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  1. Thank you for viewing this presentation. • We would like to remind you that this material is the property of the author.It is provided to you by the ERS for your personal use only, as submitted by the author. • 2012 by the author

  2. Exercise: 20 CXRsEstimate the probability of TB Graham Bothamley Homerton University Hospital NHS Foundation Trust, London; UK Christoph Lange Clinical Infectious Diseases, Research Center BorstelUniversity of Lübeck; Germany

  3. M 75yrs ex-painter and decorator Afro-Caribbean Jamaica UK 1950 Fever Night sweats Dementia Alcohol Diabetes smoker lives alone wbc 8.0/nL CRP 35 mg/L 8.091

  4. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  5. 8.138

  6. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  7. F 41yr housewife White-UK No contacts cough 3m sputum 3m weight loss 5 kg Alcoholic Smoker BCG+ 8.138

  8. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  9. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics e.g. moxifloxacin • 1 and 2 above • 1, 2 and 3 above

  10. M 47 yr unemployed White-UK No contacts Travel to W. Indies cough 3 months sputum 3 months fever 3 months sweats 3 months weight loss 12 kg Alcoholic Diabetes Hepatitis C Smoker BCG- 8.078

  11. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  12. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics e.g. moxifloxacin • 1 and 2 above • 1, 2 and 3 above

  13. 5

  14. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  15. Further investigations • Bronchoscopy • CT scan • IGRA and/or tuberculin skin test • 1 and 2 • 1, 2 and 3

  16. M 42yr 8.087

  17. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  18. The following actions should be taken: • Treat with antibiotics • Send sputum for TB smear examination • Respiratory isolation • 1 and 2 above • 2 and 3 above

  19. 47 M Temp: 37. 8 C SaO2: 89% wbc: 10.0 Neutrophils: 9.5 CRP: 120 mg/L

  20. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  21. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics e.g. moxifloxacin • 1 and 2 above • 1, 2 and 3 above

  22. M 32yrs IT White Cough 4 weeks Sputum 4 w Weight loss 1 kg Night sweats Smokes cannabis BCG+ 9.009

  23. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  24. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics • 1 and 2 above • 1, 2 and 3 above

  25. F 70 yrs Ex school assistant White UK No TB contact Cough Sputum Weight loss 1 kg Smoker 20/day >50 yrs No BCG 9

  26. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  27. 47 M Temp: 37. 8 C SaO2: 93% wbc: 8.0 Neutrophils: 7.5 CRP: 35 mg/L 8.078

  28. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  29. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics e.g. moxifloxacin • 1 and 2 above • 1, 2 and 3 above

  30. 47 M Temp: 37 C SaO2: 93% wbc: 8.0 Neutrophils: 7.5 CRP: <5 mg/L 8.078

  31. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  32. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics • 1 and 2 above • 1, 2 and 3 above

  33. M 47 yr unemployed White-UK No contacts Travel to W. Indies cough 3 months sputum 3 months fever 3 months sweats 3 months weight loss 12 kg Alcoholic Diabetes Hepatitis C Smoker BCG-

  34. Further investigations • Bronchoscopy • CT scan • IGRA and/or tuberculin skin test • 1 and 2 • 1, 2 and 3

  35. F 32yr shop assistant Afro-Caribbean No TB contacts Travel to Jamaica cough 3m no sputum haemoptysis x 1 anti-depressants BCG+

  36. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  37. M 32yrs IT Russian UK 9 yrs Friend had TB Cough 4 weeks Sputum 4 w Weight loss 1 kg Night sweats Smokes cannabis BCG+

  38. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  39. The following actions should be taken: • Respiratory isolation • Send sputum for TB smear examination • Treat with antibiotics • 1 and 2 above • 1, 2 and 3 above

  40. M 42yr unemployed Born in Gambia In UK 14 years Smoker BCG+ Temp 37.8 C SaO2 92% wbc 8.0 Neutrophils 7.0 CRP 25 mg/L

  41. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  42. The following actions should be taken: • Treat with antibiotics • Send sputum for TB smear examination • Respiratory isolation • 1 and 2 above • 2 and 3 above

  43. Further investigations • Bronchoscopy • CT scan • IGRA and/or tuberculin skin test • 1 and 2 • 1, 2 and 3

  44. F 70 yrs White UK No TB contact Fever Night sweats Weight loss 1 kg Smoker 20/day >50 yrs

  45. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  46. F 16yrs student Belgium UK 3 yrs Grandmother may have had TB Cough 2m No sputum Fever Night sweats Temp 37.8 C SaO2 93% wbc 8.0 Neutrophils 7.5 CRP 35 mg/L 9.072

  47. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

  48. The following actions should be taken: • Treat with antibiotics • Send sputum for TB smear examination • Respiratory isolation • 1 and 2 above • 2 and 3 above

  49. M 48 “housekeeper” 9.011

  50. Estimate the likelihood of active tuberculosis • 0 – 10% • 11 – 39% • 40 – 60% • 61 – 89% • 90-100% Please vote

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