuations

Imagens e arquivos do mapa