Dr.

Sathaporn Kunnathum
13 Jun 2010
Hemoptysis
Infection
Tumor
Bleeding disorder
FB
Medicine
Destructive lung
Hemoptysis or
Hematemesis
Epidemiology
Tuberculosis (TB) remains the leading cause of death
worldwide from a single infectious disease agent. Indeed
up to 1/2 of the world's population is infected with
TB.  The registered number of new cases of TB worldwide
roughly correlates with economic conditions
the highest incidences are seen in those countries of
Africa, Asia, and Latin America .
WHO estimates that eight million people get TB every
year, of whom 95% live in developing countries. An
estimated 2 million people die from TB every year. 
Clinical features
Fever
Hemoptysis
Loss of appetite
Weight loss
Fatique
Night sweats
Chest pain
Cause

Mycobacterium tuberculosis
Tuberculosis is
transmitted by
airborne droplet
nuclei(containin
g tubercle
bacilli )
 Many droplet nuclei are
capable of floating in the
immediate environment for
several hours
 Large particles may be
inhaled by a person
breathing the same air
and impact on the
trachea or wall of the
upper airway
Laboratory and physical examinations
Chest radiography
Sputum examination
Tuberculin testing
PCR test to detect
TB
TB antibody testing
bronchoscopy
Diagnosis
Usually Dx from clinical, CXY and Sputum AFB
 Radiology
 Chest radiography is the most
important method to detect TB
 TB’s characteristics of a chest
radiograph favor the diagnosis of
tuberculosis as following :
(1) Involve mainly in the upper zone
(2) patchy or nodular infiltration
(3) cavity lesion.
(4) calcification.
(5) bilateral infiltration, especially if these are in the
upper zones
(6) the persistence of the abnormal shadows without
alteration in an x-ray repeated after several weeks
this helps to exclude a diagnosis of pneumonia or
other acute infection
Milliary Tuberculosis
acute
milliary
tuberculosis
 Upper lung infiltrate

infiltrate
Tuberculom
a
Chronic fibro-cavitary pulmonary
tuberculosis

cavity
Tuberculous effusion
Sputum examination
There are direct smear and
culture
Direct smear examination
is only positive when large
numbers of bacilli begin to
be excreted
Sputum examination
A negative smear by no means
excludes tuberculosis
A negative smear in the presence
of extensive disease and cavitation
makes the diagnosis less likely.
Particularly if the negatives are
frequently repeated
 Tuberculin
testing
A positive tuberculin
test although it is of
great use in children,
but it has limited
diagnostic significance
in older age groups
• A reaction of less than 5 mm is
considered
negative
• 5-9 mm is considered positive (+)
• 10-19 mm is considered positive (+
+)
• more than 20 mm is considered
positive
(+++)
Differential Diagnosis 12
34
Bronchiectasis may confused with
chronic fibrocavenous pulmonary
tuberculosis. They also have chronic
cough, sputum production and
hemoptysis. Usually we can use chest
x-ray examination and CT scan to
distinguish them.
 Differential Diagnosis 12
3 the
Cavitary lung abscess often involves 4
dorsal segments of the lower lobes and posterior
segments of the upper lobes. Typically lung
abscess causes litt1e in the way of physical
findings, may have a air-fluid level, and is not
associated with patchy bronchogenic infiltrates.
In contrast, physical findings are prominent
over tuberculous cavities, fluid levels are rare.
And patchy infiltrates elsewhere are the rule.
 Differential Diagnosis 1234

Acute bacterial pneumonias may

resemble
florid tuberculosis in all particulars
except for
the sputum examination and
response to
antimicrobial drugs.
 Differential Diagnosis 1234

Neoplasm may resemble tuberculosis.

As in
an isolated coin lesion. ( An irregular
cavity wall
suggests necorotic neoplasm. )
Differential Diagnosis 123
45
Fever caused by some other diseases
complications
 Pneumothorax
 Bronchiectasis
 Empyema
 Extrapulmonary expansion
 Hemoptysis
 Chronic pulmonary heart disease
Treatment
The critical issue in TB control is
adopting the DOTS (1995)
( Directly Observed Treatment,
Short-course therapy; DOTS Strategy
is recommended by the WHO TB
Program.
Treatment
WHO Category of treatment
I 2IRZE + 4IR in general case
II 2IRZES + IRZE + 5IRE in relapse and default
case
Adverse effects
INH : hepatotoxicity and periphral
neuropathy
Rifampicin : gastrointestinal upset,
hepatitis
Ethambutol : optic neuritis
PZA : hepatotoxity
Streptomycin : Ototoxicity, Renal toxicity
Resources
 WHO
 Tuberculosis Resources (Columbia Medical School) 
http://www.cpmc.columbia.edu/tbcpp
 Tuberculosis, NIAID Fact Sheet
http://www.niaid.nih.gov/factsheets/tb.htm
 Positive Skin Tests for Tuberculosis (American Family Physician)
http://www.aafp.org/afp/961101ap/pat_1991.html
 National Tuberculosis Center
http://www.umdnj.edu/~ntbcweb/ntbchome.htm
 CDC; Division of Tuberculosis Elimination
http://www.cdc.gov/nchstp/tb/structure.htm
 Treatment of Tuberculosis and Tuberculosis Infection in Adults and
Children American Thoracic Society Medical Section of the American
Lung Association American Journal of Respiratory and Critical Care
Medicine Vol 149 1994 
http://aepo-xdv-www.epo.cdc.gov/wonder/PrevGuid/p0000413/p0000413.htm
 Brief History of Tuberculosis
http://www.umdnj.edu/~ntbcweb/history.htm
Thank you for your
attention