1. Tuberculosis
TB
2011-04-12

2. Tuberculosis:
A wise adventure and opportunity capitalist
He can live anywhere but teeth

3. • History
• Pathogen
• Symptoms and signs
• Diagnosis (Auxiliary examination and Diagnostic
criteria)
• Type
• Management: based on the guideline of China
• Prognosis

4. History

5. • How old is tuberculosis?
• More than 7000 years (Old Egypt----found from a
mummy)
• When the emergence of human being, the TB too

6. Pathogen

7. • Mycobacterium tuberculosis (MTB)
• Two kinds discussed today:
Mycobacterium tuberculosis(the most common reason)
Mycobacterium bovis (0.5~7.2%)
• Africa (HIV/AIDS/malnutrition+TB)>
India (malnutrition) >
China (malnutrition and DR/drug resistance)
• Why the MTB is called anti-fast bacillus?
Ziehl-Neelsen staining
Background: blue
MTB: red

10. MTB

11. Symptoms and Signs

12. • Symptoms including:
• Cough
• Sputum
• Hemoptysis / Blood stained sputum
• Chest pain
• Dyspnea
• Systemic poisoning symptoms
• Pharyngalgia (with hoarseness)
laryngophthisis

13. • Cough
• Chief and/or first symptoms
• More serious in the night than daytime
• Incidence: 71%
• Cough and blood-stained sputum continuing more than 2
weeks indicating TB strongly
• Typical cough of TB:
Dry cough or irritating dry cough
Rough cough and a little frothy sputum
Cough and blood-stained sputum
• Other type of cough with:
White sticky phlegm
purulent sputum

14. • Sputum
• Incidence: 40%
• White mucous phlegm (white frothy sputum)
• If the quantity of (purulent) sputum increased obviously, it
means ：
Accompanyed with infection: 50~60% is general bacteria
yellow purulent sputum (>100ml/d)
With bronchiectasis
Pyothorax and bronchopleural fistula (Acute or Chronic)

15. • Hemoptysis
• What is Massive Hemoptysis:
>300ml per time or >500ml/24hr
• More than 30% patients have died of Hemoptysis in China
• Type: Blood; Blood-stained sputum

16. • Chest pain
• Approximately 30%
• No specificity; Not means exacerbation of TB
• Mechanism:
TB invades parietal pleura
Adhesion or fraction of pleura
Patients with pleural effusion may suffer slight feeling of pain
A tips: Pulmonary tissue doesn’t know pain

17. • Dyspnea
• Not usual
• If patients has this symptom, it means:
Trachea or/and main bronchi are oppressed by enlarging lymph
nodes of mediastinum
Something in trachea or/and main bronchi obstructing them
Massive pleural effusion (constricting lungs obviously)
Accompanying with penumothorax
Hematogenous disseminated pulmonary tuberculosis and ARDS
(acute respiratory distress syndrome)
Accompanying with PE (pulmonary Embolism) (dyspnea,
hemoptysis and chest pain)
Accompanying with acute exacerbation of Asthma or/and severe
infection
Extensive lung involved in

18. • Systemic poisoning symptoms
• Fever (tidal fever)
• Night sweating
• Obvious or serious fatigue
• Obvious weight loss
• Abnormality of hematologic system (decrease of RBC, Plt and
WBC)
• Endocrine disturbance (paramenia ； amenorrhea)
• Insomnia
• Systemic anaphylactic reaction

19. • Fever
• 60%
• TB is active
• Usually with night sweating and cheeks flush (like drunk looks)
• Slight to moderate is common
• Hyperpyrexia:
TBM (tubercular meningitis)
TBP (tuberculous pleuritis)
CP (caseous pneumonia)
Acute hematogenous disseminated pulmonary TB
• What is “Tidal fever”?

20. • Systemic anaphylactic reaction
• Arthritis
• Red spot
• Conjunctivitis
• Anal fistula
• Others: Pleural effusion
Fever
Rash

21. • Auxiliary examination
• 5 standard unit PPD test (purified protein derivation)
• ESR (Erythrocyte Sedimentation Rate)
• CRP (C-reaction protein)
• Try to find MTB in the sputum by smear or/and culture; Biopsy
• TB antibody in blood
• TB-DNA through PCR (Polymerase Chain Reaction)
• CXR
• CT
• Others items: CBC (complete blood count / Blood routine)
Measurement of liver and kidneys function
Lumbar puncture and CSF examination (TBM)
Thoracic/Abdomen puncture and effusion
examination (TBP)

22. • Diagnostic criteria ：
• MTB has been found by any way
• No direct evidence of TB ； but we can take no account of
other diseases

23. • Type——based on pathogenesis
• Type I: Primary complex
• Type II: Acute/Subacute/Chronic hematogenous disseminated
pulmonary TB
• Type III: Secondary pulmonary TB
• Type IV: TBP (tubercular pleuritis)
• Type V: Extrapulmonary TB:
Bone TB (vertebral body
Abdominal TB
Tuberculosis of Celiac Lymph Node
Tuberculous peritonitis
Intestinal TB

24. TB-II Acute

25. TB-II subacute

26. 42 years male, Bilateral pulmonary TB-III

27. TB-III

28. TBM

29. TBM

30. tuberculosis of lumbar spine
The vertebral body is destroyed by tuberculosis
from outside to inside. Carcinoma brings the
opposite effect: from inside to outside.

31. Continuous destroy by TB

32. • Management: based on the guideline of China
• Drugs belong 1st line:
Isoniazide-INH-H; Rifampicin-RFP-R
Ethambutol-EMB-E; Pyrazinamide-PZA-Z
Streptomycin-SM-S
• Drugs belong 2nd line:
Protionamide-1321Th; Dipasic-D (INH+PAS)
Ofloxacin-OFLX-O (can representing Moxifloxacin and
Levofloxacin)
Amikacin-Am-K
• Drugs belong 3rd line:
Capreomycin-Cap-C; Rifabutin-RFB-B
Clarithromycin-Cla;
Amoxicillin and clavulanate potassium tablets;
Imipenem and Cilastatin Sodium-IMP;
Linezolid/Zyvox-Lzd

33. • Stages of management:
Intensive period
Maintenance period
IE: 2HREZ/7HRE
2HL2EZ/7HRE
Means biw (twice per week)

34. • What is the indications of stopping to take drugs?
• Symptoms disappear completely?
• No fever?
• MTB can’t be found in the sputum?
• ESR is normal?
• Imageology is normal?

35. • Persons with no TB ， but need to be carefully
monitored ：
• Glucocorticoids (GCs) ；
• Immunosuppressant
• HIV/AIDS
• DM
• Carcinoma
• Severe malnutrition
• Organ transplantation recipient
• CTD (Connective Tissue Disease)
• Other conditions

36. Thanks