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Tina Kennelly December 17, 2008

Tina Kennelly December 17, 2008. Summary. Pathogenesis Primary Disease Extrapulmonary Disease Latent Disease Reactivation Disease Diagnosing Tuberculosis Treatment Prevention. Mycobacterium. Gram positive obligate aerobic rods

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Tina Kennelly December 17, 2008

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  1. Tina Kennelly December 17, 2008

  2. Summary • Pathogenesis • Primary Disease • Extrapulmonary Disease • Latent Disease • Reactivation Disease • Diagnosing Tuberculosis • Treatment • Prevention

  3. Mycobacterium • Gram positive obligate aerobic rods • Mycobacterium tuberculosis, M. bovis, M. africanum, and M. microti all cause tuberculosis • M. tuberculosis is pathogenic for humans and M. bovis for animals • Acid-fast bacilli

  4. Outcomes after exposure: Clearance of organism Primary Disease Latent Infection Reactivation Disease Pathogenesis

  5. Tubercle Lymphadenopathy Ghon Complex Caseating Necrosis Primary Disease

  6. Ghon Complex Tubercle

  7. Extrapulmonary Tuberculosis

  8. Pott’s Disease MRI imaging modality of choice to detect spinal cord compression or cauda equina

  9. Genitourinary Tuberculosis • Direct infection or amyloidosis • Granulomas in glomeruli heal or caseate • Dysuria and hematuria • IVP helpful • Upper and lower GU tract

  10. Tuberculous pericarditis Echo is the imaging modality of choice for definitive diagnosis

  11. Tuberculoma Seizures and focal signs CT or MRI: contrast-enhanced ring lesions Tuberculous Meningitis and Tuberculoma • TB Meningitis CSF: • Lymphocytic pleocytosis • glucose • protein • CT or MRI: • may show • hydrocephalus

  12. Hematogenously disseminated TB Lesions are yellowish granulomas resembling millet seeds CXR: reticulonodular infiltrate Miliary Tuberculosis

  13. Miliary TB

  14. Latent TB • Infection with no evidence of active TB in a patient with a positive tuberculin skin test: • Negative CXR • Negative sputum cultures • Asymptomatic NOT infectious!

  15. Reactivation Disease • Previously sensitized host • Occurs in lung apices • Cavitary lesions • Immunosuppression • Exogenous reinfection • CT scan > sensitive than plain CXR Symptoms: cough, weight loss, fever, night sweats, chest pain, hemoptysis.

  16. Cavitary Lesions

  17. Tuberculin Skin Test CXR CT MRI Culture: GOLD STANDARD Sputum AFB smear Gastric aspiration Diagnosing TB

  18. Treatment of TB • Initial phase: 2 months • Rifampin, Isoniazid, Pyrazinamide, Ethambutol • Continuation phase: 4 or 7 months • Isoniazid and Rifampin • Latent TB: 6 months • Isoniazid • Directly Observed Therapy • MDR-TB vs. XDR-TB

  19. Prevention • Isolate and treat • BCG Vaccine • Treat Latent TB

  20. QUESTIONS?

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