This document provides an overview of tuberculosis (TB), including its causes, types, diagnosis, and treatment. Some key points: - TB is caused by the bacterium Mycobacterium tuberculosis and kills over 1.6 million people worldwide each year. It is a major global health problem, especially in developing countries. - Pulmonary TB affects the lungs and is the most common type. Extra-pulmonary TB can affect other organs. Diagnosis involves sputum smear, culture, chest x-ray, and tuberculin skin testing. - Treatment requires a multi-drug regimen over several months to cure the infection and prevent drug resistance. Directly observed therapy is recommended to ensure patient adherence

1. Tuberculosis
Dr. Sameh Ahmad Muhamad abdelghany
Lecturer Of Clinical Pharmacology
Mansura Faculty of medicine

2. Contents
Introduction
Risk Factors
Types - Causes
Diagnosis(C/P – Investigation)
Treatment

3. INTRODUCTION

4. Definition
 Tuberculosis (TB) is a potentially fatal contagious
disease that can affect almost any part of the body
but is mainly an infection of the lungs.
 Neo-latin word :
o Tubercle = Round nodule/Swelling
o Osis = Condition

5. Global Status of TB
 Tuberculosis (TB) kills 1.6 million people a year
o 0.2 million people infected with HIV
o 98% of these deaths occur in the developing world.
 Close to 9 million new cases develop every year and about one
third of the world’s population is infected with Mycobacterium
tuberculosis.
 TB is a major cause of death among people with HIV/AIDS
and infection is the most potent risk factor for the conversion
of latent TB infection to active TB.

6. Global Status of TB
 Multidrug-resistant TB (MDR-TB) has emerged in
nearly every country of the world. Extensively drug-
resistant TB (XDR-TB) has been identified in 17
countries and in all geographical regions.

7. Causes of TB

8. Causative Organisms
 Mycobacterium tuberculosis Human
 Mycobacterium Bovis Animals
 Others:
o Mycobacterium africanum
o Mycobacterium microti

9. Mycobacterium tuberculosis-Characteristics
 Gram positive
 Obligate aerobe
 Slow generation time: 15-20 hours
 Lipid rich cell wall contains mycolic acid:
o Responsible for many of bacterium
characteristics.
o Acid fast.
o Causes resistance to antibacterials.

10. Types of TB

11. Classification
I. Pulmonary TB
 Primary Disease
 Secondary Disease
II. Extra pulmonary
 Lymph node TB
 Pleural TB
 TB of upper airways
 Skeletal TB
 Genitourinary TB
 Miliary TB
 Pericardial TB
 Gastrointestinal TB
 Tuberculous Meningitis

12. TYPES
I. Pulmonary TB
 Primary Tuberculosis :-
 The infection of an individual who has not been
previously infected or immunised
 Lesions forming after infection is peripheral and
accompanied by hilar which may not be detectable
on chest radiography.

13. TYPES
 Secondary Tuberculosis :
 The infection that individual who has been
previously infected or sensitized is called
secondary or post primary or reinfection or
chronic tuberculosis.

14. TYPES
II. Extra-pulmonary TB
i. Lymph node TB ( tuberculuous lymphadenitis)
 Seen frequently in HIV infected patients.
 Symptoms :- Painless swelling of lymph nodes most commonly at
cervical and Supraclavical (Scrofula)
 Systemic systems are limited to HIV infected patients.
ii. Pleural TB
 Involvement of pleura is common in Primary TB
 and results from penetration of tubercle bacilli into pleural space.

15. TYPES
iii. TB of Upper airways
 Involvement of larynx, pharynx and epiglottis.
 Symptoms :- Dysphagia, chronic productive cough
iv. Genitourinary TB
• 15% of all Extra pulmonary cases.
• Any part of the genitourinary tract get infected.
• Symptoms :- Urinary frequency, Dysuria, Hematuria.

16. TYPES
v. Skeletal TB
 Involvement of weight bearing parts like spine, hip, knee.
 Symptoms :- Pain in hip joints n knees, swelling of knees,
trauma.
vi. Gastrointestinal TB
 Involvement of any part of GI Tract.
 Symptoms :- Abdominal pain, diarrhea, weight loss

17. TYPES
vii. TB meningitis
 Results from Hematogenous spead of primary & secondary TB.
viii.TB Pericarditis
 1- 8% of All Extra pulmonary TB cases.
 Spreads mainly in mediastinal or hilar nodes or from lungs.

18. TYPES
ix. Miliary or disseminated TB
 Results from Hematogenous spread of Tubercle Bacilli.
 Spread is due to entry of infection into pulmonary vein producing
lesions in different extra pulmonary sites.
x. Less common Extra Pulmonary TB
 uveitis, panophthalmitis, painful Hypersensitivity related
phlyctenular conjuctivis.

19. Risk Factors

20. Risk factors
 Elderly
 Infants
 Low socioeconomic status
 Crowded living conditions
 Disease that weakens immune system like HIV
 Alcoholism
 Recent Tubercular infection (within last 2 years) and
ect.

21. Diagnosis

22. Medical History
 HIV status
 Symptoms of disease
 History of TB exposure, infection, or disease
 Past TB treatment
 Demographic risk factors for TB
 Other medical conditions that increase risk for TB
disease (e.g., diabetes)

23. Systemic Symptoms
 Fever
 Chills
 Night sweats
 Appetite loss
 Weight loss
 Fatigue

24. Symptoms of Pulmonary TB
 Productive, prolonged cough (duration of 2-3
weeks)
 Chest pain
 Hemoptysis (bloody sputum)
 Symptoms may vary based on HIV status

26. Investigation

27. LAB
 Bacteriological test
 Obtain 3 sputum specimens for
smear examination and culture
 3 respiratory specimens will
detect 90% of smear-positive
cases
 Look forAFB smear-microscopy

28. Acid fast smear showing TB bacilli

29.  PTB+ (Pulmonary TB smear-positive)
 One AFB-positive smear; i.e. any patient with at least one
positive smear result (irrespective of quantity of AFBs seen
on microscopy)
 PTB- (smear-negative)
i. Patients with three negative smear results and radiological
findings and doctor’s decision to treat for TB
ii. Patients with negative smear results and a positive culture
result for M. tuberculosis
iii. Patients who are unable to produce sputum and with
highly suspicious radiological and clinical findings and
doctor's decision to treat for TB

30. LAB
 Sputum culture test
Culture is indicated for
i. New and retreatment PTB cases
still smear- positive at end of
intensive phase
ii. Symptomatic contacts of known
MDR cases

31. Radiography
 Chest X-Ray(CXR)
 Cannot confirm diagnosis of TB
 May have unusual appearance in
HIV-positive persons
 CXR is helpful in HIV+, smear-
negative patients

32. Tuberculin skin test (PPD)
 Injection of fluid into the skin of the lower arm.
 48-72 hours later -checked for a reaction.
 Diagnosis is based on the size of the wheal:
o <6mm negative
o 6mm-15mm Hypersensitive to tuberculin
protein(Previous TB infection or BCG – atypical
mycobacteria)
o >15mm strongly Hypersensitive to
tuberculin protein(suggestive of TB infection)

34. Other biological examinations
 Cell count(lymphocytes)
 Protein(Pandy and Rivalta tests) – Ascites, pleural
effusion and meningitis.

35. Treatment

36. Aims of TB Treatment
 Cure the patient of TB
 Prevent death from active TB or its latent effects
 Prevent relapse of TB
 Decrease transmission of TB to others
 Prevent the development of acquired resistance

37. Preventive measures
 Mask
 BCG vaccine
 Regular medical follow up
 Isolation of Patient
 Ventilation
 Natural sunlight

38. BCG vaccine
 Only vaccine available today for protection against
tuberculosis.
 effective in protecting children from the disease.
 Given 0.1 ml intradermally.
 Duration of Protection 15 to 20 years
 Should be given to all healthy infants as soon as
possible after birth unless the child presented with
symptomatic HIV infection.

39. Basic Principles of Treatment
 Determine the patient’s HIV status- this could save
their life!
 Provide safest, most effective therapy in shortest time
 Multiple drugs to which the organisms are
susceptible
 Never add single drug to failing regimen
 Ensure adherence to therapy (DOT)

40. DOTS
 Directly observed treatment, short-course
 DOT means that a trained health care worker or other
designated individual provides the prescribed TB drugs
and watches the patient swallow every dose.
 DOT for all patients on all regimens (NO exceptions)

41. FIRST LINE ANTI-TUBERCULOUS
DRUGS
 Isoniazide
 Rifampicin (Rifampin)
 Ethambutol
 Pyrazinamide
 Streptomycin

42. SECOND LINE ANTI-TUBERCULOUS
DRUGS
 Para aminosalicylic acid
 Ethionamide
 Cycloserine
 Fluoroquinolones
 Capreomycin

43. REGIMEN OF TB THERAPY
Patients with active TB:
 Initial phase (first 2-4 months): 4 drugs are used (RIPE):
(Rifampin + INH + Pyrazinamide + Ethmabutol).
 Continuation phase (next 4-6 months): at least 2 drugs are
used (INH + rifampin).

44. REGIMEN OF TB THERAPY
Patients with latent TB:
 Latent TB (i.e. patients with +ve Tuberculin skin test and had
history of contact to a person proved to have TB)
 INH alone for 6 months or dual Rifampicin + INH for 3
months.

45. REGIMEN OF TB THERAPY
TB during pregnancy:
 The only anti-TB drug which is absolutely contraindicated
is streptomycin because of the high risk of congenital
deafness.
 other first line anti-TB drugs are safe for use in pregnancy.

46. REGIMEN OF TB THERAPY
TB with liver disease
 INH, rifampin, and pyrazinamide are hepatotoxic but
because of their effectiveness, they should be used depending
on monitoring of liver function tests.
 In severe liver damage, only one drug can be used.

47. Extrapulmonary TB
 In most cases, treat with same regimens used
for pulmonary TB
 Treatment extended > 6 months depending on
site of disease
 In TB meningitis Streptomycin replaces
Ethambutol

48. Multi-Drug Resistance TB
 TB caused by strains of Mycobacterium tuberculosis
that are resistant to at least isoniazid and rifampicin,
the most effective anti- TB drug.
 3.6% are estimated to have MDR-TB.
 Treatment must be individualized
 should seek expert consultation
 6 months intensive treatment (always including an
injectable drug) followed by at least an 18 month
continuation phase

49. Extensively drug resistance TB
 is a form of TB caused by bacteria that are
resistant to isoniazid and rifampicin (i.e. MDR-
TB) as well as any fluoroquinolone and any of the
second-line anti-TB injectable drugs (amikacin,
kanamycin or capreomycin).

50. Tuberculosis and HIV
 HIV positive people with pulmonary TB may have a
higher frequency of having sputum negative smears.
 The tuberculin test often fails to work, because the
immune system has been damaged by HIV; It may
not even show a response even though the person is
infected with TB.
 Chest Xray will show less cavitation.
 Cases of Extra pulmonary TB are more common.
 Management of HIV-related TB is complex

51. Thank you!
Any Questions?