Presentation on Tuberculosis

TUBERCULOSIS. A screenshot of a computer Description automatically generated with medium confidence.

Learning Objectives. At the end of this session the participant will be able to: Define TB cases State the four key features important to classifying TB cases. Categorize TB cases Describe the criteria and method for determining an infectious period. Evaluate the risk of transmission based on clinical content of disease and diagnostic tests. Able to identify the risk behaviors and risk factors..

TUBERCULOSIS....... Tuberculosis (TB) is a bacterial infection( a bacterium called Mycobacterium tuberculosis ) spread through inhaling tiny droplets from the coughs or sneezes of an infected person . It mainly affects the lungs, but it can affect any part of the body, including the tummy (abdomen), glands, bones and nervous system . Incubation period : 2 to 10 weeks after the initial infection.

TB Classification. TB cases are also classified according to: Anatomical site of TB Disease Bacteriologic results (including drug resistance) History of previous TB treatment HIV status of the patient.

Pulmonary Tuberculosis (PTB):. Pulmonary Tuberculosis (PTB): Refers to disease involving the lung parenchymaA patient with both pulmonary and extra-pulmonary TB constitutes a case of PTB Miliary TB is classified as PTB because there are lesions in the lungs.

Extra-pulmonary Tuberculosis (EPTB):. Refers to TB disease of organs other than the lungs. Therefore the following constitute a case of EPTB: Tuberculous intrathoracic lymphadenopathy (mediastinal and/or hilar) Tuberculous pleural effusion, without radiographic abnormalities in the lungs Extra thoracic TB.

Anatomical site of TB. A screenshot of a computer Description automatically generated with medium confidence.

Classification By CDC. Class Type Description 0 No TB exposure Not infected • No history of TB exposure and no evidence of M. tuberculosis infection or disease • Negative reaction to TST or IGRA 1 TB exposure No evidence of infection • History of exposure to M. tuberculosis • Negative reaction to TST or IGRA (given at least 8 to 10 weeks after exposure) 2 TB infection No TB disease (Latent) • Positive reaction to TST or IGRA • Negative bacteriological studies (smear and cultures) • No bacteriological or radiographic evidence of active TB disease 3 TB clinically active • Positive culture for M. tuberculosis OR • Positive reaction to TST or IGRA, plus clinical, bacteriological, or radiographic evidence of current active TB 4 Previous TB disease ( not clinically active) • May have past medical history of TB disease • Abnormal but stable radiographic findings • Positive reaction to the TST or IGRA • Negative bacteriologic studies (smear and cultures) • No clinical or radiographic evidence of current active TB disease 5 TB suspected • Signs and symptoms of active TB disease, but medical evaluation not complete.

Difference between latent and Active Tuberculosis.

Incidences. Tuberculosis is a worldwide public health problem that is closely associated with poverty, malnutrition, overcrowding, substandard housing, and inadequate health care. M. tuberculosis infects an estimated one-third of the world’s population and remains the leading cause of death from infectious disease in the world. According to the WHO, an estimated 1.6 million deaths resulted from TB in 2005. In the United States, almost 15,000 cases of TB are reported annually to the CDC. After exposure to M. tuberculosis, roughly 5% of infected people develop active TB within a year..

Comprehensive study on the prevalence of TB among expatriates applying for residence visas( First study 2013).

Causes of Acquiring tuberculosis include the following:.

Clinical Manifestations. After an incubation period of 4 to 8 weeks, TB is usually asymptomatic in primary infection. Nonspecific symptoms. Nonspecific symptoms may be produced such as fatigue , weakness, anorexia , weight loss, night sweats, and low-grade fever , with fever and night sweats as the typical hallmarks of tuberculosis. Cough . The patient may experience cough with mucopurulent sputum. Hemoptysis. Occasional hemoptysis or blood on the saliva is common in TB patients. Chest pains..

Clinical Manifestations- and infectious levels. Infection eliminated Latent TB infection Subclinical TB disease Lung Heart 'GRA Culture Sputum smear infectious Preferred treatment With innate immune response* Negative Negative With acquired immune response ve ativ ativ Mycobacterium tuberculosis -reventive Active TB disease Nature Reviews I Disease Primers.

Complications. If left untreated or mistreated, pulmonary tuberculosis may lead to: Respiratory failure. Respiratory failure is one of the most common complication of pulmonary tuberculosis. Pneumothorax . Pneumothorax becomes a complication when tuberculosis is not treated properly. Pneumonia . One of the most fatal complications of tuberculosis is pneumonia as it could cause infection all over the lungs..

Prevention. *METRO GROUP OF HOSPITALS TUBERCULOSIS PREVENTION Healthy met UseMask Stop Smoking & Alcohal Stay Away from Coughing People Wash ywr Heands After Sneezing Coughing Use Personal Cutlery X - l, Sector - 12, Noida I Tel. No. 120 4366666 [email protected].

Assessment and Diagnostic Findings. TST Principle •TST detects I M. antigens.

How to diagnose latent tuberculosis?!. The main ways to diagnose LTBI are by Placing a tuberculin skin test (TST) on the forearm By getting a TB blood test, In addition to obtaining a chest radiograph (x-ray) if either one of these tests is positive . One-third of the world's population has LTBI. The TB germs are dormant (asleep) in the body..

Study on Diagnosis and Management of Latent Tuberculosis Infection in 2015 ( PUBMED).

Diagnosis for Latent Tuberculosis Infection: New Alternatives 2020 study.

Assessment and Diagnostic Findings. Assessment and Diagnostic Findings To diagnose tuberculosis, the following tests could be performed: Sputum culture: Positive for Mycobacterium tuberculosis in the active stage of the disease. Ziehl-Neelsen (acid-fast stain applied to a smear of body fluid): Positive for acid-fast bacilli (AFB). Skin tests (purified protein derivative [PPD] or Old tuberculin [OT] administered by intradermal injection [ Mantoux ]): A positive reaction (area of induration 10 mm or greater, occurring 48–72 hr after interdermal injection of the antigen) indicates past infection and the presence of antibodies but is not necessarily indicative of active disease. Factors associated with a decreased response to tuberculin include underlying viral or bacterial infection, malnutrition, lymphadenopathy, overwhelming TB infection, insufficient antigen injection, and conscious or unconscious bias. A significant reaction in a patient who is clinically ill means that active TB cannot be dismissed as a diagnostic possibility. A significant reaction in healthy persons usually signifies dormant TB or an infection caused by a different mycobacterium. The tuberculosis (TB) blood test, also called an Interferon Gamma Release Assay or IGRA, is a way to find out if you have TB germs in your body . The TB blood test can be done instead of a TB skin test (Mantoux)..

Assessment and Diagnostic Findings cont... Enzyme-linked immunosorbent assay (ELISA)/Western blot: May reveal presence of HIV . Chest x-ray : May show small, patchy infiltrations of early lesions in the upper-lung field, calcium deposits of healed primary lesions, or fluid of an effusion. Changes indicating more advanced TB may include cavitation, scar tissue/fibrotic areas. CT or MRI scan: Determines degree of lung damage and may confirm a difficult diagnosis. Bronchoscopy : Shows inflammation and altered lung tissue. May also be performed to obtain sputum if patient is unable to produce an adequate specimen. Histologic or tissue cultures (including gastric washings; urine and cerebrospinal fluid [CSF]; skin biopsy ): Positive for Myco­bacterium tuberculosis and may indicate extrapulmonary involvement..

Assessment and Diagnostic Findings cont... Needle biopsy of lung tissue: Positive for granulomas of TB; presence of giant cells indicating necrosis. Electrolytes : May be abnormal depending on the location and severity of infection; e.g., hyponatremia caused by abnormal water retention may be found in extensive chronic pulmonary TB. ABGs : May be abnormal depending on location, severity, and residual damage to the lungs. Pulmonary function studies: Decreased vital capacity, increased dead space, increased ratio of residual air to total lung capacity, and decreased oxygen saturation are secondary to parenchymal infiltration/fibrosis, loss of lung tissue, and pleural disease (extensive chronic pulmonary TB)..

Medical Management. Pulmonary tuberculosis is treated primarily with antituberculosis agents for 6 to 12 months. First line treatment. First-line agents for the treatment of tuberculosis are isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide. Active TB. For most adults with active TB, the recommended dosing includes the administration of all four drugs daily for 2 months, followed by 4 months of INH and RIF. Latent TB. Latent TB is usually treated daily for 9 months..

Treatn•ent Regirnens for Latent TB Infection Drug(s) Isoniazid Isoniazid & Rifapentine Rifampin Duration 9 months months 6 months 3 4 rnonths Interval Daily Twice weekly Daily Twice weekly Once weekly Daily Minirnurn Doses 270 76 180 52 12 120 Note: Rifampin (RIF) and Pyrazinamide (PZA) should not be offered to persons with LTBI. RIF and PZA should continue to be administered in multidrug regimens for the treatment of persons with TB disease..

Medical Management cont... Treatment guidelines. Recommended treatment guidelines for newly diagnosed cases of pulmonary TB have two parts: an initial treatment phase and a continuation phase. Initial phase. The initial phase consists of a multiple-medication regimen of INH, rifampin, pyrazinamide, and ethambutol and lasts for 8 weeks. Continuation phase. The continuation phase of treatment include INH and rifampin or INH and rifapentine , and lasts for an additional 4 or 7 months. Prophylactic isoniazid. Prophylactic INH treatment involves taking daily doses for 6 to 12 months. DOT. Directly observed therapy may be selected, wherein an assigned caregiver directly observes the administration of the drug..

Pharmacologic Therapy. The first line antituberculosis medications include:• Isoniazid (INH). INH is a bactericidal agent that is used as prophylaxis for neuritis, and has side effects of peripheral neuritis, hepatic enzyme elevation, hepatitis , and hypersensitivity. Rifampin ( Rifadin ). Rifampin is a bactericidal agent that turns the urine and other body secretions into orange or red, and has common side effects of hepatitis, febrile reaction, purpura, nausea , and vomiting . Pyrazinamide. Pyrazinamide is a bactericidal agent which increases the uric acid in the blood and has common side effects of hyperuricemia, hepatotoxicity, skin rash, arthralgias , and GI distress. Ethambutol ( Myambutol ). Ethambutol is a bacteriostatic agent that should be used with caution with renal disease, and has common side effects of optic neuritis and skin rash..

List of first line and second line drug for TB. 1st and 2nd Line Anti Tubercular Drugs - Mnemonic www.openmed.co.in Mnemonic .•PRIEST Pyrazinamide Rifampin Isoniazid (INH) Ethambutol STreptomycin Mnemonic : KTR FACEPaC Kanamycin Rifabutin Thiacetazone Fluoroquinolones Amikacin Capreomycin Ethionamide/Prothionamide Para aminosalicylic acid Cycloserine.

Nursing Management. Nursing Assessment The nurse may assess the following: Complete history. Past and present medical history is assessed as well as both of the parents’ histories. Physical examination. A TB patient loses weight dramatically and may show the loss in physical appearance..

Nursing Diagnosis. Based on the assessment data, the major nursing diagnoses for the patient include: Risk for infection related to inadequate primary defenses and lowered resistance. Ineffective airway clearance related to thick, viscous, or bloody secretions. Risk for impaired gas exchange related to decrease in effective lung surface. Activity intolerance related to imbalance between oxygen supply and demand. Imbalanced nutrition : less than body requirements related to inability to ingest adequate nutrients..

Nursing interventions for the patient include:. Promoting airway clearance. The nurse instructs the patient about correct positioning to facilitate drainage and to increase fluid intake to promote systemic hydration. Adherence to the treatment regimen. The nurse should teach the patient that TB is a communicable disease and taking medications is the most effective means of preventing transmission. Promoting activity and adequate nutrition. The nurse plans a progressive activity schedule that focuses on increasing activity tolerance and muscle strength and a nutritional plan that allows for small, frequent meals..

Nursing interventions contd... Preventing spreading of tuberculosis infection. The nurse carefully instructs the patient about important hygienic measures including mouth care, covering the mouth and nose when coughing and sneezing, proper disposal of tissues, and handwashing . Acid-fast bacillus isolation. Initiate AFB isolation immediately, including the use of a private room with negative pressure in relation to surrounding areas and a minimum of six air changes per hour. Disposal. Place a covered trash can nearby or tape a lined bag to the side of the bed to dispose of used tissues. Monitor adverse effects. Be alert for adverse effects of medications..

Discharge and Home Care Health Education. Before the discharge, the nurse should instruct the patient on: Disposal of secretions. Cough and sneeze into tissues and to dispose of all secretions in a separate trash can. Isolation. Wear a mask when going outside of the room. Activity and nutrition. Remind the patient to take a lot of rest and to eat balanced meals to aid recovery. Adverse effects. Advise the patient to watch out for adverse effects of medications and to report them to the physician immediately..

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References. 1. Lippincott Mannual of Nursing Practice, 8 th Edition,Sandra M.Nettina , Lipincot Williams & Willkins Publications , Page Numbers: 295-300. 2.Assessment and Management of Clinical Problems Medical surgical Nursing , 7 th Edition,Lewis , Keitkember , Dirkson , O’brien , Bucher Mosby Elsevier Publications , Page Numbers: 569-575..

References (Studies as EVIDENCE). 1. Prevalence of pulmonary tuberculosis among expatriates subjected to medical visa screening in Abu Dhabi, United Arab Emirates, Journal of Epidemiology and Global Health Volume 3, Issue 1 , March 2013, Pages 23-30 2. Diagnosis and Management of Latent Tuberculosis Infection Cold Spring Harb Perspect Med. 2015 Nov; 5(11): a017830. doi : 10.1101/cshperspect.a017830 PMCID: PMC4632867 PMID: 26054858 Laura Muñoz , 1,2 Helen R. Stagg , 2 and Ibrahim Abubakar 2 Author information Copyright and License information Disclaimer 3. Diagnosis for Latent Tuberculosis Infection: New Alternatives https://doi.org/10.3389/fimmu.2020.02006 ; This article is part of the Research Topic Advances in Immunotherapeutic Approaches to Tuberculosis Cl audia Carranza 1 , Si gifredo Pedraza-Sanchez 2 , Eleane de Oyarzabal-Mendez 1 and Ma rtha Torres 1,3*.

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