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Highlights on

Pulmonary Tuberculosis

Prof. Dr. Saad S Al-AniSenior Pediatric ConsultantHead of Pediatric departmentKhorfakkan Hospital

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TB Diagnosis“The first rule of TB diagnosis: is to think of TB….”

Include TB in your differential diagnosis when history, symptoms are consistent with TB diagnosisOrder the appropriate diagnostic tests

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Pulmonary infectionsPredisposing factors

1.Decreased cough reflex

2.Injury to cilia

3.Decreased function of alveolar macrophages

4.Edema or congestion

5.Retention of secretions

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3.Progressive primary pneumonia Miliary dissemination (blood stream).

Pulmonary tuberculosis

Primary1.Single granuloma within parenchyma and hilar lymph nodes (Ghon complex).

2.Infection does not progress (most common).

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Secondary

Pulmonary tuberculosisCont.

•Infection (mostly through reactivation) in a previously sensitized individual

Pathology

•Cavitary fibrocaseous lesions

•Bronchopneumonia

•Miliary TB

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Typical Progression of Pulmonary tuberculosis

1.Pneumonia2.Granuloma formation with fibrosis

3.Caseous necrosis

4.Calcification

5.Cavity formation

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Pulmonary tuberculosis

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Acid-Fast (Kinyoun) Stain of Mycobacterium

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Mycobacterium Tuberculosis Stained with Fluorescent Dye

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Fibrocaseous

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Miliary

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GranulomaGranuloma

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MycobacteriumMycobacterium

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Not Everyone Exposed Becomes InfectedProbability of transmission depends on:

1.Infectiousness 2.Type of environment 3.Length of exposure

10% of infected persons will develop TB disease at some point in their lives

* 5% within 1-2 years* 5% at some point in their lives

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Treatment of TB Disease

Include four 1st-line drugs in initial regimen1.Isoniazid (INH)2.Rifampin (RIF)3.Pyrazinamide (PZA)4.Ethambutol (EMB)Never add a single drug to a failing regimen

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Barriers to Adherence

•Stigma

•Extensive duration of treatment

•Adverse reactions to medications

•Concerns of toxicity

•Lack of knowledge about TB

and its treatment

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Improving Adherence

•Adherence is the responsibility of the provider,

not the patient and can be ensured by:

-Patient education

–Directly observed therapy (DOT)

–Case management–Incentives/enablers

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Directly Observed Therapy (DOT)

*Health care worker watches patient swallow each dose of medication

*DOT is the best way to ensure adherence

•Should be used with all intermittent regimens

Reduces relapse of TB disease and acquired drug resistance

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Remember

“A decision to test

is

a decision to treat.”

Thank you