10 The granuloma consists of a kernel of infected macrophages, surrounded by FOAMY GIANT CELLS and macrophages with a mantle of LYMPHOCYTES delineating the periphery of the structure
11 Automated screening molecular genetic test to identify Mycobacterium tuberculosis and resistance R - Xpert MBT / Rif11
12 Cultures were on a liquid environment: automated microbiological analyzer BACTEC MGIT 960 Performed in all patients with pulmonary tuberculosis (with positive and negative sputum smear)Test drug sensitivity to drugs and second rowGrowth of Mycobacterium tuberculosis in 7-14 days.Increases confirm TB in patients with negative sputum smear at 20%
13 At a molecular genetic test: GenoType MTBDRplus Perform allpatients withPositive sputum smearCarried out in parallel with the classical culture methodDetects DNK MBT , resistance to isoniazid and rifampin and isoniazid combination
14 Planting on solid medium Performed in all TB patientslungs (with positive and negative smearsputum):Bank of culturesTest drug sensitivitydrugs II series
15 Children and teenagers, in whom the following factors are diagnosed, compose a group of early revealed:1) tuberculin test range;2) primary tubinfestation;3) hyperergic Mantoux test;4) tuberculous intoxication.
16 Clinical examination of tuberculosis patients The methods of investigation of respiratory (tuberculosis) patients are conveniently divided into three groups.The First group – compulsory (obligatory) methods, which embrace clinical examination of a patient (complaints, anamnesis, examination, palpation, percussion, auscultation), thermometry, X-ray investigation (fluorography, X-raygraphy, X-rayscopy), sputum analysis for MBT, Mantoux tuberculin test (with 2 TU), general blood and urine test.The Second group – additional (supplementary) methods, which include repeated sputum analysis (bronchial lavage water) for MBT, tomography of the lungs and mediastinum, protein-tuberculin tests, immunologic tests, instrumental examinations (bronchoscopy, biopsy, bronchography, pleuroscopy).The Third group – facultative (optional) methods: investigation of the outer breathing function, blood circulation, liver and other organs and systems.
17 The laboratory diagnostics of tuberculosis The laboratory diagnostics of tuberculosis. Methods of revealing mycobacterium of tuberculosis. Atipical MBT. Sensitivity of MBTThe source of infestation of human beings are tuberculosis human patients and animals secreting tuberculosis mycobacteria. The material for revealing MBT are sputum, bronchial lavage waters, faeces, urine, fistula pus (matter), pleural cavity exudate, spinal fluid, punctates and bioptates of various organs and tissues.Sputum examination for MBT is of great epidemiological and clinical importance. When there is no sputum or it is scarce, expectorants, irritant aerosol inhalations, bronchi lavage are administered (fig.1).
22 Methods of the X-ray diagnostics of tuberculosis of respiration organs Methods of the X-ray diagnostics of tuberculosis of respiration organs. Methodical of interpretation roentgenograms of lungs and description pathological shadowsRoentgenologic examination is one of the main methods of diagnostics of tuberculosis and unspecific respiratory diseases. The following methods of roentgenologic diagnostics are used: roentgenoscopy, roentgenography, fluorography, tomography, computer tomography, target roentgenography, bronchography, fistulography, angiopulmography and bronchial arteriography, pleurography, kymography and polygraphy.
23 (1) shadows mainly in the upper zone (2) patchy or nodular shadows(3) the presence of a cavity or cavities, although these, ofcourse, can also occur in lung abscess, carcinoma, etc(4) the presence of calcification. although a carcinoma orpneumonia may occur in an areas of the lung wherethere is calcification due to tuberculosis(5) bilateral shadows, especially if these are in theupper zones(6) the persistence of the abnormal shadows withoutalteration in an x-ray repeated after several weeksthis helps to exclude a diagnosis of pneumonia orother acute infection
40 DiagnosisAccording to the history, clinical signs, chest X-ray and some other examinations, we can diagnose TBA patient with tuberculous pulmonary diseasewill come to the physician for one of threereasons:(1) Suggestive symptoms(2) A positive finding on routine tuberculintesting(3) A suspicious routine chest roentgenogram
41 How to write the diagnosis correctly? Generally, we write the diagnosis according to the site of TB, clinical patterns, the result of sputum examination and the history of chemotherapy.
42 Differential Diagnosis 1 2 3 4 Bronchiectasis may confused with chronic fibrocavenous pulmonary tuberculosis. They also have chronic cough, sputum production and hemoptysis. Usually we can use chest x-ray examination and CT scan to distinguish them.
43 Differential Diagnosis 1 2 3 4 Cavitary lung abscess often involves thedorsal segments of the lower lobes and posteriorsegments of the upper lobes.Typically lungabscess causes litt1e in the way of physicalfindings, may have a fluid level, and is notassociated with patchy bronchogenic infiltrates.In contrast, physical findings are prominentover tuberculous cavities, fluid levels are rare.And patchy infiltrates elsewhere are the rule.
44 Differential Diagnosis 1 2 3 4 Acute bacterial pneumonias may resembleflorid tuberculosis in all particulars except forthe sputum examination and response toantimicrobial drugs.
45 Differential Diagnosis 1 2 3 4 Neoplasm may resemble tuberculosis. As inan isolated coin lesion. An obstructing andinconspicuous endobronchial tumor causingdistal cbronic inflammation or a cavitingneoplastic mass. ( An irregular cavity wallsuggests necorotic neoplasm. )
46 Differential Diagnosis 1 2 3 4 5 Fever caused by some other diseases