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Types Of Resistance
Primary drug resistance: Presence of resistance to anti TB drugs in a patient who has not received anti TB drugs in the past Acquired drug resistance: Resistance to anti TB drugs in a patient during the course or after treatment with ATT
Natural drug resistance: Strains of tubercular bacilli naturally resistant to anti TB drugs. eg: M. Bovis is resistant to P A Multi drug resistance: !evelopment of resistance to both "#$ and Rifampicin with or without resistance to other anti TB drugs
Dia"nosis of MDR
!etailed treatment history including history of contact Progressive radiological worsening Absence of clinical improvement in spite of optimal ATT Persistence of sputum positivity *all and rise phenomenon
Co$p&ications of TB
/ae$optysis*
+auses are Rupture of Rasmussen aneurysm -rosion of blood vessel by broncholith Aspergilloma in a cavity Post tubercular bronchiectasis Rupture of fibrotic bands Anastamosis between bronchial and pulmonary artery
Co$p&ications of TB
-&e!ra& co$p&ications* P1-*& empyemas& pneumothora/& bronchopleural fistula Bronchiectasis TB laryngitis 0pen negative syndrome Secondary bronchitis +or pulmonale Respiratory failure Amyloidosis !isseminated .och;s Scar carcinoma
TB 0 /I1
$"' increases susceptibility to infection with tuberculosis by 10 folds Progression of TB more rapid in $"' and vice versa $igher incidence of extra pulmonary TB in $"' patients $igher ris) of intolerance to A & relapse and M!" Poses diagnostic difficulties due to atypical features and smear negativity
<ell locali2ed& often "nfiltrates cavitatory disease common with dissemination 0ften positive 0ften negative
BCG 1ACCINE
1ive attenuated vaccine !oes not protect against infection& but efficacy in preventing disease varies from 9=,:=> Route intradermally Adverse effect: )eloids& ulcers& lymphadenitis& disseminated infection
C,e$o -rop,y&a2is
8. 9. C. @sed to prevent the development of the disease !rug used is (N) at dose of A,8= mg B )g B day for 6 months In#icate# in 3antou/ * 10mm with ris) factors li)e !3& steroid therapy& malignancies 3antou/ * 'mm with $"' positive& contact with infectious person& lesion on chest ?,ray 3antou/ * 1'mm with age D CA yrs with no ris) factors