TUBERCULOSIS

DIAGNOSIS
 How To Diagnose TB??
• Tuberculosis is diagnosed by finding
Mycobacterium tuberculosis bacteria in
a clinical specimen taken from the
patient.
• A complete medical evaluation from
tuberculosis (TB) must include:
– Medical history
– Physical examination
– Tuberculin skin test
– Chest X-ray
– Microbiological examination
 Medical History

• Includes obtaining the symptoms of:

•Fever •Night- •Loss of •Persistent

time weight cough
sweating
•Loss of •Constant
appetite tiredness
• It is also important to consider
demographic factors (country of origin,
age, ethnic @ racial group, occupation)
that may increase the patient risk of
exposure to TB or to drug resistant TB.
• Should determine whether the patient
has medical conditions esp. HIV infection
that increase the risk of latent TB
infection progressing to TB disease.
 Physical Examination

• Is done to assess the patient’s general

health and find other factors which may
affect the TB treatment plan.
• It cannot be used to confirm @ rule out
TB
 Tuberculin Skin Test
• Usually known as the Mantoux tuberculin skin
test.
• Is a method for screening for exposure to TB
infection.
• A person who has infected with TB will have
developed a hypersensitivity to the TB bacteria
even they did not develop the disease.
• Is performed by injecting a small amount of
fluid (tuberculin) into skin in the lower part of
the arm.
• The skin area is inspected 48-72 hours later for
a bump.
• The reaction is read by measuring the diameter of
induration across the fore arm in millimeter (mm).
• A positive response usually shown by a hard, raised
bump at the injection site – likely to have TB infection.
• Skin test are not 100% accurate and they did not always
indicate the presence of active disease.
 Chest X-ray
• A chest radiograph is
used to detect chest
abnormalities.
• Lesion may appear
anywhere in the lungs
and may differ in size,
shape, density and
cavitation.
• Abnormalities may
suggest TB, but cannot
be used to definitively
diagnose TB.
• Chest radiograph
may be used to rule
out the possibility of
pulmonary TB in a
person who has had
a positive reaction to
Mantoux test and no
symptoms of
Abnormal chest X-ray. Arrow points to
disease. cavity in patient’s right upper lobe.
Microbiological Examination
• The acid fast smear plays an important role in
the early diagnosis of mycobacterial infections.
• Microscopy is the oldest, easiest, most rapid
and inexpensive procedure that can be
performed in the laboratory to detect the
present of acid-fast-bacilli (AFB).
• Detection of significant number of AFB (using
Ziehl-Neelsen stain) in sputum @ tissue sample
is considered a positive diagnose, although
disease may confirmed by laboratory culture of
the bacterium (difficult & slow-takes at least 4
weeks).
• If bacteria that cause
TB infection grow in
the culture (OGAWA &
LJ media), other test
may be done to
determine which
antibiotic will be most
effective in treating
the infection –
sensitivity testing.
• A positive culture for
M. tuberculosis
confirms the
diagnosis of TB
disease.
Acid Fast Staining Using Ziehl-
Neelsen Method

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