Escolar Documentos
Profissional Documentos
Cultura Documentos
Faculty of Medicine
Gadjah Mada University
Tuberculosis
is a chronic infection,
potentially of lifelong duration,
caused
by two species of mycobacteria
M.tuberculosis and, rarely,
M.bovis
It was isolated by Robert Koch in 1882
The morbidity and mortality of
tuberculosis are high in developing
countries.
source of contagious
The route of spread
Peoples of easily affected
Tuberculosis is
transmitted by
airborne
droplet
nuclei(containi
ng tubercle
bacilli )
tubercle
bacillus
Human immunity
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PULMONARY TUBERCULOSIS
Etiology: mostly
Mycobacterium tb.
Hominis
Pathogenesis:
tipe IV
hypersensitivity
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in
innate non immune resistance
to
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Absorption
Fibrosis
Calcification
Deterioration: enlargement of infected
aeras and appear newer infiltrated
regions or spreading.
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systemic signs:
Most patients present as cases of pulmonary tuberculosis
with fever, weight loss, anorexia, fatigue, night sweats
wasting.
respiratory signs:
Cough may vary from mild to severe, and sputum may be
scant and mucoid or copious and purulent
Hemoptysis may be due to cough of a caseous lesion or
bronchial ulceration
chest pain, tachypnea ect.
Physical signs: nonspecific.
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Allergic reaction to TB
Non-reaction pulmonary tuberculosis
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Chest radiography
Sputum
examination
Tuberculin testing
PCR test to detect
TB
TB antibody testing
bronchoscopy
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Diagnosis
According to the history, clinical signs, chest X-ray
and some other examinations, we can diagnose TB
A patient with tuberculous pulmonary disease
will come to the physician for one of three
reasons:
(1) Suggestive symptoms
(2) A positive finding on routine tuberculin
testing
(3) A suspicious routine chest roentgenogram
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Generally,
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Differential Diagnosis
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Differential Diagnosis
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Differential Diagnosis
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As
in an
isolated coin lesion.
An
obstructing
and inconspicuous endobronchial tumor
causing distal chronic
inflammation
or
a caviting neoplastic mass.
(An
irregular cavity
necrotic neoplasm )
wall suggests
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Pneumothorax
Bronchiectasis
Empyema
Extrapulmonary expansion
Hemoptysis
Chronic pulmonary heart disease
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Chemotherapy
Support therapy
Surgical therapy
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groups
B groups
C groups
D groups
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H. S. Patterson, M.
D.
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crowding
decreased access to health care
lower socio-economic status
HIV
? race
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systemic infection
primary infection/disease
progressive primary disease
miliary disease
meningitis
chronic TB (re-activation)
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Inhalation of Infected
Droplet Nuclei
non-specific bronchopneumonia
complete resolution
(rare)
progression
massive necrosis
(rare)
stable
DISEASE
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TO STENOSIS
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CALCIFIED
CALCIFIEDnodes
nodes
and
andperipheral
peripherallesion
lesion
(Ghon
(Ghoncomplex)
complex)
USUAL PROGRESSION
OF PRIMARY INFECTION
infection
lympho-hematogenous
spread
healed PRIMARY
infection
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pleural effusion
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ENDOBRONCHIAL SPREAD
WITH SUBSEQUENT
BRONCHOPNEUMONIA
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Disseminated TB pneumonia
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MILIARY Disease
millet seed
appearance on X-ray
Mantoux positive?
Most children still
have active primary
complex when miliary
disease strikes
most develop
meningitis
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SITES
lymphatics
meninges
pleura
miliary
skeletal
other
Avg. Age
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13
6
5
4
5y
3y
16y
1y
5y
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THANK YOU
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