Extrapulmonary Tuberculosis.ppt

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Extrapulmonary Tuberculosis Conducted by : Ms.Monika ( clinical instructor) Army college of nursing ) :

Extrapulmonary Tuberculosis Conducted by : Ms.Monika ( clinical instructor) Army college of nursing )

Introduction :

Introduction TB , is an airborne infectious disease caused by Mycobacterium tuberculosis . It most commonly affects the lungs where it is called pulmonary TB . When the infection occurs in other parts of the body it is called extrapulmonary tuberculosis . Tuberculosis is the most common fatal infectious disease in the world: one-third of the world's population is currently infected and more than 1.5 million people die each year due to tuberculosis About 15 % of TB cases are extrapulmonary. Extrapulmonary tuberculosis has become more common. Miliary TB indicates a widespread infection outside the lungs. In practice, the terms extrapulmonary, miliary, and disseminated are often used interchangeably.

Sites of infection for extra-pulmonary TB:

Sites of infection for extra-pulmonary TB Lymph glands Pleura (membrane than covers the lungs) Genito-urinary tract . In women uterine disease is probably the most common while in men the epididymis is the site most frequently affected. Bones and joints (also called osteotuberculosis) Meninges , which may be rapidly fatal if not, treated in time Bowel and/or peritoneum Pericardium (membrane around the heart ) Skin

Extrapulmonary Tuberculosis:

Extrapulmonary Tuberculosis Proportion in all TB in USA : 7% (1963) to 18% (1987) to 20% Increase maybe due to HIV infection Lymphatic TB (30%) Pleural TB (24%) Bone and joint TB (10%) Genitourinary TB (9%) Meningeal TB (6%

Etiology :

Etiology After initial invasion of tubercle bacilli can spread throughput the body via the blood & lymph to other body parts. M tuberculosis thrives in o2 rich areas. Highly aerobics sites ,such as renal cortex ,bone growth ,meninges where XPTB most commonly grows. It is commonly in client who are HIV +ve client .

Risk factors for TB include the following:

Risk factors for TB include the following HIV infection Low socioeconomic status Alcoholism Crowded living conditions Diseases or drugs that weaken the immune system Health care workers Cancer Transplantation Malnutrition Diabetes Major surgical procedures may occasionally may trigger diseased condition

Pathphysiology :

Pathphysiology Tuberculosis is caused by infection with the bacterium Mycobacterium tuberculosis . The lungs are the usual route of infection. When someone with TB infection coughs , sneezes, or talks, tiny droplets of saliva or mucus are expelled into the air , which could be inhaled by another person. Once infectious particles reach the alveoli, small sacs in your lungs, another cell called the macrophage engulfs the TB bacteria. Then the bacteria can be transmitted to your lymph system and bloodstream and spread to other organs. They grow slowly, have a unique type of cell wall with a high lipid (or fat) content.

Clinical manifestation :

Clinical manifestation The symptoms of extra-pulmonary tuberculosis depend on the site's if infection: a) LYMPH GLAND In lymphadenitis, the lymph glands become swollen painful Abscesses may form in the lymph glands and discharge giving a very unsightly combination of swelling and pus around the neck.

B) Osteo-TB or TB in the bones and joints:

B) Osteo-TB or TB in the bones and joints Osteo-TB or TB in the bones and joints, causes pain and swelling of the affected part. Spinal disease may cause paraplegia if enough of the vertebrae are destroyed to cause instability of the spine.

C) Tuberculous meningitis:

C) Tuberculous meningitis .Tuberculous meningitis may cause a wide variety of symptoms: including double vision and mental confusion developing over days or weeks. Patients may present with a headache that is either intermittent or persistent for 2-3 weeks. If not detected and treated coma may develop. TB meningitis has the highest mortality of all complications of tuberculosis. Subtle mental status changes may progress to coma over a period of days to weeks. Fever may be low-grade or absent.

d) Abdominal tuberculosis:

d) Abdominal tuberculosis Abdominal disease characteristically causes pain and constipation . If advanced it may cause complete obstruction of the bowel. e) GENITO-URINARY TB : it include painful urination, or urination frequency problems. In men, genital TB may present as epididymitis or a scrotal mass. In women, genital TB may mimic pelvic inflammatory disease .

Diagnostic evaluation :

Diagnostic evaluation Tissue and/or fluids from the suspected site of infection are collected and used in the diagnostic tests. Some of the more common types of specimens in extrapulmonary TB diagnostics are: biopsy tissue, pleural fluids, peritoneal fluid, needle aspirates, cerebro-spinal fluid, and urine. Like pulmonary TB, extrapulmonary TB relies on a specialized bacterial stain and culture called acid-fast stain.

Medical management :

Medical management Treatment is as for pulmonary disease with : isoniazid rifampicin , pyrazinamide and ethambutol for two months followed by isoniazid and pyrazinamide for four months, except for CNS disease when treatment should be continued for a full year. Steroids may be used in pericardial and meningeal disease. Prevention : BCG, or bacille Calmette and Guérin , is a vaccine for tuberculosis (TB) disease

Abbreviation of anti tuberculosis :

Abbreviation of anti tuberculosis All first-line anti-tuberculous drug names have a standard three-letter and a single-letter abbreviation: Ethambutol is EMB or E, isoniazid is INH or H, pyrazinamide is PZA or Z, rifampicin is RMP or R, streptomycin is STM or S.

Alternative Names:

Alternative Names Miliary tuberculosis; Tuberculosis - disseminated; Extrapulmonary tuberculosis