Lecture 1 Diagnoctics of tuberculosis (Stomat. F-t) Prof. L.A. Hryshchuk

1. Lecture 1 • Diagnoctics of tuberculosis • (Stomat. F-t) • Prof. L.A. Hryshchuk

4. Etiology M. tuberculosis M. bovis M. africanum

7. Thin section transmission electron micrograph of Mycobacterium tuberculosis

10. The granuloma consists of a kernel of infected macrophages, surrounded by FOAMY GIANT CELLS and macrophages with a mantle of LYMPHOCYTES delineating the periphery of the structure

11. Automated screening molecular genetic test to identify Mycobacterium tuberculosis and resistance R - Xpert MBT / Rif

12. Cultures were on a liquid environment: automated microbiological analyzer BACTEC MGIT 960 Performed in all patients with pulmonary tuberculosis (with positive and negative sputum smear) Test drug sensitivity to drugs and second row Growth of Mycobacterium tuberculosis in 7-14 days. Increases confirm TB in patients with negative sputum smear at 20%

13. At a molecular genetic test: GenoType MTBDRplus Perform all patients with Positive sputum smear Carried out in parallel with the classical culture method Detects DNK MBT , resistance to isoniazid and rifampin and isoniazid combination

14. Planting on solid medium Performed in all TB patients lungs (with positive and negative smear sputum): Bank of cultures Test drug sensitivity drugs II series

15. Children and teenagers, in whom the following factors are diagnosed, compose a group of early revealed: • 1) tuberculin test range; • 2) primary tubinfestation; • 3) hyperergic Mantoux test; • 4) tuberculous intoxication.

16. Clinical examination of tuberculosis patients • The methods of investigation of respiratory (tuberculosis) patients are conveniently divided into three groups. • The First group – compulsory (obligatory) methods, which embrace clinical examination of a patient (complaints, anamnesis, examination, palpation, percussion, auscultation), thermometry, X-ray investigation (fluorography, X-raygraphy, X-rayscopy), sputum analysis for MBT, Mantoux tuberculin test (with 2 TU), general blood and urine test. • The Second group – additional (supplementary) methods, which include repeated sputum analysis (bronchial lavage water) for MBT, tomography of thelungsand mediastinum, protein-tuberculin tests, immunologic tests, instrumental examinations (bronchoscopy, biopsy, bronchography, pleuroscopy). • The Third group – facultative (optional) methods: investigation of the outer breathing function, blood circulation, liver and other organs and systems.

17. The laboratory diagnostics of tuberculosis. Methods of revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBT • The source of infestation of human beings are tuberculosis human patients and animals secreting tuberculosis mycobacteria. The material for revealing MBT are sputum, bronchial lavage waters, faeces, urine, fistula pus (matter), pleural cavity exudate, spinal fluid, punctates and bioptates of various organs and tissues. • Sputum examination for MBT is of great epidemiological and clinical importance. When there is no sputum or it is scarce, expectorants, irritant aerosol inhalations, bronchi lavage are administered (fig.1).

18. Methods of Revealing Mycobacteria:

19. Culture of mycobacteria tuberculosis at hard egg medium

20. Radiology • Chest radiography is the most important method to detect TB • TB’s characteristics of a chest radiograph favor the diagnosis of tuberculosis as following :

21. Computer tomography

22. Methods of the X-ray diagnostics of tuberculosis of respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadows • Roentgenologic examination is one of the main methods of diagnostics of tuberculosis and unspecific respiratory diseases. The following methods of roentgenologic diagnostics are used: roentgenoscopy, roentgenography, fluorography, tomography, computer tomography, target roentgenography, bronchography, fistulography, angiopulmography and bronchial arteriography, pleurography, kymography and polygraphy.

23. (1) shadows mainly in the upper zone (2) patchy or nodular shadows (3) the presence of a cavity or cavities, although these, of course, can also occur in lung abscess, carcinoma, etc (4) the presence of calcification. although a carcinoma or pneumonia may occur in an areas of the lung where there is calcification due to tuberculosis (5) bilateral shadows, especially if these are in the upper zones (6) the persistence of the abnormal shadows without alteration in an x-ray repeated after several weeks this helps to exclude a diagnosis of pneumonia or other acute infection

24. Primary complex

25. Milliary Tuberculosis acute milliary tuberculosis

26. secondary pulmonary tuberculosis infiltrate

27. Tuberculoma

28. Chronic fibro-cavitary pulmonary tuberculosis cavity

31. Tuberculous effusion

32. Comruter tomograma patient with pulmonary TB

33. Fluorography

34. Bronchography

35. Bronchoscopy examinationVideo

36. Tuberculin testing A positive tuberculin test although it is of great use in children, but it has limited diagnostic significance in older age groups

37. TUBERCULINODIAGNOSTICS Old Tuberculin Koch

38. Dry rectified tuberculin (50000 ТU), the solvent is isotonic solution of sodium chloride – 1ml with the addition of 0,25 % carbolic acid

39. Positive Mantoux test.

40. Diagnosis According to the history, clinical signs, chest X-rayand some other examinations, we can diagnose TB A patient with tuberculous pulmonary disease will come to the physician for one of three reasons: (1) Suggestive symptoms (2) A positive finding on routine tuberculin testing (3) A suspicious routine chest roentgenogram

41. How to write the diagnosis correctly? • Generally, we write the diagnosis according to the site of TB, clinical patterns, the result of sputum examination and the history of chemotherapy.

42. Differential Diagnosis 1 2 3 4 Bronchiectasis may confused with chronic fibrocavenous pulmonary tuberculosis. They also have chronic cough, sputum production and hemoptysis. Usually we can use chest x-ray examination and CT scan to distinguish them.

43. Differential Diagnosis1 2 3 4 Cavitary lung abscess often involves the dorsal segments of the lower lobes and posterior segments of the upper lobes. Typically lung abscess causes litt1e in the way of physical findings, may have a fluid level, and is not associated with patchy bronchogenic infiltrates. In contrast, physical findings are prominent over tuberculous cavities, fluid levels are rare. And patchy infiltrates elsewhere are the rule.

44. Differential Diagnosis 1 2 3 4 Acute bacterial pneumonias may resemble florid tuberculosis in all particulars except for the sputum examination and response to antimicrobial drugs.

45. Differential Diagnosis1 2 3 4 Neoplasm may resemble tuberculosis. As in an isolated coin lesion. An obstructing and inconspicuous endobronchial tumor causing distal cbronic inflammation or a caviting neoplastic mass. ( An irregular cavity wall suggests necorotic neoplasm. )

46. Differential Diagnosis1 2 3 4 5 • Fever caused by some other diseases

47. complications • Pneumothorax • Bronchiectasis • Empyema • Extrapulmonary expansion • Hemoptysis • Chronic pulmonary heart disease