Documente Academic
Documente Profesional
Documente Cultură
By
Professor K. Osinusi
TUBERCULOSIS
Aetiological agent
mycobacterium tuberculosis
and
mycobacterium bovis
mycobacterium africanus
Characteristics of mycobacteria
It multiples slowly
It is resistant to many anti- microbial drugs
It remains viable in macrophages by subverting macrophages-
killing
Its waxy coat together with its many components substances
depress immune responses against it.
EPIDEMIOLOGY (II)
Sources of Infections:
Most important source is sputum of persons with open
tuberculosis
Mode of Spread:
Inhalation
Ingestion
Penetration of skin and mucous membrane
Predisposing Factors:
Age
Sex
Malnutrition
Intercurrent infection
Overcrowding & poor living conditions
Pathophysiology
Primary focus )
+ ) Primary Complex
regional lymph nodes )
Primary Focus
- Size – varies from a few millimeter to 2 centimeter in diameter
- Site – usually situated in the sub-pleural region
- Symptoms & signs
May be symptomless
May be associated with minor symptoms like malaise
and anorexia
May be associated with muco-cutaneous manifestations
ie erythema nodosum and phlycternular conjunctivitis
INVESTIGATIONS
Tuberculin skin test
Chest radiograph
Hilar adenopathy
Parenchymal lesions
- Patchy infiltrates
- Consolidations
- Atelectasis
- Pleural effusion
- Cavities
17. Bacteriological investigations
- Sputum ) staining
- Gastric washings ) and culture
4. ESR
5. FBC
Differential Diagnosis
Pneumonia
- Bacterial
- Viral
- Mycoplasma
Lung abscess
Bronchiectasis
Pulmonary fungal infections
Pulmonary neoplasm
PLEURAL EFFUSION
Clinical Features:
Symptoms: Fever
Weight loss
Chest pain on deep inspiration
Signs: Dullness to percussion
Diminished or absent breath sounds.
PLEURAL FLUID:
Clinical Manifestations:
- Variable, depending on the load of organism, organs affected
and immune status of the child.
- Onset of symptoms may be explosive or insiduous.
Symptoms: Fever
Anorexia
Weight loss
Cough
Wheezing
Signs: Generalised lymphadenopathy.
Hepato-splenomegaly.
Respiratory distress
signs of meningitis or peritonitis present in 20-
40% of cases.
Choroidal tubercles.
INVESTIGATIONS
- Sarcoidosis
- Eosinophilic pneumonia
- Pulmonary fungal infection
- Chicken-pox pneumonia
- Childhood histiocytosis syndrome
TUBERCULOSIS OF THE CNS
Comprises:
- Tuberculous meningitis
- Tuberculoma
Tuberculous meningitis
Occurs about 2-6 months after the primary infection
Lethargy
Nuchal rigidity
Seizures
Positive Kernig’s sign
Vomiting
Stigns of brainstem involvement
Cranial nerve palsies
+ other focal neurological signs
Stage III
- Hemiplegia or paraplegia
- Coma
- Decrebrate rigidity
- Opisthotonus
- Fundoscopy may show papilloedema and
choroidal tubercles.
INVESTIGATIONS
CSF Picture:
May be straw-coloured or may be clear and colourless
- WBC 10-500cells/cmm with predominance of
lymphocytes
Protein may be over 1GM/dl
- Glucose – Low, less than 40mg/dl
- Staining with ZN stain may yield Afb
- Culture may be positive
PROGNOSIS
CLINICAL MANIFESTATION
Headache
Fever
Convulsion
Lateralizing signs
Investigations
Tuberculin skin test
Skull X-ray
CXR
CT Scan of the brain shows discrete masses with
surrounding oedema