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TB Diagnostics
Chest X-Ray
Typical Chest Xray
Patient 1
• 18 year old female• Somalian • UK 6 months
• Non productive cough and Chest Pain
Patient 1 contd.
Outcome of Patient 1
• TB should always be actively excluded in anyone with suggestive symptoms and epidemiological risk (e.g. from high prevalence country)
Patient 2
• 17 years, Bangladeshi female
• Outbreak of TB at school
• Cough, Haemoptysis
Patient 3
• 79 year old • Polish• Living in Garage• Diagnosed in A+E
Patient 3 contd.
• Malnourished• Intermittent Treatment
Further Difficulties – Patient 4
• Sudden onset of cough, breathlessness and foul phlegm
• Pleural thickening on each side due to prior asbestos exposure
• Sputum grew Klebsiella
• DIAGNOSIS:
Bacterial chest infection
Patient 4 contd.
• Fever ↑, Weight Loss, WBC↑, CRP ↑, so referred for VATS
• ↑ Pleural Fluid
Patient 4 contd.
• HIV+ does not mean you won’t get TB again
• Normal inflammatory response is different, subtle appearance
• CXR can change quickly
Patient 5
• Mobile XRay screening unit
• Strongly positive Mantoux test
• CHAOTIC patient
Patient 5 contd.
• DNA X 6 (bronchoscopy)
• Abdominal pain ↑, weight loss ↑, fevers ↑
• Refused empirical treatment
• Refused CT scan because of IV access
• Refused Biopsy because of IV access
• U/S showed TB changes but still no organisms…
Patient 5 contd.
• 4 months later - sputum grew TB
• Biopsy showed granuloma changes
• Now has extensive disease and treatment is difficult