Pulmonary tuberculosis

Pulmonary tuberculosis

1. PULMONARY TUBERCULOSIS SUBMITTED TO : DR. JAMAL ALI MOIZ SUBMITTED BY : SUALEHA KHANAM ROLL NO. : 1 7 B P T 3 7 BPT 4th YR SUBJECT : P T IN CARDIOPULMONARY CONDITION ( B P T 4 2 ) DATE O F P R E S E NTATION : 4 / 1 / 2 2 1 JAMIA MILLIA ISLAMIA CENTRE FOR PHYSIOTHERAPY AND REHABILITATION SCIENCES

2. INTRODUCTION : Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may a l s o spread to other organs c a u s i n g e x t r a p u l m o n a r y T B . I t i s c h r a c t e r i zed b y : C o u g h i ng l a s t i n g > 3 w e e k s a r e n o t r e s p o n d t o u s u a l a n t i b i o t i c Production o f p u r u l e n t , s o m e t i m e s b l o o d s t a i n e d s p u t u m E v e n i ng r i s e o f temperature N i g h t s w e a ts W e i ght loss

3. EPIDEMIOLOGY : ETIOLOGY : c a u s e d b y m y c o bacterium t u b e r culosis . D r o p l e t s N u c l i e ( C o u g h ing , s n e e zing , laughing ) E x p o s u r e t o T B MODE OF TRANSMISSION : I n h a l a t i o n , i n g e s t i o n , i n o c u l a t i o n a n d t r a n s p l a c e n t a l r o u t e . INCIDECE AND PREVALENCE : M o s t c o m m o n c h r o n i c d i s e a s e w o r l d w i d e . A f f e c t e d 1 / 3 population . M o r e c o m m o n i n p o o r c o u ntries o f Asia a n d Africa .

4. PHASES : PRIMARY TUBERCULOSIS ( Dormant or Latent) – Although a person’s body can be infected with mycobacterium tuberculosis, they may not be showing clinical signs and symptom s . SECONDARY TUBERCULOSIS ( A c t i v e ) – This will develop after the immune system of a person is lowered. s e c ondary tuberculosis differs in clinical presentation from the primary progressive disease. In secondary disease, the tissue reaction and hypersensitivity is more severe, and patients usually form cavities in the upper portion of the lungs.

5. PATHOPHYSIOLOGY D u e t o e t i o l o g i c a l f a c t o r s B a c t e r i a g o e s t o a l v e o l i d e p o s i t s a n d m u l t i p l y S t i m u l a t e b o d y i m m u n e r e s ponse M a c r o p hages d e s t r o y m a n y b a c t e r i a a n d n o r m a l t i s s u e s D e a d b a c i l l i a n d l i v e m a s s e s surrounded b y m a c r o phages ( G h o n s t u b e r c l e ) N e c r o t i c d e g e n e r a tion o c c u r ( p r o d u c t i o n o f c a v i t y f i l l e d w i t h c h e e s e l i k e m a s s o f t u b e r c l e b a c i l l i , d e a d W B C s a n d d e a d t i s s u e s ) . I t l e a d s t o , P u l m o nary t u b e r culosis

6. SIGN AND SYMPTOMS F ever Fatigue Malaise Anorexia Rales could be heard in the lobes of involvement in the lungs Bronchial Breath Sounds Dull chest pain, tightness, or discomfort Dyspnea Haemoptysis (late-stage symptom )

7. RISK FACTORS H I V - A I D S : d u e t o c o m p r o mised i m m u n o s uppressive s y s t e m Rheumatoid Arthritis - due to immunosuppressive treatments Diabetes Mellitus End-stage Renal Disease Alcoholism Malnutrition PREVENTION : E a r l y d i a g n o s i s a n d t r e a t m e n t U s e p r o t e c t i v e r e s p i r a t o r y d e v i c e s B C G v a c c i n a t i o n

8. A S SESSMENT AND DIAGNOSTIC FINDINGS HISTORY COLLECTION PHYSICAL EXAMINATION : A b n o r m a l b r e a t h s o u n d s s p e c i a l l y o v e r t h e u p p e r l o b e s . R a l e s o r b r o n c h i a l b r e a t h s i g n s i n d i c a t i ng l u n g c o n s o l i dation C l u b b i n g o f t h e f i n g e r o r t o e s S w o l l e n o r t e n d e r l y m p h n o d e s i n n e c k o r o t h e r a r e a s . M o n t o ux t u b e r c u l i n s k i n t e s t w i t h p u r i f i e d derivatives p r o t e i n s X - r a y : Cavity formation , N o n c a l c i f i e d n o d u l e s i n f i l t r a t e s S p u t u m s m e a r ( A c i d f a s t b a c i l l u s )

9. A p e r s on with advanced tuberculosis: Infection in both lungs is marked by white arrow-heads, and the formation of a cavity is marked by black arrows. G h o n s t u b e r c l e

10. TREATMENT PHARMACOLOGICAL : A l w a y s t r e a t w i t h m u l t i p l e d r u g s T r e a t ment c o u r s e d e p e n d o n t h e c a t e g o ries o f t h e p a t i e n t . U s u a l l y 6 m o n t h s t o 9 m o n t h s F o u r d r u g s ( I s o n i a z i d , r i f a m p i c i n , e t h a m b u t o l a n d pyrszinamid ) f o r 2 m o n t h s . A n d t w o d r u g s ( I s o n i azid a n d r i f a mpicin ) f o r 4 t o 7 m o n t h s . D O T S ( d i r e c t o b s e r v e d t r e a tment s h o u r t c o u r s e ) i s g i v e n . PHYSICAL MEASURES: Isolate patients with possible TB in a private room with negative pressure . Continue isolation until sputum smears are negative for 3 consecutive determinations (usually after approximately 2-4 weeks of treatment)

11. P U L MONARY REHABILITATION P R is a multidisciplinary programme, addressed to patients with respiratory impairment t his therapy is individualized and involves physical training, psychological counselling, nutritional support, along with compliance with TB drug treatment. N u t r i tion s u p p o r t : P r o per nutrition is an important element in all stages of T B i n f e ction Nutritional supplementation may have a positive role in these patients recovery. Adding hig h c a l o rie supplements for patients with TB in first phase of t reatment has to be shown to have benefits on lean mass, body weight and physical function after 6 weeks

12. P s y c h o logical s u p p o r t : r e l a x a t i o n t e c hniques , s t r e s s m a n a gement . T herapeutic e d u c a t ion : Q u i t t i n g s m o king , avoiding e n v i ronment w i t h t o x i n s , i r r i t a n t s o r a l l e r g e ns t h a t m a y w o r s e n t h e s y m p t o m s . P R p r o g r ams i m p r o v e s s y m p t o m s , e x e r cise c a p a city a n d s o c i a l i n t e g r a t i o n . i t i n v o l v e s , B r e a t h i n g e x e rcises U p p e r a n d l o w e r l i m b s t r e n gthening e x e rcises a n d c o n d i t i o n i n g e x e r cise Relaxation e x e r cise Respiratory m u s c l e s t r e n g t hening e x e r cises L e v e l w a l k i n g

13. PR IN ACTIVE PHASE OF PULMONARY TUBERCULOSIS : E x e r cise t r a i n i n g : I n i t i a l l y t y p i cally b e d r e s t a n d a v o i d a n c e o f e x e r cise i s r e c o m m ended i n p a t i e n t w i t h s e v e r e h e m o p t y s i s A f t e r f e w d a y s , s t a r t ing w i t h p a s s i v e e x e rcise ( arm , shoulder , e l b o w , k n e e ) active - a s s i s t e d a n d a c t i v e e x e r cise E x e r cise a t s l o w p a c e w i l l b e preferred f i r s t f o l l w e d b y i n c r e a s ing t h e d e g r e e o f p r e c i s i o n a n d p o s t u r a l c o n t r o l . T h e e x e r cise m u s t t a r g e t t h e b o t h u p p e r l i m b a n d l o w e r lim b a n d w a l k t e s t m a y b e u s e d I n order to mobilize the diaphragm expansion and recovering the l u n g r e serve volumes, abdominal – diaphragmatic breathin g , t h o r a c i c mobilization against a resistance c an be used. After 1 month, the rib expansio n e x e r c i s e c a n be start .

14. PR IN POST TUBERCULOSIS SEQUELAE Airway c l e a r a n c e t e c h n i ques : P o s t u r a l d r a i nage : i t must be done before a meal, once o r s e v e r a l t i m e s a b u t n o t m o r e than 20–30 min, during w h i c h t i m e s e v e r al positions will be used, 5–10 min each. At t h e end of each position period, the drained region will be tap for 1 min. Another techniques used to diminish the sputum load are as f o l l o w a s : a u t o g e n i c d r a i n a g e , f o r c e d e x p i r a t ion , vibration with s p e c ial d e v i c e s a n d m a n u a l proce dures such as clapping and p e r c u ssion s .

15. COUGH EDUCATION :Cough education is important for patient with TB and consist o f : body positioning during coughing, control of breathing in c o u ghing (slowly nose inspiration, short apnoea and strong air e x p i r a tion in 2–3 sessions). The goal is to achieve mobilization a n d secretions removal from the bronchial tree. Exercise Training : PR programme, i n c luding physical aerobic training , therapeutic education and activities of daily living. The sessions took place three times per w e e k f o r 8 w e e k s e x e r cise training was aerobic, performed on a treadmill f o r l o w e r limb, with training intensity starting from 60% and r e a c h i n g 90% of the maximum oxygen consumption. i t l e a d s t o i m p r o v e m e n t i n e x e r cise t o l e r a n c e , Q O L , d e m i n u t i o n o f c h e s t p a i n a n d hemoptysis .

16. P R IN M D R ( M u l t i p l e d r u g r e s i stant ) TUBERCULOSIS The P R programme in their case should be started as soon as t h e i r condition becomes stable and include exercise training ( aerobic and endurance), nutrition support and psychological c ounselling. A very important part is represented by the e ducation that aims to improve the long-term adherence to t reatment and the participation in daily life activities and social r eintegration. The palliative care should also be included in v e r y s e v e r e p a t i e n t w i t h M D R - T B .

17. SUMMARY Pulmonary TB is a bacterial infection of the lungs that can cause a range of symptoms, including chest pain, breathlessness, and severe coughing. Pulmonary TB can be life-threatening if a person does not receive treatment. Most individuals who become infected with TB bacteria do not feel sick or experience any symptoms. Latent TB is not contagious but it can eventually develop into active TB. People with active TB usually begin to feel better after a few weeks of treatment. P u l m o n a r y r e h a b i l i t a t i o n u s e f u l t o o l i n p a t i e n t w i t h a c t i v e phase a n d p o s t T B s e q u e a l .

18. REFRENCES : Maguire GP, Anstey NM, Ardian M, Waramori G, Tjitra et al. Pulmonary tuberculosis, International Jour n a l of Tuberculosis and Lung Disease. J o n e s R, Kirenga BJ, Katagira W, Singh SJ, Pooler J, Okwera A, e t al. A pre-post intervention study of pulmonary rehabilitation f o r adults with post-tuberculosis lung disease in Uganda. W H O h e a l t h o r g a n i s a t ion r e p o r t o n t h e g l o b a l t u b e r c u losis e p i d e m i c G e n e r a W H O : 2 8 .