tuberculosis introduction and pathophysiology
- 1. PEDIATRIC TUBERCULOSIS Dr.Purnakala T 1st yr Pediatrics Pg
- 2. Objectives Introduction Pathophysiology Clinical Features
- 3. Persistent fever for more than 2 weeks Unremitting cough for more than 2 weeks Weight loss of 5% Or no weight gain in past 3 months
- 4. Introduction • RNTCP 1997 • NTEP –2020 • Pediatric load 10% • india tb incidence- 210 per 1 lakhs
- 5. ETIOLOGY 5 mycobacteria • M.Tuberculosis • M.Bovis • M.Africanum • M.microti • M.Canetti
- 6. CHARACTERESTICS Non spore forming, Non motile, Pleomorphic Weakly gram positive, Curved rods Acid fast ,Obligate aerobes Slow generation time 12 to 24 hrs Isolation from solid media 3 to 6 weeks From liquid medium 1 to 3 weeks NAA / RFLP
- 7. TRANSMISSION • Inhalation of infective droplet • Airborne droplet nuclei 1 to 5 micromm INCREASED RISK if Positive Acid Fast Sputum Extensive Upper Lobe Infiltrate Or Cavity Copious Sputum Production Severe Forceful Cough Poor Circulation/ Ventilation
- 8. • Reason for drug resistance 1. Poor adherence to treatment 2. Inadequate drug regimens
- 14. Natural course of the disease • Initially alveoli and alveolar ducts lymphnodes either heals by fibrosis or calcification • Sometimes with intense caseation, central part liquifies ---- leaves residual cavity • Partial obstruction hyperinflation of distal segment • Complete obstruction atelectasis • Collapse-consolidation or segmental lesion at
- 15. Contd …. • Ghon complex parenchymal lesion + lymph node site • Disseminated tuberculosis if load is high or immunity is inadequate • Meningeal TB --- 2 to 6 months • Lymph node or endobronchial tuberculosis ---3 to 9 months • Bones and joints --- in years • Primary infection --- >1 yr – endogenous regrowth( reactivation tuberculosis)
- 16. PRIMARY PULMONARY DISEASE • Parenchymal + lymphnodes (subpleural foci) • Hallmark – large size of regional lymphadenitis • Enlarged subcarinal lymphnodes – bronchoesophageal fistula PROGRESSIVE PULMONARY DISEASE • Liquefaction – adjacent bronchi – intrapulmonary dissemination
- 17. PREGNANCY AND THE NEWBORN • Congenital tuberculosis ( thro’ umblical vein ) • Aspiration or ingestion of amniotic fluid Manifestations in the baby • Prematurity • Fetal growth retardation • Low birth weight • Perinatal mortality
- 18. PERINATAL DISEASE • Congenital tuberculosis begin by the 2nd or 3rd wk of life • Respiratory distress, fever, hepatic or splenic enlargement, poor feeding, lethargy or irritability, lymphadenopathy, abdominal distention, failure to thrive, ear drainage, and skin lesions • Clinical presentation similar to bacterial sepsis or congenital infection. • Mortality remains high
- 19. CANTWELL CRITERIA Lesions during first week of life Primary hepatic complex or caseating granuloma Infection of the placenta or maternal genital tract Exclusion of postnatal transmission
- 20. Contd.. PLEURAL EFFUSION Discharge of bacilli into pleural space from subpleural pulmonary focus or caseated lymph node. Tuberculous pleurisy - low to high fever, shortness of breath, chest pain on deep inspiration, and diminished breath sounds. Rare complication - scoliosis
- 23. CENTRAL NERVOUS SYSTEM DISEASE Most serious complication and is fatal Arises from the metastatic caseous lesion in the cerebral cortex or meninges Subependymal tubercles discharges tubercle bacilli into the subarachnoid space Brainstem is the common site Cranial nerves 3 6 7 are affected. Communicating hydrocephalus Cerebral salt wasting or SIADH
- 24. STAGES 1 ST STAGE : lasts 1 to 2 weeks with non specific symptoms 2 ND STAGE : more abrupt lethargy, nuchal rigidity, seizures, positive Kernig and Brudzinski signs, hypertonia, vomiting, cranial nerve palsies, and other focal neurologic signs Directly proportionate to the communicating hydrocephalus 3RD STAGE :coma , hemiplegia or paraplegia, hypertension, decerebrate posturing,
- 25. PROGNOSIS 1st stage : excellent outcome 3Rd stage :permanent disabilities
- 26. TUBERCULOMA • Infratentorial, located at the base of the brain near the cerebellum. • Child with tuberculous meningitis deteriorates or develops focal neurologic findings while on treatment.
- 27. PERICARDIAL DISEASE The most common form of cardiac tuberculosis is pericarditis Direct invasion or lymphatic drainage from subcarinal lymph nodes Pericardial friction rub or distant heart sounds with pulsus paradoxus The pericardial fluid is typically serofibrinous or hemorrhagic.
- 28. DISSEMINATED TB
- 29. UPPER RESPIRATORY TRACT DISEASE Laryngeal tuberculosis - croup-like cough, sore throat, hoarseness,dysphagia Tuberculosis of the middle ear-aspiration Painless unilateral otorrhea, tinnitus, decreased hearing, facial paralysis, and a perforated tympanic membrane.
- 30. BONE AND JOINT DISEASE Most likely to involve the vertebrae. Tb spondylitis ---> potts disease ---->gibbus and kyphosis Tuberculous bone lesions can resemble pyogenic and fungal infections or bone tumors TB DACTYLITIS - spina ventosa
- 31. ABDOMINAL AND GI DISEASE Most common lesion is a painless ulcer on the mucosa, palate, or tonsil Tb of esophagus---> TE fistula Generalized peritonitis- hematogenous dissemination Localised peritonitis-direct extension from an abdominal lymph node
- 32. Tuberculous enteritis is - hematogenous dissemination or by swallowing The jejunum and ileum near Peyer patches and the appendix Mesenteric adenitis usually complicates enlarged nodes can cause intestinal obstruction or erodes.
- 33. GENITOURINARY DISEASE Renal tuberculosis is rare in children lymphohematogenous dissemination. spreads locally to the ureters, prostate, or epididymis. sterile pyuria and microscopic hematuria. Complications - HUN , strictures. Adolescent girls -->fallopian tubes(90%) Endometrium (50%) Ovaries and cervix Adolescent boys-->epididymitis or orchitis.