Pulmonary Tuberculosis,Fifth National Tuberculosis epidemiological survey results（March 2011）,At present the number of annual incidence of tuberculosis in China is about 1.3 million, accounting for 14.3% of global incidence, among the world is No. 2 Now the annual rate of descending is about 9% World Tuberculosis Day(24th, March),General Considerations,Etiology,epidemiology,Tuberculosis is transmitted by airborne droplet nuclei (containing tubercle bacilli ),The transmission is determined,Pathogenesis,tubercle bacillus,Human immunity,Phagocytosis period,Cell mediated immunity(CMI) Delay type hypersensitivity(DTH) T lymphocytes(CD4+):,Symbiotic period,Liquefaction and Propagation period,Human Immunity after infected tubercle bacillus and tuberculin hypersensitivity,basic pathologic changes,The result of the tuberculosis after infection,There are five common clinical patterns of tuberculosis,clinical patterns of pulmonary tuberculosis,Clinical Manifestations,systemic signs: Most patients present as cases of pulmonary tuberculosis with fever,weight loss, anorexia, fatigue, night sweats wasting. respiratory signs: Cough Hemoptysis chest pain tachypenea ect Physical signs: nonspecific.,Laboratory and physical examinations,Sputum examination direct smear sputum culture Direct smear examination is only positive when large numbers of bacilli begin to be excreted A negative smear by no means excludes tuberculosis Particularly if the negatives are frequently repeated PCR test to detect TB,(1) shadows mainly in the upper zone (2) patchy or nodular shadows (3) the presence of a cavity or cavities, although these, of course, can also occur in lung abscess, carcinoma, etc (4) the presence of calcification. although a carcinoma or pneumonia may occur in an areas of the lung where there is calcification due to tuberculosis (5) bilateral shadows, especially if these are in the upper zones (6) the persistence of the abnormal shadows without alteration in an x-ray repeated after several weeks this helps to exclude a diagnosis of pneumonia or other acute infection,Chest radiography,Primary complex,Milliary Tuberculosis,acute milliary tuberculosis,secondary pulmonary tuberculosis,infiltrate,Tuberculoma,Chronic fibro-cavitary pulmonary tuberculosis,cavity,Tuberculous effusion,Tuberculin skin test A positive tuberculin test although it is of great use in children, but it has limited diagnostic significance in older age groups Main Significance: Epidemiological survey, detect some new positive peoples, assistant diagnosis,How to judge the result? A reaction of less than 5 mm is considered negative 5-9 mm is considered positive (+) 10-19 mm is considered positive (+) more than 20 mm or with Blister is considered positive (+),Bronchoscopy examination,Endobronchial tuberculosis,Diagnosis,According to the history, clinical signs, chest X-ray and some other examinations, we can diagnose TB Patients with positive sputum examination (Clinical signs and X ray features) Patients with negative sputum examination Clinical signs and X ray features, exclude other nontuberculosis disease, positive PPD test and effective of diagnostic antituberculosis therapy,How to judge the activity of pulmonary tuberculosis,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. Upper Right secondary pulmonary tuberculosis, smear(-), retreatment,Differential Diagnosis,Differential Diagnosis :lung cancer,complications,Pneumothorax Bronchiectasis Empyema Extrapulmonary expansion Hemoptysis Chronic pulmonary heart disease,Therapy,The principles of antituberculous chemotherapy,Treatment,The critical issue in TB control is adopting the DOTS (1995) ( Directly Observed Treatment, Short-course therapy); DOTS Strategy is recommended by the WHO TB Program.,Isoniazid (INH),Isoniazid is a principal agent used to treat tuberculosis It is universally accepted for initial treatment Now considered the best antituberculous drug It should be included in all TB treatment regimens unless the organism is resistant,Advantages and Dosage,Inexpensive Highly selective for mycobacteria Well tolerated(about only 5% of patients exhibiting adverse effects) 4-8 mg/kg daily for both groups a 300mg daily oral dose is adopted,Adverse effects,The two most important adverse effects of isoniazid therapy : hepatotoxicity peripheral neuropathy,Rifampin (RFP),It is also considered the most important and potent antituberculosis agent Like isoniazid it is bactericidal and highly effective It has both intracellular and extracellular anti-bacterial activity,Dosage 450-600mg daily or twice weekly Adverse effects gastrointestinal upset hepatitis,Pyrazinamide (PZA),Pyrazinamide is a major oral agent used against mycobacteria It is an important bactericidal drug used in short-course therapy for tuberculosis The drug is used to kill int