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Pulmonary tuberculosis L de Man Dept. of Physiotherapy University of the Free State 2012.

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Presentation on theme: "Pulmonary tuberculosis L de Man Dept. of Physiotherapy University of the Free State 2012."— Presentation transcript:

1 Pulmonary tuberculosis L de Man Dept. of Physiotherapy University of the Free State 2012

2 Definition Tuberculosis is an active infection with the bacterium Mycobacterium tuberculosis

3 History Tuberculosis has been present in humans since antquity Tubercular decay in the spines of Egyptian mummies dating from 3000 – 2400 BC 460 BC Hippocrates identified phtisis as the most widespread disease of the times involving coughing up blood and fever, which was almost always fatal.

4 History Robert Koch discovered the tuberculosis bacili in 1882 and received the Nobel Prize in medicine in 1905 In 1946 the development of the antibiotic streptomycin made effective treatment and cure possible

5 History Prior to that the only treatment besides going to a sanatorium, were surgical treatment – collapsing an infected lung to rest it and allow lesion to heal

6 History Surgery discontinued in 1950s Postoperative problem was postural due to lack of structural support Due to overcompensation the patient developed posture of leaning away from the incision side

7 Thoracoplasty Left lung collapse secondary to thoracoplasty

8 Epidemiology Current estimates: around of worlds population has latent TB Between 2002 and 2020 1000 million will become newly infected 150 million will contract TB 36 million will die

9 Reasons for increase in incidence Developed countries o Immigration from high prevalence areas o HIV o Social deprivation (homelessness, poverty) o Increased proportion of elderly o Drug resistance Developing countries o Ineffective control programmes o Lack of access to health care o Poverty, civil unrest o HIV o Increased population o Drug resistance

10 Epidemiology The 22 countries account for 80% of the TB cases in the world

11 Alphabetical list of countries 1.Afghanistan 2. Bangladesh 3. Brazil 4. Cambodia 5. China 6. Democratic Republic of Congo 7. Ethiopia 8. India 9. Indonesia 10 Kenya 11. Mozambique 12. Myanmar 13. Nigeria 14. Pakistan 15. Philippines 16. Russia 17. South Africa 18. Tanzania 19. Thailand 20. Uganda 21. Viet Nam 22. Zimbabwe

12 Epidemiology In 2007, the country with the highest incidence rate was Swaziland, with 1200 cases per 100,000 people versus 15 cases per 100,000 people in United Kingdom

13 Pathology Spreads through cough, sneeze, any other way of transmitting saliva – a single sneeze can release up to 40,000 droplets (0,5 – 5 µm in diameter ) Primary TB = active disease on first exposure Most infections result in a asymptomatic,latent infection

14 Pathology Combination of primary lesion and regional lymph node involvement = Ghon focus

15 Pathology Post-primary TB = active TB Earliest chest x-ray = an ill defined opacity situated in one of the upper lobes

16 Pathology As disease progress consolidation, collapse, caseation,fibrosis and cavitation On chest x-ray – significant displacement trachea and mediastinum

17 Pathology

18 Symptoms of active TB Chronic cough Hemoptises Fever Night sweats Appetite loss Weigt loss Fatigue

19 Miliary TB Blood borne dissemination gives rise to miliary TB Classic appearance on chest x-ray = fine, 1 – 2 mm lesions distributed throughout the lung fields

20 Diagnosis Ussually confirmed by direct microscopy = Ziel-Neelsen staining Culture of samples is sputum

21 Management Rifampicic and Isoniazid for 3 months Or Isoniazid for 6 months Chemotherapy Were drug resistance is not expected, a patient can be assumed to be non- infectious after 2 weeks of appropriate therapy. Directly observed therapy (DOT)

22 Extra pulmonary TB 1. Lymphadenitis Lymph nodes of cervical and mediastinal glands

23 Extra pulmonary TB 2. Gastrointestinal TB Any part of bowel can be infected Acute abdomen Narrowing, shortening, distortion of bowel TB peritonitis 3. Pericardial disease Pericardial effusion Constrictive percarditis

24 Extra pulmonary TB 4. CNS disease Most important form and when unrecgonised and untreated = fatal Recovery rate = 60% or less with permanent neurological deficit Usual local source = caseous focus in meninges or brain

25 TB meningitis


27 Extra pulmonary TB 5. Bone and joint disease Spine is common site = Potts disease Vertebral collapse resulting in kyphosis Spinal cord compression Sinus formation Paraplegia (so called Pott's paraplegia) Prevention = Controlling the spread of tuberculosis infection Therapy = Stabilisation and decompression with\ spinal involvement

28 Physiotherapy Physio per se is not indicated Treat associated conditions or complications that may have arisen through reactions to drugs

29 References Boon NA, Colledge NR, Walker BR, Hunter JAA. 2006. Davidsons Principles and Practise of Medicine. 20 th Ed. Edinburgh London, Elsierivier Limited. p 695-703.

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