TB DISEASE

Tuberculosis is an infectious infectious disease, caused by a bacterial infectious agent M. Tuberculosis which generally attacks the lung organs in humans.

This disease is transmitted by positive smear patients who spread through droplet nuclei that come out when the patient coughs or sneezes. Bacteria that spread in the air can be inhaled by healthy people and can cause infection.

Anamnesis (medical history) and physical examination are important tools in the diagnosis of tuberculosis (TB), but laboratory tests and imaging studies are necessary to confirm the diagnosis.

An in-depth anamnesis (also known as medical history taking) is a crucial step in the diagnosis and management of many health conditions, including tuberculosis. By gathering information about the patient's symptoms, past medical history, family history, lifestyle, and other factors, clinicians can gain valuable insights into the possible causes of the patient's complaints, as well as any risk factors that may be contributing to their condition.

For patients with signs and symptoms of tuberculosis, anamnesis should include questions about their exposure to TB, any previous TB infections or treatment, their current nutritional status and growth, and any other health conditions they may have. This information can help clinicians make an accurate diagnosis and develop an appropriate treatment plan.

It is important to consider the patient's history of contact with others, especially if they have been in close contact with someone who has a communicable disease. Additionally, if the patient is employed in a job that puts them at risk for exposure to infectious diseases, this should also be taken into account. Factors such as the patient's living environment, including population density and ventilation, can also be important in determining their risk of contracting or spreading disease. Poor ventilation and crowded living conditions can increase the likelihood of disease transmission.

Supporting examinations that can be done are

Complete Blood Count

It is important to note that a complete hematological examination can provide valuable information in the diagnosis of tuberculosis. In the early stages of the disease, there may be a slight elevation in leukocyte count with a shift in the type count to the left. This means that there may be an increase in the number of immature white blood cells, which is a sign of inflammation.

Lymphocyte counts may be below normal. the erythrocyte sedimentation rate (ESR) may begin to increase, and Mild anemia with a normochromic normocytic picture may also be observed.

In addition, gamma globulin levels may be increased, which is a non-specific marker of inflammation. Decreased blood sodium levels may also be observed, although this is a less common finding in tuberculosis.

* Radio Diagnostic

Radiological examination, such as chest X-rays, is commonly used as a diagnostic tool for pulmonary tuberculosis (TB) in adults. However, it is important to note that the interpretation of X-ray images of TB in children is often challenging, as the appearance of TB lesions in children may not be typical.

In general, the most common radiographic findings of TB include pulmonary infiltrates, enlargement of the hilar or paratracheal lymph nodes, and cavitation

* Bacteriological Examination:

Pulmonary tuberculosis in adults can be established by the discovery of a positive smear on microscopic examination of sputum. The standard protocol for diagnosing tuberculosis involves collecting at least three sputum samples, ideally in the morning, on consecutive days. At least two of these samples should be smear positive for acid-fast bacilli (AFB) to confirm the diagnosis.In children, however, collecting sputum samples can be difficult, particularly in young children who cannot expectorate. As a result, gastric aspirates or gastric lavage fluid are often collected for microscopic examination to diagnose tuberculosis in children.

* Tuberculin Test Examination :

    The tuberculin test, also known as the Mantoux test, is a diagnostic test used to detect the presence of tuberculosis (TB) infection. The test involves injecting a small amount of purified protein derivative (PPD) of the TB bacteria under the skin of the forearm, and then checking for a reaction after a period of time. A positive reaction indicates that the person has been infected with TB bacteria at some point in their life, but it does not necessarily mean that they have active TB disease.

As mentioned, a positive reaction to the tuberculin test can indicate the presence of TB infection, but it is not always conclusive. In some cases, such as in children with anergy or immunosuppressed individuals, a negative reaction may occur even if TB infection is present. This can lead to false negatives and can result in a delayed diagnosis or missed diagnosis of TB. Repeat testing may be necessary if there is doubt about the results of the initial test.

* BCG rapid reaction check :

    When in the injection of BCG there is a rapid reaction (within 3-7 days) in the form of redness and induration > 5 mm, then the child is suspected of having been infected with Mycobacterium tuberculosis. At the moment this test has no meaning in determining the diagnosis of tuberculosis in adults because the weakness of this test is the presence of false positives.

* IGRA Test:

    The Interferon Gamma Release Assay (IGRA) is a blood test that can be used to screen for latent tuberculosis infection (LTBI). It is a more specific test than the Mantoux test, with similar sensitivity, and has several advantages over the Mantoux test.

* Gene Xpert MTB/ RIF Assay examination:

    Examination using amplification polymerase chain reaction (PCR) real-time multiplex is a rapid diagnostic test that can identify bacteria based on molecular DNA techniques. This test is highly sensitive and specific, with a sensitivity of up to 98%, especially in detecting rifampicin resistance in tuberculosis (TB) patients. This test works by amplifying specific regions of the bacteria's DNA, which can then be detected in real-time using fluorescence-based detection methods

The main principle of tuberculosis (TB) treatment is to adhere to a prescribed medication regimen for the duration recommended by a healthcare provider. TB is treated with a combination of antibiotics to prevent the development of drug-resistant strains of the bacteria.

▪ PNEUMONIA

Pneumonia is an infection of the lungs that can be caused by bacteria, viruses, or fungi. The symptoms of pneumonia can vary depending on the cause of the infection, but common symptoms include:

High fever (usually above 38°C or 100.4°F)

Coughing, which may produce phlegm or mucus

Rapid breathing, with a breathing rate higher than normal (usually over 20 breaths per minute)

Shortness of breath or difficulty breathing

Chest pain or discomfort, which may be worse with coughing or deep breathing

Fatigue or weakness

Headache

Confusion, especially in older adults

Loss of appetite or nausea

The diagnosis of pneumonia is typically made based on a combination of the patient's medical history, clinical symptoms, and imaging studies such as chest X-rays or CT scans. In cases of community-acquired pneumonia, it can be especially challenging to diagnose because the symptoms can be similar to other respiratory illnesses, and patients may have other underlying medical conditions that complicate the diagnosis.

Environmental factors, such as exposure to secondhand smoke or poor ventilation in the patient's home or workplace, may also be relevant in the diagnosis of pneumonia. In children, factors such as nutritional status, immunization history, and birth weight may be considered in assessing the risk for pneumonia and determining appropriate treatment options.

Pneumonia is an infection that can cause inflammation in the lungs, leading to a variety of symptoms. Some of the most common symptoms of pneumonia include: Fever, Cough: A cough is a common symptom of pneumonia and can be productive , Shortness of breath. Some patients with pneumonia may also experience discomfort or difficulty sleeping in a supine position, particularly if they are experiencing shortness of breath or chest pain.

Radiological examination

Radiological examination, specifically a chest X-ray, is a key supporting diagnostic tool for pneumonia. Radiographic findings can help confirm the presence of infection in the lungs and can also provide information about the severity and location of the infection. Radiological findings of pneumonia can include infiltrates, which are areas of increased density in the lung tissue, as well as consolidations, which are areas where the lung tissue has become solid due to fluid accumulation.

Complete Blood Count

Regarding the complete hematology examination, an increased number of leukocytes with a shift to the left indicates an acute inflammatory response, which is consistent with pneumonia. Leukopenia, or a decrease in the number of leukocytes, can also be present in some cases. An elevated LED or erythrocyte sedimentation rate is also a common finding in patients with pneumonia.

Microbiological Examinations

In terms of microbiological examinations, sputum culture and blood culture can help identify the presence of the causative organism, such as Streptococcus pneumoniae. Pneumococcal polysaccharide antigen testing may also be performed to confirm the diagnosis.

Blood Gas Analysis

Blood gas analysis can help assess the severity of the patient's hypoxemia, which is a common finding in pneumonia. In some cases, respiratory acidosis may also be present, particularly in advanced cases.

Lung Function Tests

Finally, lung function tests such as spirometry and imaging studies such as chest X-rays or CT scans can provide additional information regarding the extent and severity of lung involvement in pneumonia. These tests can help assess the presence of alveolar collapse, airway obstruction, and other factors that may contribute to the patient's symptoms.

The main treatment for pneumonia is antibiotic therapy, which aims to eradicate the causative organism(s) and resolve the infection. Empirical antibiotic therapy may be initiated before definitive identification of the causative organism(s) in order to provide prompt treatment and prevent the infection from worsening.