Silico tuberculosis

It is a pulmonary or extra pulmonary infection caused by MYCOBACTERIUM TYBERCULOSIS OR NON TUBERCULOS MYCOBACTERIA in a patients with silicosis. Mainly occur in people who are exposed to silica at work.

1. CASE PRESENTATION ON SILICO TUBERCULOSIS PReSENTED BY : P.VIGNESWARI IV/VI PHARM.D Y17PHD0821

2. BRIEF SUMMARY OF THE CASE A 55 year old male patient was admitted in hospital with Chief complaints of Cough with sputum associated with breathlessness since 2 months. Having on & off fever, decreased appetite & generalized weakness. His bowel and bladder habits were normal

3. Subjective Data Chief Complaints : C/o of sputum associated with breathlessness since 2 months. No chest pain, on &off fever – evng rise of temp , decreased appetite and weight loss , generalized weakness. H/o Present illness : Intially symptoms were moderate in intensity & gradually attained severe since few day. - Patient is non smoker. - H/o silica dust exposure at work. - Underwent CT chest which revaled ILD Medical History : Anti tussives , anti biotics .

4. Objective Data Physical examination : . Pulse – 103/min . BP - 120/70 mm Hg Systemic examination : . CVS – S1+S2+ . RS – BAE + . P/A – soft . CNS - N

5. Lab Investigations S.no Parameter Observed value Normal value 1. Pleural fluid-glucose 158.0mg/dl 60.0- 89.0 2. Pleural fluid-protien 6.5g/dl 0.3-4.1 3. Pleural fluid-ADA 74.0U/L 0.0-30.0 4. Hb 10.8g/dl 14-18 5. Haemotocrit 38.8% 43-54 6. Serum sodium 130 mmol 134-145 7. Serum chloride 89.5 mmol 95-105.0

6. USG of Thorax Right large pleural effusion with internal septations along with right basal collapse consolidation. HRCT of CHEST Moderate plueral effusion RT side
Multiple reticulo nodular lessons are seen diffusely in both lungs Interstial septal thickning noted in rt lung Multiple enlarged lymphnodes are seen Patchy area noted in rt upper lobe, fissural thickening noted

7. Assessment Based on the subjective and objective Data i.e h/o silica dust exposure & USG thorax, HRCT of chest; the final diagnosis of the patient was found to be having SILICO TUBERCULOSIS. Definition : Pulmonary or extrapulmonary infection caused by  MYCOBACTERIUM TUBERCULOSIS  or nontuberculous mycobacteria in a patient with silicosis . Etiology : H/o silica exposure at work

8. Risk Factors:

9. Pathopysiology

10. Clinical Presentations Dyspnea  ( shortness of breath ) exacerbated by exertion. Cough , often persistent and sometimes severe. Fatigue. Tachypnea (rapid breathing) which is often labored, Loss of appetite and weight loss. Chest pain. Fever . Gradual darkening of skin

11. Plan Goals : To decrease the signs and symptoms . To increase patient quality of life. To decrease the disease progression Std.treatment : There is no specific treatment for silicosis. Workers are advised to avoid further exposures to silica to prevent the disease from getting worse, limit exposure to irritants, and quit smoking. Antibiotics are prescribed for respiratory infections as needed. Those with a positive skin test for tuberculosis (TB) generally need treatment with anti-TB drugs

12. Current Drug Chart Sno Drug name Dose R.O.A Freq Duration Category Use Adrs M.o.p 1. Inj.Augmentin (amoxicillin+ clavunate 1.2gm IV TID D1-D4 Pencillin+ beta lactamases To treat bacterial infection N/V, headache, skin rashes Rfts 2 Inj.Hydrocort (Hydrocortisone) 100mg IV BD D1-D4 Corticosteroid To decrease allergy & inflammatin Heartburn, dizziness, nausea Pfts, bp , HR 3. Inj.deriphylline (theophylline) 2cc IV BD D1-D4 Xanthine's For ILD N/V, cns excitement Pfts 4. Neb.Duolin ( salbutamol+ipratropium ) 2.5mg+ o.5 mg P/N TID D1-D4 Beta 2 agonist + anti cholinergic breathlessnes Fatigue, angina, skin rash, headache FEV, Bp , HR 5. Neb.Budecort (budesonide) 0.5mg/5ml P/N BD D1-D4 Corticosteroid breathlesness NV, hypotension,fatigue,headache Pfts, LFTS 6. Syp.Planokuff -t ( codiene+triprolidine ) 5ml P/O TID D1-D4 Anti-histamine + anti tussives For cough Constipation, sleepiness, sweating, N/v BP, LFTs

13. S.NO DRUG NAME DOSE R.O.A FREQ Duration CATEGOTY USE Adrs M.O.P 7. Inj.pantocid 40mg IV OD D1-D4 Proton pump inhibitor Prophylactic Facial edema , GI upset Mg levels 8. T.Montair-lc Montelukast + levocitrazine 10mg + 5mg P/O HS D2-D4 Anti histamine For ILD Sleepiness, dry mouth,blurrd vision Lfts , Rfts 9. T.Mucinac ( acetylcysteine ) 600mg P/O BD D2-D4 Mucolytic For cough Drowsiness,dizinness Lfts

14. Pharmacist Interventions No iron supplement was given to treat hb deficiency. No TB drug was given to treat TB No drug was given to treat fever.

15. About Disease : CO-existence of silicosis and tuberculosis is known as Silico -tuberculosis. This inhaled silica impairs the function of alveolar macrophages, & severe exposure causes macrophage apoptosis About Drugs : T.Montair -LC : Administer after dinner an hour before sleep. T.Mcuinac : taken before food.

16. Life style modifications Use blasting cabinets or proper ventilation. Use respirators that protect you from inhaling silica. Don't eat or drink near silica dust. Wash your hands and face before you eat.