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Lecture 1 Diagnoctics of tuberculosis (Stomat. F-t) Prof. L.A. Hryshchuk

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Lecture 1 Diagnoctics of tuberculosis (Stomat. F-t) Prof. L.A. Hryshchuk. Etiology. M. tuberculosis M. bovis M. africanum. Thin section transmission electron micrograph of Mycobacterium tuberculosis.

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Presentation Transcript
slide1
Lecture 1
  • Diagnoctics of tuberculosis
  • (Stomat. F-t)
  • Prof. L.A. Hryshchuk
etiology
Etiology

M. tuberculosis

M. bovis

M. africanum

slide10

The granuloma consists of a kernel of infected macrophages, surrounded by FOAMY GIANT CELLS and macrophages with a mantle of LYMPHOCYTES delineating the periphery of the structure

slide11
Automated screening molecular genetic test to identify Mycobacterium tuberculosis and resistance R - Xpert MBT / Rif
cultures were on a liquid environment automated microbiological analyzer bactec mgit 960
Cultures were on a liquid environment: automated microbiological analyzer BACTEC MGIT 960

Performed in all patients with pulmonary tuberculosis (with positive and negative sputum smear)

Test drug sensitivity to drugs and second row

Growth of Mycobacterium tuberculosis in 7-14 days.

Increases confirm TB in patients with negative sputum smear at 20%

at a molecular genetic test genotype mtbdrplus
At a molecular genetic test: GenoType MTBDRplus

Perform all

patients with

Positive sputum smear

Carried out in parallel with the classical culture method

Detects DNK MBT , resistance to isoniazid and rifampin and isoniazid combination

planting on solid medium
Planting on solid medium

Performed in all TB patients

lungs (with positive and negative smear

sputum):

Bank of cultures

Test drug sensitivity

drugs II series

slide15
Children and teenagers, in whom the following factors are diagnosed, compose a group of early revealed:
  • 1) tuberculin test range;
  • 2) primary tubinfestation;
  • 3) hyperergic Mantoux test;
  • 4) tuberculous intoxication.
clinical examination of tuberculosis patients
Clinical examination of tuberculosis patients
  • The methods of investigation of respiratory (tuberculosis) patients are conveniently divided into three groups.
  • The First group – compulsory (obligatory) methods, which embrace clinical examination of a patient (complaints, anamnesis, examination, palpation, percussion, auscultation), thermometry, X-ray investigation (fluorography, X-raygraphy, X-rayscopy), sputum analysis for MBT, Mantoux tuberculin test (with 2 TU), general blood and urine test.
  • The Second group – additional (supplementary) methods, which include repeated sputum analysis (bronchial lavage water) for MBT, tomography of thelungsand mediastinum, protein-tuberculin tests, immunologic tests, instrumental examinations (bronchoscopy, biopsy, bronchography, pleuroscopy).
  • The Third group – facultative (optional) methods: investigation of the outer breathing function, blood circulation, liver and other organs and systems.
slide17
The laboratory diagnostics of tuberculosis. Methods of revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBT
  • The source of infestation of human beings are tuberculosis human patients and animals secreting tuberculosis mycobacteria. The material for revealing MBT are sputum, bronchial lavage waters, faeces, urine, fistula pus (matter), pleural cavity exudate, spinal fluid, punctates and bioptates of various organs and tissues.
  • Sputum examination for MBT is of great epidemiological and clinical importance. When there is no sputum or it is scarce, expectorants, irritant aerosol inhalations, bronchi lavage are administered (fig.1).
radiology
Radiology
  • Chest radiography is the most important

method to detect TB

  • TB’s characteristics of a chest radiograph

favor the diagnosis of tuberculosis

as following :

slide22

Methods of the X-ray diagnostics of tuberculosis of respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

  • Roentgenologic examination is one of the main methods of diagnostics of tuberculosis and unspecific respiratory diseases. The following methods of roentgenologic diagnostics are used: roentgenoscopy, roentgenography, fluorography, tomography, computer tomography, target roentgenography, bronchography, fistulography, angiopulmography and bronchial arteriography, pleurography, kymography and polygraphy.
slide23
(1) shadows mainly in the upper zone

(2) patchy or nodular shadows

(3) the presence of a cavity or cavities, although these, of

course, can also occur in lung abscess, carcinoma, etc

(4) the presence of calcification. although a carcinoma or

pneumonia may occur in an areas of the lung where

there is calcification due to tuberculosis

(5) bilateral shadows, especially if these are in the

upper zones

(6) the persistence of the abnormal shadows without

alteration in an x-ray repeated after several weeks

this helps to exclude a diagnosis of pneumonia or

other acute infection

slide25

Milliary Tuberculosis

acute milliary tuberculosis

slide36
Tuberculin testing

A positive tuberculin test although it is of

great use in children, but it has limited diagnostic significance in older age groups

tuberculinodiagnostics
TUBERCULINODIAGNOSTICS

Old Tuberculin Koch

slide38

Dry rectified tuberculin (50000 ТU), the solvent is isotonic solution of sodium chloride – 1ml with the addition of 0,25 % carbolic acid

slide40

Diagnosis

According to the history, clinical signs, chest X-rayand 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

how to write the diagnosis correctly
How to write the diagnosis correctly?
  • Generally, we write the diagnosis according to the site of TB, clinical patterns, the result of sputum examination and the history of chemotherapy.
differential diagnosis 1 2 3 4
Differential Diagnosis 1 2 3 4

Bronchiectasis may confused with chronic fibrocavenous pulmonary tuberculosis. They also have chronic cough, sputum production and hemoptysis. Usually we can use chest x-ray examination and CT scan to distinguish them.

slide43

Differential Diagnosis1 2 3 4

Cavitary lung abscess often involves the

dorsal segments of the lower lobes and posterior

segments of the upper lobes.

Typically lung

abscess causes litt1e in the way of physical

findings, may have a fluid level, and is not

associated with patchy bronchogenic infiltrates.

In contrast, physical findings are prominent

over tuberculous cavities, fluid levels are rare.

And patchy infiltrates elsewhere are the rule.

slide44

Differential Diagnosis 1 2 3 4

Acute bacterial pneumonias may resemble

florid tuberculosis in all particulars except for

the sputum examination and response to

antimicrobial drugs.

slide45

Differential Diagnosis1 2 3 4

Neoplasm may resemble tuberculosis. As in

an isolated coin lesion. An obstructing and

inconspicuous endobronchial tumor causing

distal cbronic inflammation or a caviting

neoplastic mass. ( An irregular cavity wall

suggests necorotic neoplasm. )

differential diagnosis 1 2 3 4 5
Differential Diagnosis1 2 3 4 5
  • Fever caused by some other diseases
complications
complications
  • Pneumothorax
  • Bronchiectasis
  • Empyema
  • Extrapulmonary expansion
  • Hemoptysis
  • Chronic pulmonary heart disease
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