Tuberculosis (TB)

Tuberculosis (TB) Presentation

1. Why TB One third of the world is reported to be infected. 8.2 million cases were active. 1.2-1.4 million death were reported( World Health Organization. 2013.). Tuberculosis is more common in developing countries. Tuberculosis (TB)

2. 37 million lives were saved through diagnosis and treatment between 2000 and 2013 . In 2013 an estimated 480,000 people developed multidrug resistant tuberculosis (MDR-TB). Tuberculosis is the leading killer of HIV positive people.

3. What cause it Mycobacterium tuberculosis complex It includes: Mycobacterium tuberculosis Mycobacterium africanum Mycobacterium bovis Mycobacterium microti M. tuberculosis divides every 15–20 hours

4. MOTT M. kansasii , M. simiae and M. marinum M. Scrofulaceum M. avium M. Ulcerans M. abscessus , M. fortuitum

5. Microscopy M. tuberculosis is characterized by caseating granulomas containing Langhans giant cells, which have a "horseshoe" pattern of nuclei. Organisms are identified by their red color on acid-fast staining.

6. Ziehl-Neelsen staining

7. granuloma that provides a protection and enable the bacilli to sustain a long-term persistent infection. Protective granulomas are formed by cytokines. Granulotomatous lesions are important in both regulating the immune response and minimizing tissue damage. T cells help maintain Mycobacterium within the granulomas.

8. Diagnosis Diagnosis of active tuberculosis depend on signs of lung disease for more than two weeks . Abnormal chest x-ray. Multiple sputum samples for smear culture and PCR. ( PPD) test. ( QFT ) test All tests are initial evaluation for tuberculosis.

9. Latent tuberculosis infection (LTBI) is the presence of M. tuberculosis organisms without symptoms or radiographic or bacteriologic evidence of TB disease. Approximately 90%–95% of those infected will not progress from LTBI to TB disease (CDC). Diagnosis is made be positive PPD or QFT

10. Treatment active tuberculosis isoniazid Rifampicin Pyrazinamide Ethambutol The four drugs are used for the first two months. rifampicin and isoniazid for the last four months .

11. For latent TB treatment only rifampicin and isoniazid are used both together or one of them. WHO recommend directly observed therapy (DOT), the nurse or health care worker watch the patient while taking the medicine.

12. Anatomy

13. where Right upper lobe :

14. Right middle lobe :

15. Left upper lobe

16. TB granuloma

17. TB fibrosis of lung

18. Miliary TB. Multiple tiny nodules scattered throughout both lungs

19. TB

20. TB

21. TB or Not TB?

22. Lung abscess

23. Alveolar microlithiasis .

24. Right heart failure. Well-defined masses seen with the right mid and lower zones. These ‘ pseudotumours ’ represent encysted pleural fluid within the horizontal and oblique fissures (arrows). Heart failure

25. interstitial pneumonitis (UIP) formerly cryptogenic fibrosing alveolitis .

26. Kartagener syndrome Triad of features Situs inversus (50%). Nasal polyposis and chronic sinusitis. Bronchiectasis .

27.   Mesothelioma . In this case, there are more extensive lobulated pleural masses

28. ‘ Cannon ball’ metastases

29. Miliary metastases .

30.   Pneumoconiosis –Multiple small dense bilateral pulmonary nodules.

31. Pneumoconiosis Sarcoid . organising pneumonia. Lymphoma. Metastatic disease.

32. Sarcoidosis . Egg shell calcification of both hila

33. Silicosis. Egg shell calcification of both hila .

34. Previous varicella pneumonia

35. Wegner’s granulomatosis . Large cavitating lung lesion

36. Squamous cell carcinoma

37. Aspergillomas

38. Sources and refrences About 35,300,000 results (0.26 seconds)   A–Z of Chest Radiology By Rakesh R. Misra is a Consultant Radiologist in the Department of Radiology at Wycombe Hospital, Buckinghamshire Hospitals UK. WHO site. CDC- USA Presentation prepared by: Dr. Mohamed Elafiz General practitioner – Medical commission March 4,2015