Transcript بسم الله الرحمن الرحيم

‫بسم هللا الرحمن الرحيم‬
Student Case Presentation
‫بسم هللا الرحمن الرحيم‬
Tuberculosis
Group B2 Community
Tuberculosis
• Introduction to TB
• Case History and Physical Examination
• Investigations and diagnosis
• Management
• Prevention and Control of TB
Group B2
Tuberculosis
Introduction
1. What is Tuberculosis (TB) ?
2. How Tuberculosis is transmitted ?
3. What organs does it affect ?
Group B2
Tuberculosis
Introduction
Between 2000 and 2010 there will be :
- 1,000,000,000 person newly infected
- 200,000,000 get sick
- 35,000,000 will die of TB
Group B2
Tuberculosis
• Introduction to TB
• Case History and Physical Examination
• Investigations and diagnosis
• Management
• Prevention and Control of TB
Group B2
Tuberculosis
Case History and Physical Examination
History of Chief complain :
Torki Alsolami is a 23 years old Saudi male patient presented to ER with
history of fever for 1 month duration, weight loss, and cough also for 1
month duration.
Fever: High grade
Sweating: more in the night
Cough: no blood stain (no heamoptysis)
Sputum with cough: mild
no history of contact with T.B patient
... continue
Group B2
Tuberculosis
Case History and Physical Examination
History of Past illness :
Medications: -ve
Surgeries: previous nasal deformity caused by trauma repaired by surgery
Family and social history
the patient is non-smoker, no HTN, no D.M, no cholesterol or other
chronic illnesses and –ve T.B contact
... continue
Group B2
Tuberculosis
Case History and Physical Examination
Physical Examination
Blood pressure : 111/95
Temprature: 40o C
Pulse : 72/min
Respiratory rate: 20/min
General :
General appearance : conscious + oriented
Neck : no lymph node enlargement.
Chest : resonant – equal air entry in both side – bronchial breathing.
CVS : S1+S2+ O
Abdomen : soft + lax + no organomegaly + and presence of bowl
sounds .
CNS : intact
Group B2
Tuberculosis
• Introduction to TB
• Case History and Physical Examination
• Investigations and diagnosis
• Management
• Prevention and Control of TB
Group B2
Tuberculosis
Differential diagnosis : Either Pneumonia or TB
Investigations and Diagnosis
Investigations :
1. CBC “ complete blood count”
•WBC = 8.2
•RBC = 4.57
•Hb = 12 – 8
•Hct = 36.5
•MCV = 80
•MCH = 28.
•pH = 7.3
•PT = 15.4 / 13.5
• PTT = 53.3 / 35.5
2. Blood Chemistry :
•Bun = 10
•osmo = 259
•crea = 0.8
•Na = 180
•K = 4.4
•AST = 173
•ALT = 222
•LDH = no reagent
•Glucose = 90
Group B2
Tuberculosis
Investigations and Diagnosis
Investigations (continue) :
3. Chest x-ray:
patchy or nodular shadows in the upper zones,
with loss of volume, and fibrosis with or without
cavitation.
Provisional diagnosis :
By examining the lung carefully … there was
right side vesicular sound wich may indicate
right side T.B
... continue
Group B2
Tuberculosis
Investigations and Diagnosis
Special investigations :
1. Acid fast stain  sputum= +ve
“many acid fast bacilli”
2. Mantoux tuberculin skin test
“induration = indicates infection with M.
tuberculosis
Group B2
Tuberculosis
• Introduction to TB
• Case History and Physical Examination
• Investigations and diagnosis
• Management
• Prevention and Control of TB
Group B2
Tuberculosis
Management
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TB treatment needs long time. and it might be extended up to 12 months.
but basically it needs 6 months.
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for
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HIV patients needs 2 years of that course
devloped.
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using the 2nd line drugs (clarithromycin..azithromycin and capromycin )
the first 2 month
Rifampcin
Isoniazid
Pyrazinamide
ethambutol or streptomycin are given,and for the next 4 month the
first two given.
because of multiresistance
Group B2
Tuberculosis
Management
Drugs
1. Anti T.B
Plus :
2. Klacid “ anti-biotic drug
3. ceftriaxone
-ve Pressure room
Group B2
Tuberculosis
• Introduction to TB
• Case History and Physical Examination
• Investigations and diagnosis
• Management
• Prevention and Control of TB
Group B2
Tuberculosis
Prevention of TB
•
Case finding & treatment.
•
BCG( Bacille Calmette Guerin) immunization which is lived
attenuated M.bovis and it’s given to the newborns in KSA.
•
It potentiates the cellular immunity activity and tuberculin
test( Mantoux) postivity.
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Should’ve not given to HIV patient.
Group B2
Tuberculosis
Control of TB
Among the case:
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Reporting the case
isolation
concurrent disinfection
follow up
Among the contacts:
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Mantoux test + chest x-ray+ sputum for AFB
Prophylaxis with rifampcin
follow up and education
Group B2
Tuberculosis
Hussain Morfeq
Yasser Noor elahi
Maher Abdulsalam
Yasser AL-Qasmi
Nabeel Nourah
Mohammed Badawod
Mohammed Abdulmajeed
Motasim Jawi
Meshari Bairgdar
Mohammad Bukhary
Hasan Al-Aidarous
Hassan Moria
Faisal A. Basonbul
Motas Abdulraof Sait
Mohammed A.Husni
Amro M. Daous
Ahmed A. Al-Jubali
Ammar Beiary
Done by : Group B2 Community
Group B2