Pulmonary tuberculosis

• this is chronic granulomatous infection of the lungs caused by M.tuberculosis
• pulmonary tuberculosis is worsen by HIV and multidrug resistant tuberculosis(MDR-TB)
• diagnosis: 1)initial diagnostic test is Xpert MTB/RIF Ultra assay and this can also detect rifampicin resistance
• we can also do genotype MTB'DR PLUS as a confirmatory test for rifampicin resistance and it also detects isoniazid resistance
• if a patient is negative on sputum with Xpert MTB/RIF but their HIV positive then we need futher investigations and at the moment give the patient empiric anti-tuberculosis therapy
• all patients who are Xpert MTB/RIF ultra positive need more sputum to be sent for AFB(to identify specific bacteria that caused TB) to allow for initiation of treatment
• all patients with rifampicin resistant detected on Xpert MTB/RIF more sputum should be sent to "DR-TB reflex" testing
• all patients should be screened for HIV. if patient have both HIV and and TB,then cotrimoxazole prophylaxis should be give nomatter their CD4 count
• induction of sputum with nebulised sodium chloride 5% should be done with patients that are unable to produce sputum spontaneously-maybe they are severely ill
• patients that we suspect may have TB lymphadenitis we can use a wide needle 18G for aspiration of abscess on lymph node to take to Xpert MTB/RIF ultra
• urine lipoarabinomannan(LAM)-is used to detect mycobacterial LAM antigen- is a good diagnostic test for HIV infected patients that have signs and symptoms of pulmonary TB with CD4 <100 cells/microL
• Medicine treatment: all patients with active TB, positive on Xpert MTB/RIF ultra and are rifampicin sensitive, they should get 2 months intensive phase treatment and 4 months continuation phase treatment
• patients who are at risk of having resistant TB,sputum should be sent for genotype MTB'DR plus LPA to exclude isoniazide resistance.
• R-Rifampicin, H-Isoniazid, Z-Pyrazinamide, E-Ethambutol
• Medicine Treatment two months initial phase(RHZE-150/75/400/275):30-37kg give 2 tablets, 38-54kg 3tablets, 55-70kg 4tablets,71kg and above give 5tablets.
• medicine treatment 4 months continuation phase (RH-150/75):30-37kg give 2tablets, 38-54kg 3tablets. (RH-300/150):55kg and above give 2tablets
• the use of INH may result in the development of a peripheral neuropathy that results from drug-induced pyridoxine deficiency-vitamin B6-especially in diabetic,HIV and alcoholics,so give pyridoxine 25mg daily