PULMONARY

TUBERCULOSIS
BSN 3- A & E
 Table of contents

01 02 03
Introduction Signs and Symptoms Diagnostics and
(Anatomy & Pathogenesis)
Laboratories

04 05 06
Management and Nursing Hypothetical Case
Tx Interventions
 Objectives
✓ Define pulmonary tuberculosis (PTB) and its causes.
✓ Explain the treatment options for PTB, including medication
and Directly Observed Therapy (DOT).
✓ Discuss the importance of completing the entire course of
treatment.
✓ Outline preventive measures to reduce the spread of PTB.
✓ Explain the role of public health initiatives in controlling PTB.
✓ Understand the importance of early diagnosis and treatment
in preventing the spread of PTB.
01
Introduction
Pulmonary Tuberculosis

is a chronic, infectious disease caused by

the bacterium Mycobacterium tuberculosis.
It most commonly affects the lungs, but it
can also spread to other parts of the body,
such as the brain, kidneys, and spine.
 1 Slow growing bacteria

2 Characterized by a lipid-rich cell wall

No environmental source: specific

3
human pathogen

Sub-species of Mycobacterium
4
tuberculosis:

✓ Mycobacterium africanum
✓ Mycobacterium bovis
✓ Mycobacterium microti
✓ Mycobacterium caprae
MYCOBACTERIUM TUBERCULOSIS
✓ Mycobacterium pinnipedii
 Transmission:

✓ Primarily transmitted through the air when a person with active TB coughs,
sneezes, or speaks.
✓ Close contact with an infected individual increases the risk of
transmission.
✓ Not easily transmitted through casual contact or by touching surfaces.

Remember:

Tuberculosis (TB) is a contagious bacterial infection. It can be spread through

the air and can lead to serious illness if left untreated. Early diagnosis and
treatment are crucial for preventing the spread of TB and improving outcomes.
People with weakened immune systems are at higher risk for TB.
01
Introduction
(Anatomy)
 Respiratory System

✓ Primary Functions: obtaining oxygen & removing carbon

dioxide
✓ Includes tubes that remove particles from (filter) incoming air &
transport air into & out of the lungs, as well as microscopic air
sacs where gases are exchange
✓ Helps control the temperature & water content of the air,
produce vocal sounds, & participate in the sense of smell &
the regulation of blood pH
01
Introduction
(Pathogenesis)
 A contact with open Pulmonary Tuberculosis
(sputum AFB positive)

Inhaled Mycobacterium tuberculosis

reaches the lungs

Cleared, with no infection Latent infection only/healed primary Active primary disease:
disease (45%) Ghon Focus
(50%)

Reactivated disease (10%) Progressive primary

disease
Reactivated disease (10%) Progressive primary
disease

Increased if:

✓ Increasing age
malnutrition Clinical syndromes:
✓ Steroids/HIV
✓ Pulmonary TB
✓ Anti-TNF treatment
✓ Lymph node TB
✓ Pleural TB
✓ Pericardial TB
✓ Miliary TB
✓ TB Meningitis
✓ Bone and joint TB
✓ GI Tract TB
✓ Genitourinary TB
02
Signs &
Symptoms
Cardinal signs and symptoms of TB:
✓ Cough
✓ Fever
✓ Night Sweats
✓ Weight Loss
 Stages of TB Infection and Corresponding Symptoms

A. Primary B. Latent C. Active

Most people don't experience The immune system walls off ✓ Cough

symptoms during this stage. the bacteria, preventing them ✓ Coughing up blood or mucus

Some may develop flu-like from causing harm. ✓ Chest pain

symptoms, including: ✓ There are no symptoms ✓ Pain with breathing or

✓ Low fever during this stage. coughing

✓ Tiredness ✓ However, the bacteria ✓ Fever

✓ Cough remain alive and can ✓ Chills

become active later. ✓ Night sweats

 Extrapulmonary TB: Symptoms Beyond the Lungs

TB can spread from the lungs to other parts of the body, known as Extrapulmonary
TB. Symptoms vary depending on the affected area.

✓ Fever
✓ Chills
✓ Night sweats
✓ Weight loss
✓ Loss of appetite
✓ Tiredness
✓ Pain near the site of infection
03
Diagnostics &
Laboratories
Tuberculin Skin Test (TST) or Mantoux Test

✓ Determines if you have been infected with

tuberculosis (TB) bacteria.
✓ A small amount of tuberculin is injected into your
skin: the skin is checked for a reaction.
✓ If it’s positive, it means that you have been
infected with TB bacteria.
✓ Does not necessarily mean you have active TB
disease.
✓ Further testing may be required to determine if
treatment is needed.
Interferon-Gamma Release Assay (IGRA)

✓ A blood test used to diagnose latent tuberculosis

infection.
✓ IGRAs measure interferon-gamma, a protein
released by immune cells in response to TB
bacteria.
✓ A positive IGRA result indicates a latent TB infection
but does not necessarily mean you have active TB
disease.
✓ Additional testing, such as chest X-ray or sputum
culture, may be necessary to determine if you have
active TB disease.
 Chest X-ray

✓ A crucial confirmatory test for tuberculosis (TB).

✓ If a tuberculin skin test (TST) or other screening
tests suggest a possible TB infection, a chest X-
ray is often performed to visualize the lungs.
✓ In individuals with active TB, the X-ray may show
characteristic abnormalities such as infiltrates,
cavities, or pleural effusions.
✓ These findings can help confirm the diagnosis
and aid in determining the severity of the
infection.
 Sputum Culture

✓ Involves collecting a sputum sample (mucus

coughed up from the lungs)
✓ Cultured in a laboratory to check for
Mycobacterium tuberculosis
✓ Positive sputum culture is the most reliable way
to diagnose TB
✓ Typically done on people with TB symptoms
(cough, chest pain, fever, weight loss)
✓ Used to monitor the effectiveness of TB treatment
✓ A negative sputum culture doesn't always mean
you don't have TB
Acid-Fast Bacilli (AFB) Smear

✓ Screens for tuberculosis (TB)

✓ Sputum sample is collected and stained with a
special dye
✓ Examined under a microscope to identify acid-fast
bacilli (Mycobacterium tuberculosis)
✓ Positive result suggests TB infection but may miss
cases with low bacterial load
✓ Often followed by a sputum culture for
confirmation
 GeneXpert MTB/RIF

✓ Rapid molecular diagnostic test for

Mycobacterium tuberculosis
✓ Detects TB and rifampicin resistance
✓ Highly sensitive and specific
✓ Provides results within hours (compared to weeks
for traditional culture)
✓ Valuable in resource-limited settings
✓ Improves TB diagnosis and treatment initiation
✓ Leads to better patient outcomes
04
Management &
Treatment
 Common Treatments for TB
Isoniazid (INH) Rifampin
Interferes with the synthesis of mycobacterial Inhibits the synthesis of RNA in TB
cell walls, ultimately leading to the death of bacteria, preventing them from replicating
the TB bacteria. It's a cornerstone of TB and growing. It's another essential
treatment and is highly effective when used component of TB treatment and is known
in combination with other antibiotics. for its potency.

Pyrazinamide Ethambutol
A bactericidal agent that works by Disrupts the synthesis of cell wall
disrupting the metabolism of TB bacteria. components in TB bacteria. It's often
It's particularly effective in treating used in combination with other
dormant or latent TB infections. antibiotics to prevent the development
of drug-resistant TB strains.
Directly Observed Therapy (DOT) is a crucial strategy
in the fight against tuberculosis (TB). It involves a
healthcare provider directly observing a patient take
their TB medications.

✓ Ensures adherence to treatment: Prevents missed

doses and incorrect medication usage.
✓ Prevents drug resistance: Reduces the risk of TB
bacteria becoming resistant to antibiotics.
✓ Provides support and accountability: Encourages
patients to stay on track with their treatment.
✓ Improves treatment outcomes: Increases the
chances of a successful recovery.
05
Nursing
Interventions
✓ Ensure the patient is in a negative-pressure isolation room, wears appropriate PPE,
and practices proper hand hygiene to prevent transmission of TB.
✓ Monitor the patient's adherence to medication regimen through directly observed
therapy (DOT) and assess their understanding of the importance of completing the
entire course of treatment.
✓ Provide education on cough etiquette, hydration, and oxygen therapy to manage
respiratory symptoms. Encourage a nutritious diet and weight monitoring to support
healing and prevent malnutrition.
✓ Address the patient's emotional needs through counseling and social services
support; while ensuring they have access to necessary resources for home care and
follow-up.
✓ Establish a clear timeline for treatment and follow-up, with regular monitoring of
symptoms, medication adherence, and overall progress.
06
Hypothetical
Case
A 35-year-old male, Mr. D., presents to the outpatient department with a 3-month history
of chronic cough, intermittent low-grade fever, night sweats, weight loss of 5 kg, and
fatigue. He has a history of smoking 10 cigarettes per day for the last 15 years and reports
living in a densely populated urban area. His symptoms have progressively worsened
despite taking over-the-counter cough medications. He denies any previous history of
tuberculosis but recalls frequent exposure to people with chronic cough in his
community. He works as a construction laborer and lives with his wife and two children.

✓ Blood pressure: 110/70 mmHg

✓ Pulse rate: 95 bpm
✓ Respiratory rate: 24 cpm
✓ Temperature: 37.8°C
✓ O2 Saturation: 96%
 Patient History

• Chief Complaint: Chronic cough for 3 months, weight loss, intermittent fever,
night sweats, fatigue.

• History of Present Illness:

✓ Cough initially dry, later productive with blood-streaked sputum.
✓ Fever mostly in the evening, relieved by paracetamol.
✓ Significant unintentional weight loss (5 kg in 3 months).
✓ Progressive fatigue and weakness.
• Past Medical History: No known history of tuberculosis. No previous
hospitalizations.

• Family History: No known family members with active TB.

• Social History: Smoker (10 cigarettes/day for 15 years), alcohol use on weekends,
lives in a crowded neighborhood. Frequent exposure to people with chronic cough.

• Travel History: No significant travel outside the country.

• Immunization History: BCG vaccine received as a child.

 Physical Assessment

• General Appearance: Thin, undernourished male, appears weak, with signs of

fatigue.

• Respiratory System:
✓ Inspection: Slight chest retractions with increased respiratory effort.
✓ Palpation: Increased tactile fremitus over the upper left lung field.
✓ Percussion: Dullness over the left upper lobe.
✓ Auscultation: Crackles and bronchial breath sounds in the left upper lobe.
 Diagnostics and Laboratories

• Sputum Microscopy (AFB smear): Positive for acid-fast bacilli (AFB).

• GeneXpert MTB/RIF: Mycobacterium tuberculosis detected; no rifampicin

resistance.

• Chest X-ray: Consolidation and cavitary lesions in the upper left lobe suggestive of
active pulmonary TB.
Diagnostics and Laboratories

• CBC:
✓ Hemoglobin: 12 g/dL (slightly low)
✓ WBC: 11,000/mm³ (within normal range)
✓ Platelets: 230,000/mm³

• ESR: Elevated at 40 mm/hr.

• HIV Testing: Negative.

 Management/Treatment

The patient is diagnosed with drug-susceptible Pulmonary TB. Treatment follows

the standard 6-month DOTS (Directly Observed Treatment, Short-Course) regimen:

• Intensive Phase (2 months):

✓ Isoniazid (INH) 300 mg daily
✓ Rifampicin (RIF) 600 mg daily
✓ Pyrazinamide (PZA) 1,500 mg daily
✓ Ethambutol (EMB) 800 mg daily
 Management/Treatment

• Continuation Phase (4 months):

✓ Isoniazid (INH) 300 mg daily
✓ Rifampicin (RIF) 600 mg daily

• Vitamin B6: 25-50 mg/day to prevent INH-induced peripheral neuropathy.

• Nutritional Support: High-protein, high-calorie diet recommended to address weight

loss and malnutrition.

• Follow-up Sputum AFB Tests: After 2 months to assess response to treatment.

 Nursing Interventions

✓ Educate the patient on proper cough etiquette and the use of masks to prevent
the spread of tuberculosis.
✓ Emphasize the importance of strict adherence to the DOTS regimen for
successful treatment and prevention of drug resistance.
✓ Provide health education to the patient and family about tuberculosis, its
transmission, and the importance of early detection and treatment completion.
✓ Collaborate with a nutritionist to ensure the patient follows a high-calorie, high-
protein diet to combat weight loss and improve recovery.
 Nursing Interventions

✓ Regularly monitor for potential side effects of TB medications, such as liver

toxicity, peripheral neuropathy, and visual disturbances.
✓ Offer emotional support to address concerns about TB-related stigma and
promote family involvement in the treatment process.
✓ Assist the local health unit in identifying and screening close contacts for TB
through contact tracing.
Thank You!
BSN 3- A & E

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