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PULMONARY

TUBERCULOSIS
Presented by:
(Name of Physician)
(Site)

Pulmonary Tuberculosis

PULMONARY TUBERCULOSIS (PTB)


is a disease caused by a bacteria called
Mycobacterium tuberculosis that is mainly acquired
by inhalation of infectious droplets containing viable
tubercle bacilli

Reference: DOH. http://www.doh.gov.ph/node/367.html

Signs & Symptoms


The most common symptom of
pulmonary
tuberculosis
is
persistent cough, productive of
mucus and sometimes with blood
(hemoptysis).
Approximately 75% of the patients
complain of chronic cough (2
weeks or more) and significant
weight loss.

Sweats and chills, fatigue and body


malaise,
and
fever
are
less
consistently reported (about half of
the patient population).
Reference: CDC.

Is Pulmonary Tuberculosis Contagious?


Yes, when people with active
pulmonary TB cough, sneeze,
speak, sing or spit, they expel
infectious aerosol droplets.
A single sneeze can release up
to 40,000 droplets. Each one of
these droplets may transmit
the
disease,
since
the
infectious dose of tuberculosis
is very low and inhaling fewer
than ten bacteria may
cause an infection.
Reference: CDC.

Risk Factors
The major factors that determine the risk of
exposure to Mycobacterium Tubercle (MTB) include:
Number of infectious cases in the community
- If there is no MTB source, there will be no
exposure and, therefore, there will be no PTB!
Infectivity - Risk of developing the disease is
directly proportional to the exposure to infected
individuals.
Early and adequate diagnosis and intervention
decreases the risk of exposure of people in the
community.
Reference: CDC.

Risk Factors
Number
and
nature
of
interactions
between
an
infectious case and a susceptible
contact.
Climatic Conditions - Outdoors,
TB Bacilli expelled from respiratory
tract of an infectious person are
rapidly dispersed and are quickly
rendered nonviable by sunlight.
The risk for transmission during
such encounter is very limited.

Reference: CDC.

PTB Diagnosis: Tests and Procedures


Chest X-ray (CXR) cannot be used to definitively
diagnose PTB. Patients consulting with CXR
findings suggestive of PTB should undergo sputum
microscopy regardless of symptoms
Sputum microscopy for acid fast bacilli (or
Sputum AFB) is the initial work-up of choice for PTB
suspects
Sputum TB culture with drug susceptibility
testing (DST) is primarily recommended for
patients who are at risk for drug resistance:
All cases of retreatment / treatment failure
Household
contacts
of
patients
with
multidrug resistant TB (MDR-TB)
patients who may be infected with HIV

Reference: http://www.slideshare.net/raissa_09/tuberculosis-20

Test & Procedures


Sputum smear examination is the preferred method for the
diagnosis of PTB. No diagnosis of PTB shall be made based on
the result of X-ray examinations alone. Skin tests for PTB
infection (PPD skin tests) should not be used as a basis for the
diagnosis of PTB in adults.
Results of Sputum Microscopy are interpreted and
reported as follows:
SMEAR POSITIVE if at least two sputum specimens are
AFB (+)
SMEAR NEGATIVE if none of the specimens are AFB (+)
DOUBTFUL When only one of the 3 sputum specimens is
(+). In this case a second set sputum must be collected
again. If at least one of the second three is (+), the
diagnosis is now labelled SMEAR POSITIVE.

Reference: Comprehensive and Unified Policy for TB Control in the

Proper Sputum Collection


Patient must be made aware of the importance of
sputum quality. Mucus from the nose and throat and
saliva from the mouth are not good specimens. The
following are the steps to obtain a good specimen:
Clean and thoroughly rinse
the mouth with water.
Breathe deeply 3 times.
After the third breath, cough
hard and try to bring up
sputum from deep in the
lungs.
Expectorate sputum into a
clean container with a wellfitted cap.
Collect
at
least
1
teaspoonful (5-10ml).
Examine the specimen to
see thatReference:
it is CDC.
nothttp://www.bccdc.ca/NR/rdonlyres/E6572A06-EA63-41A1-9BA5just saliva.

Prevention
To prevent the spread of TB to other family members
and the community:

The infected person must


cover his/her mouth and
nose when coughing or
sneezing.

Allow sunshine and fresh air


into the home. As much as
possible keep windows and
doors open.

N95 mask is the proper


personal protective device
Reference: MAYO CLINIC. http://www.mayoclinic.org/diseasesthat can be used.

Treatment
Treatment for TB uses antibiotics to kill the
bacteria.
TB requires much longer periods of treatment
(around 6 to 24 months) to entirely eliminate
the PTB
mycobacteria
drugs: from the body.

R ifampicin
I soniazid
P yrazinamide
E thambutol
S treptomycin

Reference: CDC. http://www.cdc.gov/tb/topic/treatment/de

Return to Work
Decisions about infectiousness of a person on treatment
of TB should always be individualized on the basis of the
following:
The extent of illness.
The presence of cavitary pulmonary disease.
The degree of positivity of sputum AFB smear results.
The frequency and strength of cough.
The likelihood of infection with multi-drug resistant
organisms.
The nature and circumstances of the contact between
the infected person and exposed contacts.

Reference: CDC.

Myths & False Perceptions


Only thin people get TB
TB is acquired from using the
eating utensils of a TB-infected
person, or from food.
TB is inherited.
TB is acquired from having sex.

Reference: WHO.

What You Can Do?


Take charge of your health and live a
healthy life. Always seek the advice of
your Medical Clinic Team.
Attend to your Annual Medical Check-up
and have the results interpreted by your
onsite physician.
Do a regular follow-up check-up.

1. The most common symptom of pulmonary


tuberculosis is persistent cough, productive of mucus
and sometimes with blood (hemoptysis).
2. PTB requires much longer periods of treatment
(around 6 to 24 months) to entirely eliminate the
mycobacteria from the body.
3. TB is NOT acquired from using the eating
utensils of a TB-infected person, or from food.

QUESTIONS/CLARIFICATIONS

End of
Presentation
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