Download Pulmonary tuberculosis(1) - Learning

Pulmonary tuberculosis
L de Man
Dept. of Physiotherapy
University of the Free State
2012
Definition

Tuberculosis is an active infection with the
bacterium Mycobacterium tuberculosis
History

Tuberculosis has been present in humans
since antquity

Tubercular decay in the spines of Egyptian
mummies dating from 3000 – 2400 BC

460 BC Hippocrates identified phtisis as the
most widespread disease of the times
involving coughing up blood and fever, which
was almost always fatal.
History
Robert Koch discovered
the tuberculosis bacili in
1882 and received the
Nobel Prize in medicine in
1905
 In 1946 the development of
the antibiotic streptomycin made
effective treatment and cure possible

History

Prior to that the only treatment besides
going to a sanatorium, were surgical
treatment – collapsing an infected lung to
“rest” it and allow lesion to heal
History

Surgery discontinued in 1950’s

Postoperative problem was postural due
to lack of structural support

Due to overcompensation the patient
developed posture of leaning away from
the incision side
Thoracoplasty

Left lung collapse secondary to
thoracoplasty
Epidemiology
Current estimates: around ⅓ of world’s
population has latent TB
 Between 2002 and 2020

1000 million will become newly infected
150 million will contract TB
36 million will die
Reasons for increase in incidence

Developed countries

Developing countries
o
Immigration from high
prevalence areas
HIV
Social deprivation
(homelessness, poverty)
Increased proportion of
elderly
Drug resistance
o
Ineffective control
programmes
Lack of access to health
care
Poverty, civil unrest
HIV
Increased population
Drug resistance
o
o
o
o
o
o
o
o
o
Epidemiology

The 22 countries account for 80% of the
TB cases in the world
Alphabetical list of countries
1.Afghanistan
12. Myanmar
2. Bangladesh
13. Nigeria
3. Brazil
14. Pakistan
4. Cambodia
15. Philippines
5. China
16. Russia
6. Democratic Republic of Congo
17. South Africa
7. Ethiopia
18. Tanzania
8. India
9. Indonesia
19. Thailand
20. Uganda
21. Viet Nam
10 Kenya
11. Mozambique
22. Zimbabwe
Epidemiology
In 2007, the country with the highest
incidence rate was Swaziland, with 1200
cases per 100,000 people
versus
15 cases per 100,000 people in United
Kingdom
Pathology
Spreads through cough, sneeze, any other
way of transmitting saliva – a single
sneeze can release up to 40,000 droplets
(0,5 – 5µm in diameter)
 Primary TB = active disease on first
exposure
 Most infections result in a
asymptomatic,latent
infection

Pathology

Combination of primary lesion and
regional lymph node involvement =
Ghon focus
Pathology
Post-primary TB = active TB
 Earliest chest x-ray = an ill defined
opacity situated in one of the upper lobes

Pathology
As disease progress consolidation,
collapse, caseation,fibrosis and cavitation
 On chest x-ray – significant displacement
trachea and mediastinum

Pathology
Symptoms of active TB
Chronic cough
 Hemoptises
 Fever
 Night sweats
 Appetite loss
 Weigt loss
 Fatigue

Miliary TB
Blood borne dissemination gives rise to
miliary TB
 Classic appearance on chest x-ray = fine,
1 – 2 mm lesions distributed throughout
the lung fields

Diagnosis
Ussually confirmed by direct microscopy
= Ziel-Neelsen staining


Culture of samples
is sputum
Management
Rifampicic and Isoniazid for 3 months
 Or Isoniazid for 6 months
 Chemotherapy
 Were drug resistance is not expected, a
patient can be assumed to be noninfectious after 2 weeks of appropriate
therapy.
 Directly observed therapy (DOT)

Extra pulmonary TB
1.
Lymphadenitis
Lymph nodes of cervical and mediastinal
glands
Extra pulmonary TB
2. Gastrointestinal TB




Any part of bowel can be infected
Acute abdomen
Narrowing, shortening, distortion of bowel
TB peritonitis
3. Pericardial disease


Pericardial effusion
Constrictive percarditis
Extra pulmonary TB
4. CNS disease


•
Most important form and when unrecgonised
and untreated = fatal
Recovery rate = 60% or less with permanent
neurological deficit
Usual local source = caseous focus in meninges
or brain
TB meningitis
Extra pulmonary TB
5. Bone and joint disease






•
Spine is common site = Pott’s disease
Vertebral collapse resulting in kyphosis
Spinal cord compression
Sinus formation
Paraplegia (so called Pott's paraplegia)
Prevention = Controlling the spread of
tuberculosis infection
Therapy = Stabilisation and decompression with\
spinal involvement
Physiotherapy


Physio per se is not indicated
Treat associated conditions or
complications that may have arisen
through reactions to drugs
References

Boon NA, Colledge NR, Walker BR,
Hunter JAA. 2006. Davidson’s Principles and
Practise of Medicine. 20th Ed. Edinburgh
London, Elsierivier Limited.
p 695-703.