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PRIMARY TUBERCULOSIS DR.MUHAMMAD FAROOQUE M.B.,B.S. D.T.C.D. IN THE NAME OF ALLAH,THE MOST GRACIOUS,THE MOST MERCIFUL
PRIMARY TUBERCULOSIS DR. MUHAMMAD FAROOQUE MB BS  DTCD
WHAT IS TUBERCULOSIS? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Epidemiology: Global Threat ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
2 MILLION PEOPLE DIE EVERY YEAR EQUAL TO 20 SUCH STADIUMS
HISTORY OF TB ,[object Object],[object Object],[object Object],[object Object],[object Object]
KING TUTANKHAMEN EGYPTIAN PHARAOH                                
BARUCH SPINOSA DUTCH PHILOSOPHER                             
SIMON BOLIVER VENEZUELAN REVOLUTIONARY LEADER                                
JOHN KEATS ENGLISH POET                             
EDGAR ALLAN POE AMERICAN WRITER,POET                              
FREDERIC CHOPIN POLISH COMPOSER , PIANIST                           
ROBERT LOUIS STEVENSON SCOTISH WRITER                                
ANTON CHEKHOV RUSSIAN WRITER                          
FRANZ KAFKA CZECH NOVELIST                               
ELEANOR ROOSEVELT  AMERICAN HUMANIYARIAN/FIRST LADY                               
EUGENE ONEILL AMERICAN PLAYWRIGHT                               
GEORGE ORWELL ENGLISH NOVELIST/ESSAYIST                            
REASONS FOR INCREASING INCIDENCE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TUBERCULOSIS WAS A KILLER AND IT REMAINS A KILLER DISEASE EVEN TODAY . ,[object Object],[object Object],[object Object]
M.HAEMOPHILUM  BCG M.GENAVENSAE M.FORTUITUM M.CHELONEI. . MAC(HIV-ASSOCIATED) DISSEMINATED(SEEN IN IMMUNODEFICENY STATES) M.TUBERCULOSIS M.MARINUM M.FORTUITUM M.CHELONEI. M.LEPRAE M.ULCERANS SOFT TISSUE/SKIN M.MALMOENSE M.BOVIS, M.FORTUITUM M.CHELONEI. M.TUBERCULOSIS MYCOBACTERIUM AVIUM COMPLEX (M.SCROFULACEUM,M.INTRACELLULARE & M.AVIUM) LYMPH NODE M.BOVIS  M.XENOPI  MAC M.KANSASII M.MALMOENSE M.TUBERCULOSIS PULMONARY LESS COMMON MAJOR SITE-SPECIFIC MYCOBACTERIAL DISEASE.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
 
TRANSMISSION ,[object Object],[object Object],[object Object],[object Object]
INFECTIVITY OF THE PATIENT. ,[object Object],[object Object],[object Object],[object Object],[object Object]
ROUTE OF TRANSMISSION AIRBORNE BY DROPLET NUCLEUS
HOW DROPLET NUCLEI ARE PRODUCED & SPREAD ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
JOURNEY OF DROPLET NUCLEUS ,[object Object],[object Object],[object Object]
WHO IS AT RISK? HIV, Silicosis, DM(IDDM), Immunocompromised, CRF, Malignancy(leukemia,) GIT Diseases associated with malnutition,.Gastectomy,Jejuno-ileal bypass,ca pancreas, malabsorption ASSOCIATED DISEASES ,[object Object],[object Object],[object Object],[object Object],[object Object],PATIENT-RELATED
PREVENTION OF TRANSMISSION (especially in hospital setting) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TIME TABLE FOR TB. PRIMARY COMPLEX TST POSITIVE Meningeal,Miliary,Pleural dis. GIT,Bone & Joint,L/N disease Post prim;Dis due to reactivation or reinfection Genito-Urinary & Skin Lesion ,[object Object],[object Object],[object Object],[object Object],[object Object],MANIFESTATION TIME FROM INFECTION
TST
Screening for TB   “ppd” the Mantoux  Tuberculin Skin Test ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for TB   Anergy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for TB   Boost Phenomenon / Two-Step Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin Skin Test Positive Result ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin Skin Test Positive Result ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin Skin Test Positive Result ,[object Object],[object Object],[object Object],[object Object]
Tuberculin Skin Test False Positive Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculin Skin Test False Negative Results ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],A negative ppd DOES NOT rule-out active disease
SKIN TESTING IN TB SINGLE PRICK TEST. READ AT 2-4 DAYS. POSITIVE IF INDURATION 5-14 MM(=HEAF GRADE 2) >15 MM =HEAF GRADE 3-4 MULTIPUNCTURE METHOD. READ AT 3-7 DAYS. GRADE 1:4– 6 PAPULES. GRADE 2: CONFLUENT.FORMING RING. GRADE 3:CENTRAL INDURATION GRADE 4: > 10 MM INDURATION   MANTOUX TEST HEAF METHOD
Bacillus Calmette-Guerin Vaccine “BCG” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Screening for TB   Boost Phenomenon / Two-Step Testing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
PRIMARY PULMONARY TUBERCULOSIS. ,[object Object],[object Object]
PRIMARY TB ORGANS INVOLVED ,[object Object],[object Object],[object Object],[object Object]
---
Prim;Pulm;TB. ,[object Object],[object Object],[object Object]
 
 
DIFFERENCE B/W INFECTION & DISEASE INFECTION MEANS THAT MTB IS IN THE BODY BUT IMMUNE SYSTEM IS KEEPING THE BACTERIA UNDER CONTROL.
YES NO Defined as TB case +ve -ve Infectivity +ve -ve S/S +ve -ve Sputum C/S +ve -ve Sputum D/S +ve -ve CXR +ve +ve TST +ve +ve MTB DISEASE TB infection DIFF;B/W
FATE OF INFECTION ,[object Object],[object Object],[object Object],[object Object]
RISK OF PROGRESSION OF INFECTION TO DISEASE . ,[object Object],[object Object],[object Object],[object Object],[object Object]
NATURAL HISTORY OF UNTREATED TB . ,[object Object],[object Object],[object Object]
50% Dead 25% CURED 25% chronic
STAGES OF DISEASE PATHOLOGY STAGE 1 DROPLET NUCLEI INHALED… REACH ALVEOLI.---VASODILATION—INFLUX OF PMN & MACROPHAGES
STAGES OF DISEASE PATHOLOGY  Stage 2   ,[object Object],[object Object],[object Object]
 
Stages of disease PATHOLOGY STAGE 3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stages of disease PATHOLOGY STAGE 3 CONTD; ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
Stages of disease PATHOLOGY Stage 4 ,[object Object],[object Object],[object Object]
STAGES OF DISEASE PATHOLOGY STAGE 5 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pathology of TB. ,[object Object],[object Object],[object Object],PRIMARY OR GHON FOCUS PRIMARY OR GHON COMPLEX
OUTCOME OF PRIMARY INFECTION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinical Features of Prim; Pulm:TB ,[object Object],[object Object],[object Object]
Clinical Features of Primary Pulmonary TB. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ERYTHEMA NODOSUM PHLECTENULAR CONJUNCTIVITIS  DACTILITIS HYPERSENSITIVITY LYMPHADENOPATHY  COLLAPSE  CONSOLIDATION OBSTRUCTIVE EMPHYSEMA  CAVITATION PL EFFUSION  ENDOBRONCHIAL LESION  MILIARY  MENINGITIS  PERICARDITIS DISEASE INFLUENZA LIKE ILLNESS TST CONVERSION PRIMARY COMPLEX  INFECTION (4-8 WEEKS) FEATURES OF PRIMARY TB
Radiological features ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Diagnosis of primary pulmonary Tuberculosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COMPLICATIONS OF PRIMARY TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
COLLAPSE/CONSOLIDATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
COLLAPSE/CONSOLIDATION clinical presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Bronchiectasis ,[object Object],[object Object]
Obstructive emphysema ,[object Object],[object Object],[object Object]
Broncholith ,[object Object]
Erythema nodosum ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Phlyctenular conjunctivitis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pleural effusion ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
Miliary TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
 
CRYPTIC MILIARY TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
TB  MENINGITIS ,[object Object],[object Object],[object Object],[object Object]
SYMPTOMS OF TBM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SIGNS OF TBM ,[object Object],[object Object],[object Object],[object Object],[object Object]
INVESTIGATIONS FOR TBM. ,[object Object],[object Object],[object Object],[object Object],[object Object]
TB IN HIV ,[object Object],[object Object],[object Object],[object Object],[object Object]
TB IN HIV  ,[object Object],[object Object],[object Object],[object Object],[object Object]
THANK YOU

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Primary Tuberculosis 1

  • 1. PRIMARY TUBERCULOSIS DR.MUHAMMAD FAROOQUE M.B.,B.S. D.T.C.D. IN THE NAME OF ALLAH,THE MOST GRACIOUS,THE MOST MERCIFUL
  • 2. PRIMARY TUBERCULOSIS DR. MUHAMMAD FAROOQUE MB BS DTCD
  • 3.
  • 4.
  • 5. 2 MILLION PEOPLE DIE EVERY YEAR EQUAL TO 20 SUCH STADIUMS
  • 6.
  • 7. KING TUTANKHAMEN EGYPTIAN PHARAOH                             
  • 8. BARUCH SPINOSA DUTCH PHILOSOPHER                          
  • 9. SIMON BOLIVER VENEZUELAN REVOLUTIONARY LEADER                             
  • 10. JOHN KEATS ENGLISH POET                          
  • 11. EDGAR ALLAN POE AMERICAN WRITER,POET                           
  • 12. FREDERIC CHOPIN POLISH COMPOSER , PIANIST                        
  • 13. ROBERT LOUIS STEVENSON SCOTISH WRITER                             
  • 14. ANTON CHEKHOV RUSSIAN WRITER                       
  • 15. FRANZ KAFKA CZECH NOVELIST                            
  • 16. ELEANOR ROOSEVELT AMERICAN HUMANIYARIAN/FIRST LADY                            
  • 17. EUGENE ONEILL AMERICAN PLAYWRIGHT                           
  • 18. GEORGE ORWELL ENGLISH NOVELIST/ESSAYIST                         
  • 19.
  • 20.
  • 21. M.HAEMOPHILUM BCG M.GENAVENSAE M.FORTUITUM M.CHELONEI. . MAC(HIV-ASSOCIATED) DISSEMINATED(SEEN IN IMMUNODEFICENY STATES) M.TUBERCULOSIS M.MARINUM M.FORTUITUM M.CHELONEI. M.LEPRAE M.ULCERANS SOFT TISSUE/SKIN M.MALMOENSE M.BOVIS, M.FORTUITUM M.CHELONEI. M.TUBERCULOSIS MYCOBACTERIUM AVIUM COMPLEX (M.SCROFULACEUM,M.INTRACELLULARE & M.AVIUM) LYMPH NODE M.BOVIS M.XENOPI MAC M.KANSASII M.MALMOENSE M.TUBERCULOSIS PULMONARY LESS COMMON MAJOR SITE-SPECIFIC MYCOBACTERIAL DISEASE.
  • 22.
  • 23.  
  • 24.  
  • 25.  
  • 26.
  • 27.
  • 28. ROUTE OF TRANSMISSION AIRBORNE BY DROPLET NUCLEUS
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34. TST
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43. SKIN TESTING IN TB SINGLE PRICK TEST. READ AT 2-4 DAYS. POSITIVE IF INDURATION 5-14 MM(=HEAF GRADE 2) >15 MM =HEAF GRADE 3-4 MULTIPUNCTURE METHOD. READ AT 3-7 DAYS. GRADE 1:4– 6 PAPULES. GRADE 2: CONFLUENT.FORMING RING. GRADE 3:CENTRAL INDURATION GRADE 4: > 10 MM INDURATION MANTOUX TEST HEAF METHOD
  • 44.
  • 45.
  • 46.
  • 47.
  • 48. ---
  • 49.
  • 50.  
  • 51.  
  • 52. DIFFERENCE B/W INFECTION & DISEASE INFECTION MEANS THAT MTB IS IN THE BODY BUT IMMUNE SYSTEM IS KEEPING THE BACTERIA UNDER CONTROL.
  • 53. YES NO Defined as TB case +ve -ve Infectivity +ve -ve S/S +ve -ve Sputum C/S +ve -ve Sputum D/S +ve -ve CXR +ve +ve TST +ve +ve MTB DISEASE TB infection DIFF;B/W
  • 54.
  • 55.
  • 56.
  • 57. 50% Dead 25% CURED 25% chronic
  • 58. STAGES OF DISEASE PATHOLOGY STAGE 1 DROPLET NUCLEI INHALED… REACH ALVEOLI.---VASODILATION—INFLUX OF PMN & MACROPHAGES
  • 59.
  • 60.  
  • 61.
  • 62.
  • 63.  
  • 64.  
  • 65.
  • 66.
  • 67.
  • 68.
  • 69.
  • 70.
  • 71. ERYTHEMA NODOSUM PHLECTENULAR CONJUNCTIVITIS DACTILITIS HYPERSENSITIVITY LYMPHADENOPATHY COLLAPSE CONSOLIDATION OBSTRUCTIVE EMPHYSEMA CAVITATION PL EFFUSION ENDOBRONCHIAL LESION MILIARY MENINGITIS PERICARDITIS DISEASE INFLUENZA LIKE ILLNESS TST CONVERSION PRIMARY COMPLEX INFECTION (4-8 WEEKS) FEATURES OF PRIMARY TB
  • 72.
  • 73.  
  • 74.
  • 75.
  • 76.
  • 77.  
  • 78.
  • 79.
  • 80.
  • 81.
  • 82.
  • 83.  
  • 84.
  • 85.
  • 86.  
  • 87.
  • 88.  
  • 89.  
  • 90.
  • 91.
  • 92.
  • 93.
  • 94.
  • 95.
  • 96.