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Pulm TB


Pulm TB gp a chronic granulomatous disease caused by myco tuberculosis involving commonly apical n post. Segments of upper lobe or apical segment of lower lobe

Etiopathology-
Conditions favouring infection of tubercle bacilli.
-malnutrition
-diabetes
-immunosuppressive drugs
-HIV Infection
-hemophilia
-chr renal failure
-silicosis
There is an initial preexudate phase followed by exudative phase which proceed to caseation n dev of cheesy material.
Around d edge of caseation,develop d productive lesion,there is Aggregation of epitheloid cells n giant Langerhans cells which form tubercles.

C/f
SYMPTOMS
1. General
-loss of weight and loss of appetite
-fever.evening rise
-night sweats
-tiredness malaise
-mental symptoms
-amenorrhoea
2.respiratory
-cough persist more than 3 weeks
-sputum may be mucoid purulent or bld stained
-hemoptysis
-pain in chest
-breathlessness
-localised wheeze
-recurrent cold and pneumonia
3.physical signs
-pallor and cachexia in advanced cases
-fever,tachycardia n tachypnoea
-crepts in apices of lungs.
-consolidation,cavitation,collapse,fibrosis,pleural effusion or pneumothorax may b present.

Investigations
1.blood examination
-moderate anemia
-white cell count is usually normal
-ESR is usually raised
2.chest x ray
3.sputum examination
-sputum culture for tubercle bacilli
-guinea pig inoculation studies.
4.laryngeal swabs
5.gastric aspiration(lavage)
6.bronchoalveolar lavage
7.tuberculin test
8.BACTEC radiometric growth detection
9.ELISA testing for antibodies.

Treatment
AntiTB drugs
-isoniazid(H) 300mg
-ridampicin(R) 450mg
-pyrazinamide (Z) 1500mg
-ethambutol(E) 1000mg
-streptomycin(S) 1250mg

Short Course Chemotherapy

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