41 y/0 women present with Hemoptysis for 1 month and prolonged fever

Lab Investigations

Lymph node biopsy

  • Granuloma with caseous necrosis in the center, Langhan type giant cell, epitheloid histiocytes and Surrounding the epitheloid histiocytes are lymphocytic infiltrates like T cell and B cell and fibroblast are also found in the outer region.

Sputum Collection

  • Spontaneous sputum sample
  • Sputum induction
  • Bronchoscopy
  • Gastric washing

AFB stain with ziehl nielsen or kinyoun stain to detect M. tb

Nucleic acid amplification test

Culture

  • Solid (Loweinstein jensen)
  • Liquid (Middlebrook)
  • Automated Bactec broth culture system

Mantoux test for detecting induration and categorize patient with various risk of contracting TB

Other basic test :

  • FBC Low Hb, WBC high in monocytes and also neutrophils
  • ESR high (inflammatory nature)

Chest radiograph
Consolidation at upper right zone

  • Increase vocal fremitus and vocal resonance
  • Dull to percussion
  • Bronchial breath sounds

+ve result

Diagnosis: Pulmonary TB

pathogenesis:

  1. host inhales droplet nuclei containing tubercle bacilli
  2. bacteria travels to lungs alveolar
  3. alveolar macrophages takes up bacteria via phagocytosis and majority were destroyed
  4. those survived, multiply inside macrophages and induced cell mediated immunity
  5. immune cell surround infected area forming GRANULOMA
  6. 90-95% become latent after that, if immune system compromised, bacteria escaped and multiply.
  7. spread to upper lobes triggering immune system forming more caseous necrosis.
  8. cavitates formed, bacteria disseminates to systemic or back into airways

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Immediate action for contact tracing to prevent further spread of disease

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Treatment and management

  • most conmon TB drugs -> Isoniazid , Rifampin, Ethambutol and Pyrazinamide
    Drug Resistance TB - use combination antibiotics such as fluoroquinalones with amikacin / capreomycin for 20-30 months
    Add on therapy for resistance tb will be Bedaquiline and Linezolid

sign and symptoms
1)bad cough that lasts 3 weeks or longer
2)pain in the chest
3)coughing up blood or sputum
4)weakness and fatigue
5)weight loss
6)no appetite
7)chills
8)fever
9)night sweats

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complications
1)spinal pain
2)joint damage
3)liver or kidney problems
4)cardiac tamponade(heart)
5)meningitis(swelling of the brain membranes)

Interferon-γ release assay
Measures γ-interferon released from the patient’s lymphocytes after exposure to PPD in cell culture

Causes: Mycobacterium tuberculosis bacteria
Risk factors:

  1. Immunosuppressed patients


    -AIDS patients


    -diabetes


    -certain cancers


    -malnutrition


    -taking drugs to treat rgeumatoid arthritis, Crohn's disease, psoriasis


  2. Travelling/living in areas/countries that hve high rates of TB cases( India, Indonesia, China, Philippines)


  3. Poverty and substance use:


    -lack access to medical care


    -IV drugs abuser


    -excessive alcohol consumption


    -tobacco use


  4. Working/living place:


    -health care workers


    -living with someone infected with TB