Osteo articular tuberculosis -1
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osteoarticular tuberculosis for resident doctors pursuing post graduate course
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Osteo articular tuberculosis -1
- 1. Rsivaprasad Orthopaedic surgeon OSTEO-ARTICULAR TUBERCULOSIS
- 2. Robert Koch (1843 - 1910).
- 4. 20% of AIDS patients have T.B. 50% of young adults with T.B. have AIDS AIDS & TUBERCULOSIS
- 5. TB Population- 1/5 of world population – (2Mil.) 50% - Active Spine TB 50% - Children Every day – 1000 die of TB in India
- 6. HAVOC of TB
- 8. Increase in No. of Cases
- 9. High Burden Countries (HBC) - 22 80% of New Cases are from these 22 countries. Global Plan is aimed at these countries
- 20. Cold abscess
- 21. Cold abscess Cord compression Quadri / Paraplegia Tense paravertebral abscess with or without neurological symptoms Costotransversectomy
- 29. Cold Abscess
- 36. (17) Pott abscess in a patient with tuberculous spondylitis. Radiograph of the thoracic spine demonstrates vertebra plana of D11 with an associated soft-tissue-density mass, the latter finding being consistent with a tuberculous (Pott) abscess. (18) Gibbus deformity secondary to tuberculous spondylitis. Sagittal T1-weighted (a) and T2-weighted (b) MR images show vertebral collapse with high signal intensity in the adjacent vertebral bodies. The vertebral collapse has resulted in a gibbus deformity and spinal cord compression.
- 39. Tuberculous dactylitis. (20) Radiograph of the right hand shows fusiform soft-tissue swelling around the first metacarpal bone, along with associated periostitis. (21) Radiograph of the left hand shows cystic expansion of the proximal phalanx of the index finger, a finding that is called spina ventosa.
- 40. (22) Ankylosis secondary to tuberculous arthritis. Radiograph of the knee shows loss of joint space secondary to cartilage destruction, resulting in ankylosis. (23) Tuberculous arthritis . Radiograph demonstrates only minimal sclerosis and new bone formation in the right hip, considering the degree of bone destruction that is seen. (24) Chronic tuberculous arthritis. Radiograph demonstrates complete joint destruction in the right hip, along with associated soft-tissue swelling and calcification.
- 58. MANAGEMENT OF OSTEOARTICULAR TUBERCULOSIS
- 65. First-Line Treatment of Tuberculosis (TB) for Drug-Sensitive TB
- 66. Anti-T.B.Drugs # Drug Dose/Kg Dose/ day Complications 1 Streptomycin 15-20mg 0.75G Vertigo, Tinnitus, deafness 2 Isoniazid 5-10mg 300mg Sin Peripheral Neuritis 3 Rifampicin 10mg 600mg-Sin Hepato toxic 4 Ethambutol 15mg 800mg Optic Neuritis 5 Pyrazinamide 20-35mg 2 G Hyperuricemia Arthralgia & Hepatitis
- 68. Causes of Drug Resistance Drug Resistance (DR) is a MAN MADE problem due to Improper prescription or administration of chemotherapy Non-adherence of patients to treatment Lack of drug availability (irregular drug supply under programme conditions) Lack of drug control (deregulated, consumer-driven treatment) MDR spreads due to: Lack of awareness about the regimens among doctors Apparently High treatment cost Non-availability of second line drugs
- 69. Multidrug-Resistant Tuberculosis (MDR TB) and Possible Effective Treatments
- 70. Extensively Drug-Resistant Tuberculosis (XDR TB) Diminishing Options for Treatment
- 71. New Tuberculosis (TB) Drugs Under Development
- 77. TUBERCULOSIS OF SPINE POTT’S DISEASE
- 80. Thoracic & Lumbar spine
- 81. Position – Thoracic spine Approach from left side
- 82. Exposure Select the rib that in the midaxillary line lies opposite the maximum convexity of the kyphosis.
- 86. Thoracic & Lumbar spine
Notas do Editor
- Born on 11 December 1843, in Klausthal Germany, Koch was one of thirteen children. His father was a mining official. He grew up to be an avid chess player, an admirer of Johann Goethe and above all a brilliant scientific investigator. He obtained a medical degree from the University of Gottingen, in 1866, after studying firstly natural science and then medicine. One of Koch's teachers at the university was the German pathologist Friedrich Henle who has had a huge influence on the development of histology. Another teacher was the chemist first to synthesise an organic compound (urea) from an inorganic substance in 1828, Friedrich Wohler. After graduation Koch became a physician in various provincial towns and a surgeon during the 1870-72 Franco-Prussian war.
- A typical tb granuloma central necrosis giant cells sorrounded by lymphocytes&histiocytes
- Psoas abscess
- Tuberculosis, which results from an infection with Mycobacterium tuberculosis , can usually be cured with a combination of first-line drugs taken for several months. Shown here are the four drugs in the standard regimen of first-line drugs and their modes of action. Also shown are the dates these four drugs were discovered—all more than 40 years ago.
- Drug resistance in Tuberculosis is multi-factorial.Most importantly it is man made: either due to improper prescription or by non-adherence to the treatment. Patient non compliance is mostly because of drug cost or side effects with the 1 st line drugs. Whatever the reason may be, it leads most often to a deadly consequence like MDR TB.
- MDR TB occurs when a Mycobacterium tuberculosis strain is resistant to isoniazid and rifampin, two of the most powerful first-line drugs. To cure MDR TB, healthcare providers must turn to a combination of second-line drugs, several of which are shown here. Second line drugs may have more side effects, the treatment may last much longer, and the cost may be up to 100 times more than first-line therapy. MDR TB strains can also grow resistant to second-line drugs, further complicating treatme
- XDR TB occurs when a Mycobacterium tuberculosis strain is resistant to isoniazid and rifampin, two of the most powerful first-line drugs, as well as key drugs of the second line regimen—any fluoroquinolone and at least one of the three injectable drugs shown above. XDR TB strains may also be resistant to additional drugs, greatly complicating therapy.
- Several new types of TB drugs currently under development are shown here with their mechanisms of action. NIAID has supported the development of two of these compounds, SQ-109 and PA-824, which are denoted by asterisks (*) above.