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Wednesday, December 9, 2015

Danger of Pulmonary tuberculosis or PTB


Pulmonary tuberculosis.
infection of the lungs by Mycobacterium tuberculosis.
The usual course of untreated disease is tuberculous pneumonia, formation of tuberculous granulation tissue, necrosis, calcification, and cavity formation.
It may spread to other lung segments via the bronchi, or to other organs via the blood or lymph vessels.
Treatment- complex combination of antibiotics for approx. 6 months

TB in Malaysia increased by 25 per cent over the last ten years and is still rising; over 1700 more cases occur each year than in 1987 when TB was at its lowest. Most cases occur in major cities, particularly in East Malaysia.
People are at higher risk of TB if they have lived in parts of the world where TB is more common. Asia and Africa.
In Malaysia, around seven out of every ten people with TB come from any a  population group as Malay , Chinese and Indian.

Pathlogy Of  TB lungs
Here is the gross appearance of a lung with tuberculosis

·         Bacilli are ingested by leucocytes and then absorbed by marcopages.
·         More leucocytes form a barrier around this collection of cells and form a mass known as a, ‘tuberculous follicle’.
·         The centre of this area undergoes necrosis and becomes soft and cheesy in consistency.
·         The material should move into the bronchi and coughed up leaving a cavity.
·         Fibroblasts lay down a capsule around the tubercle in which calcium salts become depositied and healing takes place.
·         Cavity formation and calcification are features of TB and these sites remain sources of potential infection- postprimary pulmonary tuberculosis

Aetiology of TB
It is usually spread by the coughs or sneezes of an infected person, but is not highly contagious. Prolonged close contact with a person with TB—for example, living in the same household—is usually necessary for infection to be passed on.

Predisposing risk factors
1.      Environment
2.      Poor hygiene
3.      Over crowding
4.      Lower socio-economic groups
5.      Malnutrition
6.      Smoking
7.      Alcoholism

Disease factors
1.      Diabetes Mellitus
2.      Congenital heart disorder
3.      Leukaemia
4.      Hodgkin’s disease

5.      Long-term corticosteroids
6.      Immunosuppresive drugs

What are the Risk Factor
People whose resistance to infection is impaired: for instance, the elderly and the new born, people with serious chronic illness, those on steroid tablet treatment, those with HIV/Aids, with insulin-dependant diabetes, alcoholics and others. If people in these categories have dormant TB germs in their body, they are at risk of active TB developing

Clinical Features of TB
1.      Malaise, irritability
2.      Loss of appetite  weight loss
3.      Pyrexia and tachycardia
4.      Night sweats
5.      Productive cough
6.      Haemoptysis
7.      Dyspnoea
8.      Pain on breathing

How to detect and diagnosed
·         Imaging- Bronchoscopy, x-ray

·         Haematology- anaemia

·         Microbiology- sputum culture

·         Immunology- Mantoux skin test

·         Cavitatory Pulmonary TB

Medical Treatment Provided
1.      TB treatment involves using three or four special TB-antibiotics.
2.      They are tablets and capsules, which are normally given before and after breakfast.
3.     rifampicin, isoniazid, pyrazinamide and ethambutol

Techniques to deprive bacilli of O2
·         Thoracoplasty

·         Artificial pneumothorax

·         Phrenicolysis

·         Scalenectomy

·         Plombage

Physiotherapy Treatment
·         Not indicated in the rest stage.

·         SOB  DBE’s, advice on pacing

·         Retained secretions  ACBT

·         ↓ mobility  Ax and Rx according

·         RX of post-TB lungs  bronchiectasis and restrictive lung disease

Infection Control.
·         Patients cared for in side room. Door SHOULD be SHUT!

·         Gloves and apron on

·        Face masks

What we need to know?
·         Tuberculosis infection - this means a person has TB organisms in their body, but there is no evidence that the germs are active, growing or causing damage to body tissues.

·         TB disease - this term refers to the fact that there is at least one area of the body where TB germs are growing and causing tissue damage. The term "active tuberculosis" refers to TB disease. The most common places in the body where TB occurs are the lungs and in lymph glands.

·         Rene Laennec- French physician who invented the stethoscope died of TB aged 45 in 1826.

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