tubrculosis ppt

Leadership and management Assignment
Name Mihret Asnake ……………………271/13
Sub to Mr. Shimelis

 Pulmonary tuberculosis (TB)
is a chronic contagious
infectious disease
characterized by formation of
tubercles and granulomas in
the lungs. It may also affect
meninges, kidney, bones,
lymph nodes
 One third of the world's population is thought to
have been infected with M. tuberculosis,
 and new infections occur at a rate of about one
per second.
 Tuberculosis is the second-largest cause of death
from an infectious agent worldwide.

 about 80% of the population in many Asian and
African countries test positive in tuberculin tests,

while only 5–10% of the U.S. population test
positive.
• Class 0: no exposure; no infection
• Class 1: exposure; no evidence of infection
• Class 2: latent infection; no disease( positive PPD
reaction but no clinical evidence of active TB)
• Class 3: disease; not clinically active
• Class 4: disease; clinically active
• Class 5: suspected disease; diagnosis pending
mycobacterium
tuberculosis
mycobacterium bovis
mycobacterium avium
 Close contact with someone who has active TB.
 Immunocompromised status
 Substance abuse
 Any person without adequate health care
 Preexisting medical conditions or special
treatment
 Immigration from countries with a high
prevalence of TB
 Institutionalization
 Living in overcrowded, substandard housing
 Being a health care worker performing high-risk
activities:
 Other
 Elderly ,Infants
 People with weakened immune systems, poor nutrition
 Poverty, Substandard housing
 Chronic smokers, Family history of TB.
 Other lung diseases, DM, Poor health, Alcoholics
 TB bacteria can live in your body
without making you sick this is called
latent TB infection .
 People with latent TB infection do

not feel sick and do not have any
symptom.
 People with latent TB infection are

not infectious and cannot spread TB
bacteria to others.
 TB bacteria become active if the immune
system can't stop them from growing.
 When TB bacteria are active (multiplying in

your body), this is called TB disease.
 People with TB disease may spread the

bacteria to people they spend time with
every day
A Person with Latent TB Infection A Person with TB Disease
• Has no symptoms • Has symptoms that may include:
- a bad cough that lasts 3 weeks or longer
- pain in the chest
- coughing up blood or sputum
- weakness or fatigue
- weight loss
- no appetite
- chills
- fever
- sweating at night
• Does not feel sick • Usually feels sick
• Cannot spread TB bacteria to others • May spread TB bacteria to others
•Usually has a skin test or blood test result indicating • Usually has a skin test or blood test result indicating
TB infection TB infection
•Has a normal chest x-ray and a negative sputum • May have an abnormal chest x-ray, or positive
smear sputum smear or culture
• Needs treatment for latent TB infection to • Needs treatment to treat active TB disease
prevent active TB disease
 When people with active pulmonary TB cough,
sneeze, speak, sing, or spit, they expel infectious
aerosol droplets 0.5 to 5 µm in diameter.
 A single sneeze can release up to 40,000
droplets. Each one of these droplets may

transmit the disease
 The probability of transmission from one person
to another depends upon the number of

infectious droplets expelled by a carrier, the
effectiveness of ventilation, the duration of
exposure.
 A susceptible person inhales mycobacterium
bacilli and becomes infected.
 The bacteria are transmitted through the airways

to the alveoli, where they are deposited and
begin to multiply.
 The bacilli also are transported via the lymph

system and bloodstream to other parts of the
body (kidneys, bones, cerebral cortex) and other
areas of the lungs (upper lobes).
 Phagocytes (neutrophils and macrophages)
engulf many of the bacteria, and TB-specific
lymphocytes lyse (destroy) the bacilli and
normal tissue.
 This tissue reaction results in the

accumulation of exudate in the alveoli,
causing bronchopneumonia.
 Granulomas, new tissue masses of live and

dead bacilli, are surrounded by
macrophages, which form a protective wall
around the granulomas.
 Granulomas are then transformed to a fibrous
tissue mass, the central portion of which is called
a Ghon tubercle.
 The material becomes necrotic, forming a

cheesy mass.
 This mass may become calcified and form a

collagenous scar.
 The Ghon tubercle ulcerates, releasing the
cheesy material into the bronchi.
 The bacteria then become airborne, resulting

in further spread of the disease.
 Then the ulcerated tubercle heals and forms

scar tissue.
 It spreads slowly downward to the hilum of the

lungs and later extends to adjacent lobes.
 Constitutional  Pulmonary
symptoms symptoms
 Anorexia  Initially non
 Weight loss productive cough
 Malaise  Later mucopurulent
 Low grade fever with cough

 Dyspnoea
night sweat
 Chest pain
 Fatigue
 Hemoptysis
◦Coughing up blood
◦Excessive sweating, especially at
night , Fatigue
◦Fever , Unintentional weight loss
◦Wheezing , Loss of weight
◦Loss of energy, Poor appetite, Night
sweats
◦Fever ,Pruritis
 A complete history, physical examination, tuberculin
skin test, chest x-ray, acid-fast bacillus smear, and
sputum culture are used to diagnose TB.
 If the person is infected with TB, the chest x-ray

usually reveals lesions in the upper lobes and the
acid-fast bacillus smear contains mycobacterium.
 Biopsy- Biopsy of the affected tissue (rare)
 Bronchoscopy
 Chest CT scan
 Chest x-ray
 Thoracentesis
 TB Vaccine (BCG), or bacille Calmette-Guérin,
is a vaccine for TB disease
 If you test positive for latent TB infection, take

medications to reduce your risk of developing
active tuberculosis
 If you have active TB,
 Stay home.,Ventilate the room, Cover

your mouth, Wear a mask.
Aims /Objectives
 Reduce the clinical features
 Prevent transmission of infection
 Bring back the patient to normal condition.
 Medical management
 Early diagnosis and treatment
 Isolation of the patient
 First line  Second line
tuberculosis  aminoglycosides:
drugs  polypeptides:
Ethambutol
Isoniazid  thioamides:
Pyrazinamide
Rifampicin  cycloserine
;
Streptomycin
 rifabutin
 macrolides: e.g., clarithromycin (CLR);
 linezolid (LZD);
 thioacetazone (T);
 thioridazine;
 arginine;
 vitamin D;
 Lung damage
 Pain
 Meningitis
 Drug resistance
 Miliary TB
 Medication side effects
 Death
 Maintain respiratory isolation until patient
responds to treatment or until the patient is no
longer contagious.
 Administer medicines as ordered.
 Always check sputum for blood or purulent

expectoration.
 Encourage questions and conversions so that

the patient can air his or her feelings.
 Encourage the patient to stop smoking.
 Teach the patient to cough or sneeze into

tissue paper and dispose secretions
properly
 Advise patient to have plenty of rest and eat

balanced meals.
 Be alert for signs of drug reaction.

 If the patient is receiving ethambutol, watch for
optic neuritis.
 If the patient receives rifampicin (Rifampin),

watch for hepatitis and purpura. Also observe
the patient for complications like hemoptysis.
 Emphasize the importance of regular follow-up

examinations and instruct the patient and his
family about the signs and symptoms of
recurring TB

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Leadership and management Assignment

Name Mihret Asnake ……………………271/13

Sub to Mr. Shimelis

from an infectious agent worldwide.

African countries test positive in tuberculin tests,

 People with latent TB infection do

 People with latent TB infection are

 When TB bacteria are active (multiplying in

 People with TB disease may spread the

• Does not feel sick • Usually feels sick

• Cannot spread TB bacteria to others • May spread TB bacteria to others

droplets. Each one of these droplets may

to another depends upon the number of

 The bacteria are transmitted through the airways

 The bacilli also are transported via the lymph

 This tissue reaction results in the

 Granulomas, new tissue masses of live and

 The material becomes necrotic, forming a

 This mass may become calcified and form a

 The bacteria then become airborne, resulting

 Then the ulcerated tubercle heals and forms

 It spreads slowly downward to the hilum of the

 Low grade fever with cough

 If the person is infected with TB, the chest x-ray

 Biopsy- Biopsy of the affected tissue (rare)

 If you test positive for latent TB infection, take

 If you have active TB,

 Stay home.,Ventilate the room, Cover

 Administer medicines as ordered.

 Always check sputum for blood or purulent

 Encourage questions and conversions so that

 Teach the patient to cough or sneeze into

 Advise patient to have plenty of rest and eat

 Be alert for signs of drug reaction.

 If the patient receives rifampicin (Rifampin),

 Emphasize the importance of regular follow-up

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