1. Diagnosis of Pulmonary Tuberculosis Presenter: 4A Ri 范綱志 Sep. 29,2008

4. Screening for prior infection Tuberculin skin test 篩出感染者

16. Diagnosis of Pulmonary TB

18. Medical History

22. Physical Examination

24. Chest radiography

29. X-ray-based evaluation causes over-diagnosis of TB NTI, Ind J Tuberc, 1974 Over- diagnosis

30. Bacteriologic Exam

33. Three sputum smears are optimal

38. AFB smear AFB (shown in red) are tubercle bacilli

39. Reporting on AFB Microscopy Number of bacilli seen Result reported None per 100 oil immersion fields Negative 1-9 per 100 oil immersion fields Scanty, report exact number 10-99 per 100 oil immersion fields 1+ 1-10 per oil immersion field 2+ > 10 per oil immersion field 3+

40. Proportion of patients with pulmonary TB who have positive AFB smears AFB positivity in TB patients 0 10 20 30 40 50 60 70 HIV Negative Early HIV Late HIV

45. Microscopy is more objective and reliable than X-ray Inter-observer agreement

46. Microscopy is a more specific test than X-ray for TB diagnosis Specificity

47. Diagnosis of Pulmonary TB Cough 3 weeks AFB X 3 Broad-spectrum antibiotic 10-14 days If symptoms persist, repeat AFB smears, X-ray If consistent with TB Anti-TB Treatment If 1 positive , X-ray and evaluation If 2/3 positive : Anti-TB Rx If negative :

48. Diagnosis of pulmonary TB

49. Recommended Diagnostic Approach

52. Thanks for your attention!