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Characteristic :
1. Resistant for weeks in a dry
atmosphere
2. Not resistant to sunlight, ultraviolet
light, temperature ≥ 60°C.
3. Endotoxin (-), exotoxin (-)
4. Hematogen spread
5. Slow growing(24-32 hours)
6. Clinical manifestation not specific
7. Aerob, lung is organ
predilection
1. Replicates narrow spectrum becomes
dorman
…tuberculosis
Special issue on TB children: diagnosis, theraphy, preventif ,
and TB in HIV infection
Most clinical manifestation TB in children not typical
Diagnosis TB children difficults, often overdiagnosis
overtreatment
In the other hand underdiagnosis undertreatment
Transmission
Adult patient, active pulmonary TB
cough, sneezing, talking, singing
droplet nuclei: 1-5
In the air can last for a long time
Inhalation, until alveoli, middle and lower lobe
Incubation period 2-12 weeks (4-8 weeks)
Pathology
reg lymph node primary focus remote foci
liquefaction
cavity
aerodes airway
lymphangitis
primary focus
droplet nuclei
alveoli ingestion by PAM’S
inhalation
intracellular replication
of bacilli
destruction
destruction of PAM’S of bacilli
hematogenic spread
primary
acute hematogenic occult hematogenic
complex
spread spread
multiple organs
CMI
disseminated primary TB remote foci
Figure. Pathogenesis of primary tuberculosis
TB immune Response
The body’s response to Mycobacterium tuberculosis: humoral and
celular responses
Humoral response mediated by B lymphocytes
Serological tests are sensitive & specific is not easy to find
0 - - - -
prophylaxis
1 + - - I
prophylaxis
2 + + - II
3 + + + treatment
Diagnostic
Clinical manifestation
Tuberkulin test
X-rays
Microbiological examination
Anatomic pathological examination
Peripheral blood examination
Source infection
The others : - bronchoscopy
- serological
- interferon test
Clinical
manifestation
Clinical manifestation
Without symptoms
General symptoms/non-specific
Specific symptoms/specific
General symptoms/non-
specific
Chronic fever
Anorexia and body weight ↓ / not increased
Malnutrition
Malaise
Chronic cough
Continued or recurrent diarrhea
The others
Specific symptoms
Respiratoric : cough, dyspneu, wheezing
Neurologic : seizures, stiff neck
Orthopaedic : gibbus, lame
Lymphe : hyperthrophy, scrofuloderma
Gastrointestinal tract : continuing diarrhea
The others
What is this?
Tuberculin Tests
TUBERCULIN Tests
Tuberculin PPD-S Tuberculin OT
Strength
mg/dosage TU PPD RT 23 2 TUmg/dosage Dilution
Mild 1
0,00002 1 - 0,01
(First) 10,000
1
0,00001 5 2 -
Moderate 2,000
(Intermediate) 1
- 10 5 0,1
1,000
Strong 1
0,005 250 100 1,0
(Second) 100
PPD (Purified Protein Derivative) RT 23 2TU
From culture 7 strain special Mycobacterium
tuberculosis
How to perform tuberculin
test
1. Mantoux test : intracutaneus injection
2. “Multiple puncture” : Heaf method 6 needle
Tine method 4 needle
3. “Patch test”
How to perform Mantoux test
With needle size 25-26 gauge Read the results after injected 48-
Take > 0.1 ml of fluid and remove air 72 hour
Intracutaneus injection 0.1 ml in volar Measuring the diameter of
forearm induration not hyperemia
stated in mm
Standard dose of Tuberculin test
Mantoux method 0.1 ml PPD - RT23 2 - 5 TU
PPD-S 5 - 10 TU
1 1
OT --------- - ---------
2.000 1.000
Intracutaneus injection, regio volar forearm
Diameter induration :
0 - 5 mm : negative
5 - 9 mm : positive/doubting
> 10 mm : positive
The meaning of positive
tuberculin test
1. TB infection :
dorman (not active TB)
active (active TB)
1 bl 2 bl 6 bl 9 bl 12 bl
Guideline from patients
treated irregular
Retreatment TB in children
Supelementation
You can give vitamin B6 to minimize peripheral neuritis or less intake
vitamin B6
Dosage 5-10 mg per 100 mg INH per day in patients with HIV or severe
malnutrition
Treatment outcome
Preventive
Socio-economic changes
Chemoprophylaxis
Immunization: BCG
Vaccination BCG
Vaccination BCG
• BCG (Bacille Calmette-Guerin): vaccine from
live attenuated Mycobacterium bovis
• Vaccination BCG does not prevent TB infection
but the risk of severe TB like TB meningitis dan
milliary TB
• Vaccine BCG given the age of 0-3 months, the
best time between 2-3 months
• Vaccine BCG intradermal 0.1 ml with needle
gauge 26-27 long syringe 10 mm
• Storage: should not be expose to sunlight,
stored at temperature 2-8°C ,not to be frozen
• Protection effect after 8-12 weeks around 0-80%
• Diluted vaccine should be used within 3-6 hours
The incidence of post-vaccination
follow-up BCG (KIPI)
Lymphadenitis suppurative in axilla or neck, sometimes encountered
after vaccination BCG, doesn’t need treatment unless arishing fistula ,
you must treated with tuberculosis drugs
Disseminated BCG-itis is rare, are often associated with severe
immunodeficiency
The other complication: erythema nodosum, iritis, lupus vulgaris &
osteomyelitis
BCG Contraindication
Results of tuberculin tes > 5 mm
Positive HIV or at hingg risk of HIV infection, immunocompromised due to
steroids, immunosuppresive drugs, radiation therapy, a malignancy of the
bone marrow or lymphatic system
Severe malnutrition
High fever
Suffered extensive skin infections
Hsitory of tuberculosis before
Pregnancy
Recommendation
BCG given at age 1-2 months
The baby close contact with TB patients +3 acid resistant bacteria (BTA
+3), the baby received INH prophylaxis therapy although asymptomatic
clinical manifestation
If the patient contact should performed sputum examination and if we
found BTA -, the patient should continue treatment, and the baby can
given vaccination BCG 2 weeks after treatment 6 months