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ROADMAP TO DIAGNOSIS & TREATMENT OF EXTRAPULMONARY TB DR. LIZA D. MARIPOSQUE OCTOBER 23, 2008
MOST COMMON EXTRAPULMONARY SITES FOR TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
LYMPADENITIS ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
PLEURAL TEBERCULOSIS ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculosis of the Upper Airways ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
GENITOURINARY TUBERCULOSIS ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
SKELETAL TUBERCULOSIS ,[object Object],[object Object]
Weight-bearing joints are most commonly affected. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
TUBERCULOUS MENINGITIS & TUBERCULOMA ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
GASTROINTESTINAL TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tuberculous peritonitis ,[object Object],[object Object],[object Object],[object Object]
PERICARDIAL TB  (TUBERCULOUS PERICARDITIS) ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
MILIARY OR DISSEMINATED TB ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
Less Common Extrapulmonary TB ,[object Object],[object Object],[object Object]
HIV-ASSOCIATED TUBERCULOSIS ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
DIAGNOSIS OF TB ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
AFB Microscopy ,[object Object],[object Object],[object Object],[object Object],[object Object]
MYCOBACTERIAL CULTURE ,[object Object],[object Object],[object Object],[object Object]
NUCLEIC ACID AMPLIFICATION ,[object Object],[object Object],[object Object]
DRUG   SUSCEPTIBILITY TESTING ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],RADIOGRAPHIC PROCEDURES
Tuberculin Rxn Size ≥ 10 Recently infected person ( ≤ 2yrs) ≥ 5 Persons w/ fibrotic lesions on CXR ≥ 5 a Close contacts of TB pt. ≥ 5 HIV-infected person or persons receiving immunosupressive Tx TUBERCULIN Rxn SIZE, mm RISK GROUP
≥ 15 Low risk persons c ≥ 10 Persons w/ high-risk medical conditions b TUBERCULIN Rxn SIZE, mm RISK GROUP
[object Object],[object Object]
ANTI-TB TREATMENT
FIRST-LINE AGENTS ,[object Object],[object Object],[object Object],[object Object],[object Object]
ISONIAZIDE (INH) ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
HRE e 2 mos. pregnant HRZE a 2 mos. New culture(-) HRZE a,b 2 mos. New smear or culture (+) DRUGS DURATION (month) INDICATION INITIAL PHASE
ZEQ + S 18-24 mos. Resistance to H + R RZE g Throughout 6 mos. Resistance or intolerance to H Failure & relapse f DRUGS DURATION (month) INDICATION INITIAL PHASE
HRZES i 3 mos. Standardized re-tx (susceptibility testing unavailable) 1 IV h  + 3 of these 4: ethionamide, cycloserine, Q, PAS 24 mos. Resistance to all 1 st -line drugs DRUGS DURATION (month) INDICATION INITIAL PHASE
HRE 2 mos. Drug intolerance to Z HZE 12 mos. Drug intolerance to R DRUGS DURATION (month) INDICATION INITIAL PHASE
HR 7 mos. Pregnant Failure & relapse f New culture(-) New smear or culture (+) INDICATION HR a 2 mos. HR a,c,d 4 mos. DRUGS DURATION (months) CONTINUATION PHASE
HR 7 mos. Drug intolerance to Z HRE 5 mos. Standardized re-tx (susceptibility testing unavailable) DRUGS DURATION (months) INDICATION CONTINUATION PHASE
Footnotes: ,[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
25-30mg/kg 15-20mg/kg Ethambutol 30-40mg/kg, max 3G 20-25mg/kg, max 2G PZA 10mg/kg, max 600mg 10mg/kg, max 600mg Rifampin 15mg/kg, max 900mg 5mg/kg, max 300mg INH TRICE-WKLY DAILY DOSE DRUG DOSAGE RECOMMENDED DOSAGE FOR INITIAL Rx OF TB IN ADULT
[object Object],[object Object],[object Object],[object Object],[object Object]
Drug Resistance ,[object Object],[object Object],[object Object]

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Roadmap To Diagnosis & Treatment Of Extrapulmonary Tb

  • 1. ROADMAP TO DIAGNOSIS & TREATMENT OF EXTRAPULMONARY TB DR. LIZA D. MARIPOSQUE OCTOBER 23, 2008
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  • 37. Tuberculin Rxn Size ≥ 10 Recently infected person ( ≤ 2yrs) ≥ 5 Persons w/ fibrotic lesions on CXR ≥ 5 a Close contacts of TB pt. ≥ 5 HIV-infected person or persons receiving immunosupressive Tx TUBERCULIN Rxn SIZE, mm RISK GROUP
  • 38. ≥ 15 Low risk persons c ≥ 10 Persons w/ high-risk medical conditions b TUBERCULIN Rxn SIZE, mm RISK GROUP
  • 39.
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  • 44. HRE e 2 mos. pregnant HRZE a 2 mos. New culture(-) HRZE a,b 2 mos. New smear or culture (+) DRUGS DURATION (month) INDICATION INITIAL PHASE
  • 45. ZEQ + S 18-24 mos. Resistance to H + R RZE g Throughout 6 mos. Resistance or intolerance to H Failure & relapse f DRUGS DURATION (month) INDICATION INITIAL PHASE
  • 46. HRZES i 3 mos. Standardized re-tx (susceptibility testing unavailable) 1 IV h + 3 of these 4: ethionamide, cycloserine, Q, PAS 24 mos. Resistance to all 1 st -line drugs DRUGS DURATION (month) INDICATION INITIAL PHASE
  • 47. HRE 2 mos. Drug intolerance to Z HZE 12 mos. Drug intolerance to R DRUGS DURATION (month) INDICATION INITIAL PHASE
  • 48. HR 7 mos. Pregnant Failure & relapse f New culture(-) New smear or culture (+) INDICATION HR a 2 mos. HR a,c,d 4 mos. DRUGS DURATION (months) CONTINUATION PHASE
  • 49. HR 7 mos. Drug intolerance to Z HRE 5 mos. Standardized re-tx (susceptibility testing unavailable) DRUGS DURATION (months) INDICATION CONTINUATION PHASE
  • 50.
  • 51.
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  • 53. 25-30mg/kg 15-20mg/kg Ethambutol 30-40mg/kg, max 3G 20-25mg/kg, max 2G PZA 10mg/kg, max 600mg 10mg/kg, max 600mg Rifampin 15mg/kg, max 900mg 5mg/kg, max 300mg INH TRICE-WKLY DAILY DOSE DRUG DOSAGE RECOMMENDED DOSAGE FOR INITIAL Rx OF TB IN ADULT
  • 54.
  • 55.