Diagnoctics%20of%20tuberculosis

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

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Etiology
M. tuberculosis M. bovis M. africanum
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Thin section transmission electron micrograph of
Mycobacterium tuberculosis
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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
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Automated screening molecular genetic
test to identify Mycobacterium tuberculosis and
resistance R - Xpert MBT / Rif
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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

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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
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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
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• 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.

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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
  the lungs and 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.

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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).

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Methods of Revealing Mycobacteria
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Culture of mycobacteria tuberculosis at hard egg
medium
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Radiology

• Chest radiography is the most important
• method to detect TB
• TBs characteristics of a chest radiograph
• favor the diagnosis of tuberculosis
• as following

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Computer tomography
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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.

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• (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

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Primary complex
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Milliary Tuberculosis
acute milliary tuberculosis
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secondary pulmonary tuberculosis
infiltrate
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Tuberculoma
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Chronic fibro-cavitary pulmonary tuberculosis
cavity
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Tuberculous effusion
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Comruter tomograma patient with pulmonary TB
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Fluorography
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Bronchography
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Bronchoscopy examinationVideo
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• Tuberculin testing
• A positive tuberculin test although it
  is of
• great use in children, but it has limited
  diagnostic significance in older age groups

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TUBERCULINODIAGNOSTICS
Old Tuberculin Koch
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Dry rectified tuberculin (50000 ?U), the solvent
is isotonic solution of sodium chloride 1ml
with the addition of 0,25 carbolic acid
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Positive Mantoux test.
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Diagnosis
According to the history, clinical signs,
chest X-ray and 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
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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.

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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.

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Differential Diagnosis 1 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.

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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.

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Differential Diagnosis 1 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. )

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Differential Diagnosis 1 2 3 4 5

• Fever caused by some other diseases

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complications

• Pneumothorax
• Bronchiectasis
• Empyema
• Extrapulmonary expansion
• Hemoptysis
• Chronic pulmonary heart disease