CBD 3

HISTORY
• Ms A, 32 malay lady present to hkl with complaints of cough and
fever.
• Her fever started four days ago , was mild and was not relieved by
rest and she did not take any over the counter medication
• Her cough stated 3 weeks prior and is productive in nature She
recently noticed her sputum to bloody.
• Upon further questioning, she also complained of night sweats for
the past 4 days.
• She did not experience any weight loss or weight gain, her appetite
and bowel movements are normal. She did not experience any chest
pain or wheezes through out this three weeks.
Social history
• She is staying with her fiancé who also works with her and he was said to
have the same issue as her.
• She is a teetotler and does not smoke
• She denied using illicit substances

Family history
• There is no family history of asthma or malignancy in her family

Past medical and surgical history

• No significant history
Physical examination
• Patient appeared to be comfortable and was not in ant distress.
• Her heart rate were elevated
• Swelling at the clavicular region were noted.
• On auscultation, coarse crackles were heard.
• Besides that, the physical examination was unremarkable.

Investigations that were ordered for the patients

• Chest x ray
• Acid fast bacilli smear and culture
• Mantoux test
• Hiv rapid test
Pulmonary tb
Epidemiology
• Ages 21 – 60
• Males are more prone than females
Clinical features
• productive cough, haemoptysis and chest pain
• nonspecific constitutional symptoms such as loss of appetite, unexplained weight
loss, fever, night sweats and fatigue.
• Adult patients presenting with unexplained cough lasting more than two weeks with
or without constitutional symptoms should be investigated for PTB.
• The typical symptoms may be absent in the immunocompromised or elderly patients
Etiology
• Mycobacterium tuberculosis
slow-growing obligate aerobe and a facultative intracellular parasite. M tuberculosis,
are aerobic, non–spore-forming, nonmotile, facultative, curved intracellular rods
measuring 0.2-0.5 μm by 2-4 μm. Their cell walls contain mycolic, acid-rich, long-
chain glycolipids and phospholipoglycans.
• Mycobacterium bovis
• Mycobacterium africanum
• Mycobacterium microti

Transmission
organism is spread primarily as an airborne aerosol from an individual who
is in the infectious stage of TB ( respiratory droplets)
Important high risk groups :

• TB contacts
• Immunocompromised patients
• Human Immunodeficiency Virus infection
• Chronic obstructive pulmonary disease
• End-stage renal disease
• Malignancy
• Malnutrition
• Use of immunosuppresant drugs in rheumatoid arthritis
• Substance abusers and cigarette smokers
• Drug user
• Intravenous drug users
• Excessive alcohol consumption
• Current smoker

• People living in overcrowded conditions

• Homelessness
• History of incarceration
• Institutionalisation
• Prison
Latent tb vs. active tb
Coming to a diagnosis
AFB
NAA ( nucleic acid amplification )
• Rapid identification of MTb complex
• Differentiating between MTb and non-tuberculosis mycobacteria
• Identifying tb in smear negative sputum
• Routinely used for suspected cases of CNS TB
• Useful at initial stages of tb only ( remains positive despite treatment due to detection of dead
orgamisms)
• Useful in rapid commencement of treatment and also rapid identification of drug resistance
Imaging
Management ( based on 3rd edition cpg )

six-month regimen consisting of two months of daily EHRZ* (2EHRZ) followed by

four months of daily HR* (4HR) is recommended for newly-diagnose
Directly observed therapy ( DOT )
Contact tracing
References
• Kumar and clarks clinical medicine
• Cpg tuberculosis 3rd edition
• https://emedicine.medscape.com/article/230802-overview