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TB & pneumonia_1.pptx
- 1. Pneumonia & TB By: كوثر طارق نور كريم ميثم مينا محمد فاطمة مازن زينب فاضل صفاء Supervised by: Hussain Al Shemmary Heba Fakhrulddin
- 2. Pneumonia • Pneumonia is defined as an acute respiratory illness associated with recently developed segmental, lobar or multilobar radiological shadowing. • It is classified as: community-acquired pneumonia, hospitalacquired (nosocomial) pneumonia. • *Lobar pneumonia: is a radiological and pathological term referring to homogeneous consolidation of one or more lung lobes, often with pleural inflammation. • *broncho pneumonia refers to more patchy alveolar consolidation with bronchial and bronchiolar inflammation, often affecting both lower lobes.
- 4. Etiology • Many germs can cause pneumonia. The most common are bacteria and viruses in the air we breathe. Your body usually prevents these germs from infecting your lungs. But sometimes these germs can overpower your immune system, even if your health is generally good. • Community-acquired pneumonia Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by: • Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after you've had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
- 5. Cont. • Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically isn't severe enough to require bed rest. • Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location. • Viruses, including COVID-19. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very serious. Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe.
- 6. Clinical Features The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer. Signs and symptoms of pneumonia may include: • Chest pain when you breathe or cough • Confusion or changes in mental awareness (in adults age 65 and older) • Cough, which may produce phlegm • Fatigue • Fever, sweating and shaking chills • Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) • Nausea, vomiting or diarrhea • Shortness of breath
- 8. Risk factors • Pneumonia can affect anyone. But the two age groups at highest risk are: 1.Children who are 2 years old or younger 2.People who are age 65 or older Other risk factors include: • Being hospitalized. You're at greater risk of pneumonia if you're in a hospital intensive care unit, especially if you're on a machine that helps you breathe (a ventilator). • Chronic disease. You're more likely to get pneumonia if you have asthma, chronic obstructive pulmonary disease (COPD) or heart disease. • Smoking. Smoking damages your body's natural defenses against the bacteria and viruses that cause pneumonia. • Weakened or suppressed immune system. People who have HIV/AIDS, who've had an organ transplant, or who receive chemotherapy or long-term steroids are at risk.
- 10. Complication • Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including: • Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure. • Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung heals. • Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery. • Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.
- 11. Diagnosis • Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn't always possible. • Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. However, it can't tell your doctor what kind of germ is causing the pneumonia. • Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream • Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection.
- 12. Cont. • CT scan. If your pneumonia isn't clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs. • Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural area and analyzed to help determine the type of infection.
- 14. Treatment • Treatment for pneumonia involves curing the infection and preventing complications. People who have community-acquired pneumonia usually can be treated at home with medication. Specific treatments depend on the type and severity of your pneumonia, your age and your overall health. The options include: • Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your symptoms don't improve, your doctor may recommend a different antibiotic. • Cough medicine. This medicine may be used to calm your cough so that you can rest. Because coughing helps loosen and move fluid from your lungs, it's a good idea not to eliminate your cough completely. In addition, you should know that very few studies have looked at whether over-the-counter cough medicines lessen coughing caused by pneumonia. If you want to try a cough suppressant, use the lowest dose that helps you rest. • Fever reducers/pain relievers. You may take these as needed for fever and discomfort. These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others).
- 15. Tuberculosis • TB is caused by infection with Myobacterium tuberculosis (MTB). • It mainly affects the lungs, making pulmonary disease the most common presentation. • Other commonly affected organ systems include the respiratory system, the gastrointestinal (GI)system, the lymphoreticular system, the skin, the central nervous system, the musculoskeletal system, the reproductive system and the liver.
- 17. Factors increasing the risk of TB 1. Patient related: • Age(children >young adults <elderly) • First-generation immigrants from high- prevalence countries. • Close contacts of smear–positive patient; worse in overcrowding, e.g. prisons, dormitories. • CXR evidence of self-healed TB • Primary infection <1yr previously • Tobacco use.
- 19. Cont. 2.Associated disease: • Immunosuppression: HIV, anti-tumour necrosis factor (TNF) therapy, high-dose corticosteroids, cytotoxic agents • Malignancy (especially lymphoma and leukaemia) • Type 1 diabetes mellitus • Chronic kidney disease • Silicosis • GI disease with malnutrition (gastrectomy, bypass, pancreatic cancer, malabsorption) • Deficiency of vitamin D or A • Recent measles in children
- 20. Clinical features • When TB germs survive and multiply in the lungs, it is called a TB infection. A TB infection may be in one of three stages. Symptoms are different in each stage. • Primary TB infection. The first stage is called the primary infection. Immune system cells find and capture the germs. The immune system may completely destroy the germs. But some captured germs may still survive and multiply. Most people don't have symptoms during a primary infection. Some people may get flu-like symptoms, such as: • Low fever. • Tiredness. • Cough.
- 21. Cont. • Latent TB infection. Primary infection is usually followed by the stage called latent TB infection. Immune system cells build a wall around lung tissue with TB germs. The germs can't do any more harm if the immune system keeps them under control. But the germs survive. There are no symptoms during latent TB infection. • Active TB disease. Active TB disease happens when the immune system can't control an infection. Germs cause disease throughout the lungs or other parts of the body.
- 22. Cont. • Active TB disease may happen right after primary infection. But it usually happens after months or years of latent TB infection. Symptoms of active TB disease in the lungs usually begin gradually and worsen over a few weeks. They may include: • Cough. • Coughing up blood or mucus. • Chest pain. • Pain with breathing or coughing. • Fever. • Chills. • Night sweats. • Weight loss. • Not wanting to eat. • Tiredness. • Not feeling well in general.
- 23. Cont. • Active TB disease outside the lungs. TB infection can spread from the lungs to other parts of the body. This is called extrapulmonary tuberculosis. Symptoms vary depending on what part of the body is infected. Common symptoms may include: • Fever. • Chills. • Night sweats. • Weight loss. • Not wanting to eat. • Tiredness. • Not feeling well in general. • Pain near the site of infection.
- 24. Cont. • Active TB disease in the voice box is outside the lungs, but it has symptoms more like disease in the lungs. Common sites of active TB disease outside the lungs include: • Kidneys. • Liver. • Fluid surrounding the brain and spinal cord. • Heart muscles. • Genitals. • Lymph nodes. • Bones and joints. • Skin. • Walls of blood vessels. • Voice box, also called larynx.
- 28. Investigations • Mycobacterial infection is usually confirmed by direct microscopy (Ziehl–Neelsen or auramine staining) and culture of sputum or other samples from the respiratory tract or other infected site. An estimated 5000–10000 acid-fast bacilli must be present for sputum to be smear-positive, whereas only 10–100 viable organisms are required for sputum to be culture-positive. Standard culture takes up to 8 wks. Liquid culture media (e.g. BACTEC) can expedite growth and drug sensitivity testing (7–21 days). Where multiple drug-resistant TB (MDRTB) is suspected, molecular tools may be employed to test for the presence of the rpo (rifampicin resistance) gene.
- 29. Management • Approach Considerations Isolate patients with possible tuberculosis (TB) infection in a private room with negative pressure (air exhausted to outside or through a high-efficiency particulate air filter). Medical staff must wear high-efficiency disposable masks sufficient to filter the tubercle bacillus. Continue isolation until sputum smears are negative for 3 consecutive determinations (usually after approximately 2-4 wk of treatment). Unfortunately, these measures are neither possible nor practical in countries where TB is a public health problem. • Drug therapy For initial empiric treatment of TB, start patients on a 4-drug regimen: isoniazid, rifampin, pyrazinamide, and either ethambutol or streptomycin. Once the TB isolate is known to be fully susceptible, ethambutol (or streptomycin, if it is used as a fourth drug) can be discontinued.
- 30. Resources • Daviadson’s Essentials of Medicine. • MAYO CLINIC