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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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Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

  • Lecture 1

  • Diagnoctics of tuberculosis

  • (Stomat. F-t)

  • Prof. L.A. Hryshchuk


Etiology
Etiology

M. tuberculosis

M. bovis

M. africanum



Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

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


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk
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 microbiological analyzer BACTEC MGIT 960

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 microbiological analyzer BACTEC MGIT 960

Performed in all TB patients

lungs (with positive and negative smear

sputum):

Bank of cultures

Test drug sensitivity

drugs II series


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk


Clinical examination of tuberculosis patients
Clinical examination of tuberculosis patients diagnosed, compose

  • 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.


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk
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).


Methods of revealing mycobacteria
Methods of Revealing Mycobacteria: revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBT


Culture of mycobacteria tuberculosis at hard egg medium
Culture of revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBT mycobacteria tuberculosis at hard egg medium


Radiology
Radiology revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBT

  • Chest radiography is the most important

    method to detect TB

  • TB’s characteristics of a chest radiograph

    favor the diagnosis of tuberculosis

    as following :


Computer tomography
Computer tomography revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBT


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

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.


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

(1) respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows 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


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Primary complex respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Milliary Tuberculosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

acute milliary tuberculosis


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

secondary pulmonary tuberculosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

infiltrate


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Tuberculoma respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Chronic fibro-cavitary pulmonary tuberculosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

cavity


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Tuberculous effusion respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Comruter tomograma patient with pulmonary tb
Comruter tomograma patient with pulmonary TB respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Fluorography
Fluorography respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Bronchography
Bronchography respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Bronchoscopy examination video

Bronchoscopy examination respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadowsVideo


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Tuberculin testing respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

A positive tuberculin test although it is of

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


Tuberculinodiagnostics
TUBERCULINODIAGNOSTICS respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

Old Tuberculin Koch


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Dry respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows rectified tuberculin (50000 ТU), the solvent is isotonic solution of sodium chloride – 1ml with the addition of 0,25 % carbolic acid


Positive mantoux test
Positive Mantoux test. respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Diagnosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

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? respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

  • 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 respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows1 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.


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Differential Diagnosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows1 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.


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Differential Diagnosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows 1 2 3 4

Acute bacterial pneumonias may resemble

florid tuberculosis in all particulars except for

the sputum examination and response to

antimicrobial drugs.


Lecture 1 diagnoctics of tuberculosis stomat f t prof l a hryshchuk

Differential Diagnosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows1 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 Diagnosis respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows1 2 3 4 5

  • Fever caused by some other diseases


Complications
complications respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows

  • Pneumothorax

  • Bronchiectasis

  • Empyema

  • Extrapulmonary expansion

  • Hemoptysis

  • Chronic pulmonary heart disease