Case detecting

8/7/2019 Case detecting

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Tuberculosis:Tuberculosis:

case detectingcase detecting

Lecturer: Ph.D.Lecturer: Ph.D.

M.G.DolynskaM.G.Dolynska


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Main ways of the new casesMain ways of the new cases

revealingrevealing PassivePassive

Obligate diagnostical minimum (clinical,Obligate diagnostical minimum (clinical,radiological examination, direct smearradiological examination, direct smearmicroscopy)microscopy)

ActiveActive

Screening XScreening X--ray examination for adultsray examination for adultsScreening Mantoux test for childrenScreening Mantoux test for children


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ZiehlZiehl -- Nielsen stainingNielsen staining


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ZNZN--stainingstaining

Advantages Disadvantages Advantages Disadvantages CheapnessCheapness

SimplicitySimplicity

QuicknessQuickness

Low sensitivityLow sensitivity

Lack of viability andLack of viability and

drug sensitivitydrug sensitivityevaluationevaluation

Inability to detectInability to detectmycobacteria typesmycobacteria types


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Cultural testCultural test

LewensteinLewenstein--YensenYensen

Middlebrook setMiddlebrook set BACTEC setBACTEC set


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CultureCulture


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Cultural methodsCultural methods

Advantages Disadvantages Advantages Disadvantages High sensitivityHigh sensitivity

Drug resistanceDrug resistance

evaluationevaluation

Possibility of typingPossibility of typing

Taking timeTaking time

ExpensivenessExpensiveness

Hazard to theHazard to thepersonnelpersonnel


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Mantoux skin test with 5TU (Seibert) interpretationMantoux skin test with 5TU (Seibert) interpretation

Induration 5 mmInduration 5 mm Children in close contact with known or suspectedChildren in close contact with known or suspected

contagious cases of tuberculosis diseasecontagious cases of tuberculosis disease Children suspected to have tuberculosis disease becauseChildren suspected to have tuberculosis disease because

ofof ffindings on chest radiograph consistent with active orindings on chest radiograph consistent with active orpreviously active tuberculosispreviously active tuberculosis

Clinical evidence of tuberculosis diseaseClinical evidence of tuberculosis disease Children receiving immunosuppressive therapy or withChildren receiving immunosuppressive therapy or with

immunosuppressive conditions, including HIV infectionimmunosuppressive conditions, including HIV infectionInduration 10 mmInduration 10 mm

Children at increased risk of disseminated disease:Children at increased risk of disseminated disease: Those younger than 4 years of ageThose younger than 4 years of age Those with other medical conditions, includingThose with other medical conditions, including

Hodgkins disease, lymphoma, diabetes mellitus,Hodgkins disease, lymphoma, diabetes mellitus,chronic renal failure, or malnutritionchronic renal failure, or malnutrition

From American Academy of Pediatrics. Tuberculosis.From American Academy of Pediatrics. Tuberculosis.

In: Red book: 2003 report ofIn: Red book: 2003 report of the committee on infectious diseases. 25ththe committee on infectious diseases. 25th edition. Elkedition. ElkGrove (IL): Pickering LK; 2003Grove (IL): Pickering LK; 2003..


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Mantoux skin test with 5TU (Seibert) interpretationMantoux skin test with 5TU (Seibert) interpretation

((continuationcontinuation))

Children with increased exposure to tuberculosis disease:Children with increased exposure to tuberculosis disease: Those born, or whose parents were born, in highThose born, or whose parents were born, in high--prevalenceprevalence

regions of the worldregions of the world

Those frequently exposed to adults who are HIVThose frequently exposed to adults who are HIV--infected,infected,homeless, users of illicit drugs, residents of nursing homes,homeless, users of illicit drugs, residents of nursing homes,incarcerated or institutionalized, or migrant farm workersincarcerated or institutionalized, or migrant farm workers

Those who travel to highThose who travel to high--prevalence regions of the worldprevalence regions of the worldInduration 15 mmInduration 15 mm

Children 4 years of age or older without any risk factorsChildren 4 years of age or older without any risk factors

From American Academy of Pediatrics. Tuberculosis.From American Academy of Pediatrics. Tuberculosis.In: Red book: 2003 report ofIn: Red book: 2003 report of the committee on infectious diseases. 25ththe committee on infectious diseases. 25th edition. Elkedition. Elk

Grove (IL): Pickering LK; 2003Grove (IL): Pickering LK; 2003


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Mantoux skin test procedureMantoux skin test procedure


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Result appreciationResult appreciation


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Result appreciationResult appreciation


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Hyperergic tuberculin reactionHyperergic tuberculin reaction


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PCRPCR--testtest

1.1. Probe processingProbe processing(DNA purification)(DNA purification)

2.2. DNA meltingDNA melting3.3. Primers hybridizationPrimers hybridization

4.4. Complement DNAComplement DNA

chains buildingchains building


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Radiological examination:Radiological examination:purposespurposes

Case detectingCase detecting

Differential diagnosisDifferential diagnosis

TreatmentTreatment controlcontrol


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Radiological examination:Radiological examination:

main approachesmain approaches Screening (fluoroscopy, roentgenoscopy)Screening (fluoroscopy, roentgenoscopy)

Additional examinationAdditional examination tomographytomography

Movement observingMovement observing -- radioscopyradioscopy


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Routine clinical examinationRoutine clinical examination

Complaints:Complaints:

General:General:

Fatigue, malaise, weakness, sweating, feverFatigue, malaise, weakness, sweating, fever

Local:Local:

Cough with mucous sputum, hemophtysisCough with mucous sputum, hemophtysis

Chest painChest pain DyspnoeDyspnoe


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Anamnesis:Anamnesis:

Diseases onset:Diseases onset:

SuddenSudden

InsidiousInsidious

WavyWavy


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Respiratory tract examinationRespiratory tract examination

Percussion: dull sound, tympanic soundPercussion: dull sound, tympanic sound

Auscultation: weakened breathing, dry orAuscultation: weakened breathing, dry ormoisture ralesmoisture rales


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Anamnesis:Anamnesis:

Social and professional historySocial and professional history

At risk:At risk:

Low incomeLow income

Profession: industry workers, miners, healthProfession: industry workers, miners, healthcare workerscare workers

Family history: TB contactFamily history: TB contact

Personal history: diseases, substances abusingPersonal history: diseases, substances abusing


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Routine blood testRoutine blood testNormal Normal TuberculosisTuberculosis

HbHb

LeukocytesLeukocytes

eosinophileosinophilband neutrophilband neutrophil

segm. Neutrophilsegm. Neutrophil

lymphocytelymphocyte

monocytemonocyte

ESRESR

120120--160g/l160g/l

4,04,0 -- 9,09,0

0,50,5 -- 5%5%11 -- 6%6%

4747 -- 72%72%

1919 -- 37%37%

33 -- 11%11%

22 -- 1515 mm/hourmm/hour

(up to 15)(up to 15)

(up to 30(up to 30mm/hour)mm/hour)

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Case detecting