| ID | 98 |
|---|---|
| Name | Investigation: See under primary and post-primary pulmonary tuberculosis |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigation: 1. X-Ray chest- Hilar lymph node enlargement, fibrotic band, patchy opacities or calcification of lesion may be seen, usually sitoated on upper lobe. 2. Tuberculin test- Positive. 3. Bacteriological examination- sputum for AFB is positive (at least 3 smears done) in open cases only. 4. Biopsy of enlarged lymph nodes. 5. Blood- High ESR, Lymphocytosis. |
| Management | |
| Introduction | The patients with ‘latent tuberculosis infection’ in whom the primary complexes undergo spontaneous healing, reactivation of the disease may occur with active tuberculosis in about 5-10% of the cases in their lifetime, ‘the post-primary pulmonary tuberculosis’ if the host’s immune defenses are impaired (due to endogenous cause, or corticosteroid therapy, or other immunosuppressive drugs); half of these cases occur in the 2 years following primary infection. Re-exposure of the person to the positive case of pulmonary tuberculosis also results in post-primary tuberculosis infection and accounts for about one-third of the total patients. In case of HIV-infected patients, if further infected with tuberculosis, up to 50% of the cases will develop active tuberculosis within 2 years of infection. Most of the adult tuberculosis are due to post-primary disease. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Onset is usually insidious 2. Cough is an early symptom. 3. Sputum- usually mucoid at first, but may become purulent latter on. 4. Haemoptysis- in early stage blood stained sputum. 5. Dyspnoea on exertion. 6. Pleuritic chest pain. 7. Low grade afternoon fever. 8. Sweating especially during night. 9. Weakness, lassitude, weight loss, loss of appetite. 10. Symptoms of complications may be present. 11. A few medium or course crepitations may be present over the upper lobe. The crepitations may be present only after coughing. 11. Breath sound may be vesicular with prolonged expira-tion. 12. Percussion note losses its normal resonance. 13. There may be physical sings of consolidation, cavitation, fibrosis, pleurisy with or without effusions, spontaneous pneumothorax etc. Symptoms & signs which should always raise the suspicion of TB- 1. Persistent cough. 2. Hemoptysis 3. Pleural pain not associated with acute illness 4. Spontanious pneumothorax 5. Lathergy 6. Weightless. |
| Preventions | |
| Treatment | |
| Complications | Complications: 1. Pleurisy, 2. Pleural effusion, 3. Spontaneous Pneumothorax, 4. Tuberculous empyema or pyopneumothorax, 5. Tuberculous laryngitis, 6. Tuberculous enteritis, 7. Ischio rectal abscess & fistula-in-ano, 8. Dissemination of T. B. via blood stream to produce renal tuberculosis or tuberculous meningitis, 9. Respiratory failure and R. V. F. 10. Secondary infection etc. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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