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Definition
It usually affects the lungs but can be present anywhere in the body.
History
Mode of transmission
The mode of infection is by
talking
Epidemiology
Each year 2 billion people or one third the earths population dies from tuberculosis.
Pathogenesis
Tuberculosis is divided into three clinically important categories: Primary TB Secondary Reactivated TB Disseminated TB
Primary Tuberculosis
Primary TB is the initial infection caused by inhalation of tubercle bacilli. Inhaled tubercle bacilli are engulfed by alveolar macrophages in which they replicate to form the initial lesion or Ghon focus. Ghon focus together with lymph nodes forms the
primary complex.
This occurs about 3-8 weeks from the time of infection. The lesion heals spontaneously 2-6 months leaving behind a calcified nodule. Few bacilli survived in the healed lesion & remain
Disseminated Tuberculosis
The spread of the disease most often occur in the apex of lungs but may be widely disseminated in the lungs, kidneys, meninges, bones and other organs
causing Pulmonary tuberculosis Renal tuberculosis Tubercular meningitis Bone and joint tuberculosis Miliary tuberculosis Intestinal tuberculosis Skin tuberculosis
Symptoms
The symptoms of tuberculosis are-: Fever
Weight loss
Loss of appetite
Morphological features
Acid-fast rods of size about 2-3 0.4m Straight or slightly curved with rounded ands Branching and filamentous form also seen Beaded, barred forms- seen specially in sputum Arranged singly or in clumps. Non motile Nonsporing noncapsulated
Lab diagnosis
Lab diagnosis based upon two types-:
Pulmonary tuberculosis
Specimens -: Sputum Laryngeal swab Bronchial washings Bronchial alveolar lavage(BAL) Gastric lavage
Collection
Sputum
Processing
Microscopic examination Culture method Microscopy &culture is done after concentration of specimen
Concentration of specimen
They can be classified into two types-: Methods that kill bacteria Treatments with hypochlorite Treatment with antiformin Autoclave method- they kill bacilli so cannot be used for culture
Methods that do not kill bacteria Petroffs method Modified Petroffs method
Petroffs method
Sputum is incubated with an equal volume of 4% sodium hydroxide solution at 37C with frequent shaking till it becomes clear for 20 mins. Then centrifuged at 3000rpm for 20 mins. Then neutralize the sediment with N/10 HCL. Then sediment is used for smear preparation and culture.
Others as the site is involved for e.g. bone marrow, liver biopsy, pleural effusion etc.
Collection of specimens
C.S.F
Through lumbar puncture,in aseptic conditions. Best site for puncture is the interspace between 3rd and 4th lumber vertebrae.
URINE
Early morning atleast 30-40 ml midstream urine sample should be collected in two 25 ml bottles. For 3 consecutive days.
Processing
CSF Centrifuge the fluid. use the deposit and make the smear& culture.
URINE Centrifuge the Both specimen as received at1500g for 30 mins. Remove the supernatant and pool the centrifuge deposit. Treat the pooled deposit by Petroffs method. Make smear and culture.
Ziehl-Neelsen stain-:shows acid- fast bacilli against blue /green background. Fluorescent stain-: shows yellow luminous rods against dark background. Sensitivity of microscopy is 10,000baclli /ml of sputum
Ziehl-Neelsen procedure
Heat fix the smear Put carbol fuchsin over it Heat from the below until fume appears,heat being applied at intervals to keep stain hot Keep for 5 mins Wash with water Pour 20% sulphuric acid until yellowish brown colour appears Wash with water Malachite green/methylene blue 1min. counter stain.
minimum 300oil immersion fields of Z.N stained smears are examined and reported as:
00 AFB in 300 OIF - AFB not seen 1-2 AFB in 300 OIF - doubtful-repeat smear 1-9AFB in 100 OIF - 1+ 1-9AFB in 10 OIF - 2+ 1-9 AFB in 1 OIF - 3+ 10 or more AFB IN 1 OIF - 4+
Cultural characteristics
Solid media-:colonies are
Bottom creeps up the side Forms prominent surface pellicle, extends along the sides above the medium
Identification
To identify isolate, following observations are helpful Slow growth at 36c taking 2-6 weeks No pigment production Weakly catalase positive Niacin-positive Nitrate reduction positive
Tuberculin test
Also called Mantoux test. Principle-: It is a type 4 hypersensitivity reaction.
Procedure-: Purified protein derivative(PPD) is inoculated intradermally on forearm. Site observed at 72 hours for appearance of erythma & induration.
Interpretation
About Erythma & induration-: 10mm positive test Below 5mm indicate indicates negative Between 5&9mm indicates doubtful test.
Treatment
Bacteriocidal and Bacteriostatic drugs are available for treating tuberculosis
Prevention
By vaccination of BCG i.e. Bacilli Calmette-Guerin.
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