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» Home » CAD » Infectious Disease » Mycobacterium » Tuberculosis (TB)
Background
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It most commonly affects the lungs but can also affect other parts of the body, such as the bones, lymph nodes, and brain. TB is transmitted through the air when an infected person speaks, coughs, or sneezes, and other people inhale the bacteria.
Symptoms of TB may include a persistent cough, chest pain, fatigue, weight loss, and fever. If left untreated, it can be life-threatening. It can be treated with a combination of antibiotics, but it is important to complete the full course of treatment to prevent the development of drug-resistant TB.
Epidemiology
According to the World Health Organization (WHO), TB is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. In 2020, an estimated 10 million people developed TB, and 1.4 million died.
It is most prevalent in countries with high rates of HIV infection, poverty, and inadequate healthcare systems. The highest burden of TB is in the South-East Asia and Western Pacific regions, followed by the African region. Despite progress in reducing the global burden of TB, the disease remains a significant public health threat.
The WHO’s End TB Strategy aims to end the global TB epidemic by 2030 through a combination of measures, including expanding access to diagnosis and treatment, improving infection control, and developing new tools and strategies to prevent and control the disease.
Anatomy
Pathophysiology
The pathophysiology of tuberculosis involves the infection and colonization of the body by the bacterium Mycobacterium tuberculosis. When a person inhales droplets containing M. tuberculosis, the bacteria can enter the respiratory tract and begin to replicate. In most cases, the immune system can contain the infection and prevent it from spreading.
However, in some cases, the bacteria can evade the immune system and establish an infection in the lungs, known as active TB disease. M. tuberculosis is a slow-growing bacterium that can survive within the body for long periods. It can form clusters known as tubercles, which contain a mixture of bacteria, immune cells, and other materials. These tubercles can form in various parts of the body, including the lungs, bones, and lymph nodes.
In the early stages of infection, the immune system may be able to contain the bacteria and prevent them from spreading. However, if the immune system becomes compromised, the bacteria can multiply and cause active disease. Symptoms of TB may include a persistent cough, chest pain, fatigue, weight loss, and fever.
Etiology
Mycobacterium tuberculosis is a type of bacterium that causes tuberculosis. It is a member of the M. tuberculosis complex, which includes other types of mycobacteria, such as M. africanum, M. bovis, and M. microti. M. tuberculosis is a slow-growing, obligate-aerobic bacterium that can survive in extreme conditions and is resistant to many antibiotics due to its high lipid content in the cell wall.
It is transmitted through the air when an infected person speaks, coughs, or sneezes, and other people inhale the bacteria. It is most commonly found in the lungs but can also affect other body parts. TB can be treated with a combination of antibiotics, but it is essential to complete the entire course of treatment to prevent the development of drug-resistant TB.
Genetics
Prognostic Factors
Tuberculosis is a severe and potentially life-threatening infection caused by the bacterium Mycobacterium tuberculosis. It can spread to other parts of the body, such as the bones, lymph nodes, and brain, and cause serious complications. If left untreated, TB can also lead to drug-resistant strains of the bacterium, which are more challenging to treat.
People with HIV are particularly at risk for complications from TB, as their compromised immune systems make it more difficult to fight off the infection. TB can also cause malnutrition and pose risks to pregnant women and their unborn babies. However, the outcome can be improved with timely and appropriate treatment, which is why people with TB need to complete the full course of therapy to ensure that the infection is fully eradicated and to prevent the development of drug-resistant TB.
Clinical History
Clinical History
Patients with secondary tuberculosis exhibit distinct clinical manifestations compared to primary progressive disease. In secondary tuberculosis, the immune response and hypersensitivity reactions are heightened, leading to a more severe tissue reaction. Consequently, these patients frequently develop cavities primarily located in the upper regions of the lungs.
A chronic cough is a finding associated with secondary tuberculosis. This persistent cough is often accompanied by coughing up of blood, which indicates lung tissue damage. Furthermore, patients with secondary tuberculosis commonly experience unintended weight loss. In addition to weight loss, secondary tuberculosis patients often suffer from low-grade fever.
This persistent mild elevation in body temperature results from the immune system’s efforts to combat the infection. Moreover, night sweats are a common complaint in secondary tuberculosis. These nocturnal episodes of excessive sweating can disrupt sleep and contribute to the overall debilitation experienced by the patients.
Physical Examination
Physical Examination
Patients with secondary tuberculosis exhibit distinct clinical manifestations compared to primary progressive disease. In secondary tuberculosis, the immune response and hypersensitivity reactions are heightened, leading to a more severe tissue reaction. Consequently, these patients frequently develop cavities primarily located in the upper regions of the lungs. A chronic cough remains a prevalent symptom among the hallmark physical findings associated with secondary tuberculosis.
This persistent cough is often accompanied by hemoptysis, the coughing up of blood, which can be alarming and indicate lung tissue damage. Furthermore, patients with secondary tuberculosis commonly experience unintentional weight loss due to the metabolic demands imposed by the infection and the accompanying inflammatory response.
In addition to weight loss, secondary tuberculosis patients often suffer from low-grade fever. This persistent mild elevation in body temperature results from the immune system’s efforts to combat the infection. Moreover, night sweats are a common complaint in secondary tuberculosis. These nocturnal episodes of excessive sweating can disrupt sleep and contribute to the overall debilitation experienced by the patients.
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Differential Diagnoses
Pneumonia
Histoplasmosis
Sarcoidosis
Malignancy
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
The primary treatment for TB involves a combination of antibiotics. The most commonly used drugs include isoniazid, rifampin, ethambutol, and pyrazinamide. These drugs are typically taken daily or several times a week for six to nine months, although the duration may vary depending on the type and severity of the infection.
TB treatment consists of two phases – the intensive phase and the continuation phase. During the intensive phase, patients receive a combination of four drugs for about two months to kill the bacteria and reduce their numbers rapidly. Following the intensive phase, the continuation phase involves a reduced drug regimen to eliminate any remaining bacteria and prevent relapse. To ensure adherence to the medication regimen and minimize the development of drug-resistant strains, it is recommended that TB patients receive DOT.
This involves healthcare providers or trained individuals directly observing patients taking their prescribed medications. Throughout the treatment process, regular monitoring is crucial. Patients undergo periodic check-ups, including physical examinations, sputum tests, and chest X-rays, to assess treatment progress and determine if any adjustments to the medication regimen are necessary.
Compliance with the full course of treatment is vital to achieve a successful outcome. In cases of drug-resistant TB, treatment can be more complex and prolonged. Drug-resistant strains require alternative medications or second-line drugs, which are often more expensive and can have more significant side effects. Treatment duration for drug-resistant TB can range from 20 months to 24 months, and in some cases, surgery may be required.
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
Indicated for pulmonary multidrug resistant tuberculosis (MDR-TB) :
Weeks 1-2: 400 mg orally daily
Weeks 3-24: 200 mg orally 3 times a week, with at least 2 days between doses
the maximum duration of therapy is 24 weeks
The combination regimen of bedaquiline, pretomanid, and linezolid iIndicated for pulmonary extensively drug resistant (XDR) or unresponsive MDR TB:
Pretomanid: 200 mg orally daily for 26 weeks
Bedaquiline: 400 mg orally daily for 2 weeks, following 200 mg 3 times a week for 24 weeks (a total of 2+24 weeks=26 weeks)
Linezolid 1200 mg orally daily for 26 weeks, if required adjust the dose
Indicated for Tuberculosis drug-resistant :
600
mg
Orally or IV
daily
as part of an appropriate combination regimen including pyridoxine; reduction in dose 300-450 mg once daily or 600 mg for patients who develop toxicity, 3-4 times per week may be used.
400mg orally/intravenous every day
Latent tuberculosis infection
:
>30kg:300mg orally every day for nine months
3-month regimen
900mg orally weekly once for three months
Active tuberculosis disease
5mg/kg orally/intramuscularly every day.Do not exceed 300mg every day
10mg/kg orally twice a week. Do not exceed 600mg/day
15 - 25
mg/kg
Tablet
Orally
once a day
60
days
15 - 30
mg/kg
Orally
once a day
4 g orally 3 times a day
Sprinkle granules over acidic foods or mix them with acidic liquids
The recommended treatment for pulmonary tuberculosis is the administration of rifampin 600 mg/isoniazid 300 mg (equivalent to 2 capsules) orally once a day
This fixed dosage has been proven to be therapeutically effective after the patient has been gradually adjusted to the individual components
Administer 10 mg/kg intravenously every five days for a total of 12 injections May be repeated after one month and simultaneously use with tryparsamide
Indicated for Multidrug-Resistant Pulmonary Tuberculosis:
Administer 100mg twice a day for 24 weeks.
Indicated for pulmonary multidrug resistant tuberculosis (MDR-TB) :
Age: ≥ 5 years
Weeks 1-2 (Weight ≥ 30 kg): 400 mg orally daily for 2 weeks
Weeks 3-24 (Weight ≥ 30 kg): 200 mg 3 times a week with at least 2 days between each dose
Weeks 1-2 (Weight 15-<30 kg): 200 mg orally daily 2 weeks
Weeks 3-24 (Weight 15-<30 kg): 100 mg 3 times a week with at least 2 days between each dose
Indicated for Tuberculosis drug-resistant :
600 mg Oral/IV daily as part of an appropriate combination regimen including pyridoxine; reduction in dose to 300 to 450 mg once daily or 600 mg for patients who develop toxicity, 3 to 4 times per week may be used.
Latent tuberculosis infection
:
10-15mg/kg orally every day
3-month regimen
<2 years: Not recommended
>12 years: 900mg orally weekly once for three months
Active tuberculosis disease
10-15mg/kg orally every day. Do not exceed 300mg every day
10-20mg/kg orally twice a week. Do not exceed 600mg/day
15 - 25
mg/kg
Tablet
Orally
once a day
15 - 25
mg/kg
Tablet
Orally
once a day
15 - 30
mg/kg
Tablet
Orally
once a day
200-300 mg/kg daily orally divided into 2-4 equal dosages; should not exceed more than 10 g daily
Sprinkle granules over acidic foods or mix them with acidic liquids
Future Trends
References
https://www.ncbi.nlm.nih.gov/books/NBK441916/
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» Home » CAD » Infectious Disease » Mycobacterium » Tuberculosis (TB)
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It most commonly affects the lungs but can also affect other parts of the body, such as the bones, lymph nodes, and brain. TB is transmitted through the air when an infected person speaks, coughs, or sneezes, and other people inhale the bacteria.
Symptoms of TB may include a persistent cough, chest pain, fatigue, weight loss, and fever. If left untreated, it can be life-threatening. It can be treated with a combination of antibiotics, but it is important to complete the full course of treatment to prevent the development of drug-resistant TB.
According to the World Health Organization (WHO), TB is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. In 2020, an estimated 10 million people developed TB, and 1.4 million died.
It is most prevalent in countries with high rates of HIV infection, poverty, and inadequate healthcare systems. The highest burden of TB is in the South-East Asia and Western Pacific regions, followed by the African region. Despite progress in reducing the global burden of TB, the disease remains a significant public health threat.
The WHO’s End TB Strategy aims to end the global TB epidemic by 2030 through a combination of measures, including expanding access to diagnosis and treatment, improving infection control, and developing new tools and strategies to prevent and control the disease.
The pathophysiology of tuberculosis involves the infection and colonization of the body by the bacterium Mycobacterium tuberculosis. When a person inhales droplets containing M. tuberculosis, the bacteria can enter the respiratory tract and begin to replicate. In most cases, the immune system can contain the infection and prevent it from spreading.
However, in some cases, the bacteria can evade the immune system and establish an infection in the lungs, known as active TB disease. M. tuberculosis is a slow-growing bacterium that can survive within the body for long periods. It can form clusters known as tubercles, which contain a mixture of bacteria, immune cells, and other materials. These tubercles can form in various parts of the body, including the lungs, bones, and lymph nodes.
In the early stages of infection, the immune system may be able to contain the bacteria and prevent them from spreading. However, if the immune system becomes compromised, the bacteria can multiply and cause active disease. Symptoms of TB may include a persistent cough, chest pain, fatigue, weight loss, and fever.
Mycobacterium tuberculosis is a type of bacterium that causes tuberculosis. It is a member of the M. tuberculosis complex, which includes other types of mycobacteria, such as M. africanum, M. bovis, and M. microti. M. tuberculosis is a slow-growing, obligate-aerobic bacterium that can survive in extreme conditions and is resistant to many antibiotics due to its high lipid content in the cell wall.
It is transmitted through the air when an infected person speaks, coughs, or sneezes, and other people inhale the bacteria. It is most commonly found in the lungs but can also affect other body parts. TB can be treated with a combination of antibiotics, but it is essential to complete the entire course of treatment to prevent the development of drug-resistant TB.
Tuberculosis is a severe and potentially life-threatening infection caused by the bacterium Mycobacterium tuberculosis. It can spread to other parts of the body, such as the bones, lymph nodes, and brain, and cause serious complications. If left untreated, TB can also lead to drug-resistant strains of the bacterium, which are more challenging to treat.
People with HIV are particularly at risk for complications from TB, as their compromised immune systems make it more difficult to fight off the infection. TB can also cause malnutrition and pose risks to pregnant women and their unborn babies. However, the outcome can be improved with timely and appropriate treatment, which is why people with TB need to complete the full course of therapy to ensure that the infection is fully eradicated and to prevent the development of drug-resistant TB.
Clinical History
Patients with secondary tuberculosis exhibit distinct clinical manifestations compared to primary progressive disease. In secondary tuberculosis, the immune response and hypersensitivity reactions are heightened, leading to a more severe tissue reaction. Consequently, these patients frequently develop cavities primarily located in the upper regions of the lungs.
A chronic cough is a finding associated with secondary tuberculosis. This persistent cough is often accompanied by coughing up of blood, which indicates lung tissue damage. Furthermore, patients with secondary tuberculosis commonly experience unintended weight loss. In addition to weight loss, secondary tuberculosis patients often suffer from low-grade fever.
This persistent mild elevation in body temperature results from the immune system’s efforts to combat the infection. Moreover, night sweats are a common complaint in secondary tuberculosis. These nocturnal episodes of excessive sweating can disrupt sleep and contribute to the overall debilitation experienced by the patients.
Physical Examination
Patients with secondary tuberculosis exhibit distinct clinical manifestations compared to primary progressive disease. In secondary tuberculosis, the immune response and hypersensitivity reactions are heightened, leading to a more severe tissue reaction. Consequently, these patients frequently develop cavities primarily located in the upper regions of the lungs. A chronic cough remains a prevalent symptom among the hallmark physical findings associated with secondary tuberculosis.
This persistent cough is often accompanied by hemoptysis, the coughing up of blood, which can be alarming and indicate lung tissue damage. Furthermore, patients with secondary tuberculosis commonly experience unintentional weight loss due to the metabolic demands imposed by the infection and the accompanying inflammatory response.
In addition to weight loss, secondary tuberculosis patients often suffer from low-grade fever. This persistent mild elevation in body temperature results from the immune system’s efforts to combat the infection. Moreover, night sweats are a common complaint in secondary tuberculosis. These nocturnal episodes of excessive sweating can disrupt sleep and contribute to the overall debilitation experienced by the patients.
Differential Diagnoses
Pneumonia
Histoplasmosis
Sarcoidosis
Malignancy
The primary treatment for TB involves a combination of antibiotics. The most commonly used drugs include isoniazid, rifampin, ethambutol, and pyrazinamide. These drugs are typically taken daily or several times a week for six to nine months, although the duration may vary depending on the type and severity of the infection.
TB treatment consists of two phases – the intensive phase and the continuation phase. During the intensive phase, patients receive a combination of four drugs for about two months to kill the bacteria and reduce their numbers rapidly. Following the intensive phase, the continuation phase involves a reduced drug regimen to eliminate any remaining bacteria and prevent relapse. To ensure adherence to the medication regimen and minimize the development of drug-resistant strains, it is recommended that TB patients receive DOT.
This involves healthcare providers or trained individuals directly observing patients taking their prescribed medications. Throughout the treatment process, regular monitoring is crucial. Patients undergo periodic check-ups, including physical examinations, sputum tests, and chest X-rays, to assess treatment progress and determine if any adjustments to the medication regimen are necessary.
Compliance with the full course of treatment is vital to achieve a successful outcome. In cases of drug-resistant TB, treatment can be more complex and prolonged. Drug-resistant strains require alternative medications or second-line drugs, which are often more expensive and can have more significant side effects. Treatment duration for drug-resistant TB can range from 20 months to 24 months, and in some cases, surgery may be required.
Indicated for pulmonary multidrug resistant tuberculosis (MDR-TB) :
Weeks 1-2: 400 mg orally daily
Weeks 3-24: 200 mg orally 3 times a week, with at least 2 days between doses
the maximum duration of therapy is 24 weeks
The combination regimen of bedaquiline, pretomanid, and linezolid iIndicated for pulmonary extensively drug resistant (XDR) or unresponsive MDR TB:
Pretomanid: 200 mg orally daily for 26 weeks
Bedaquiline: 400 mg orally daily for 2 weeks, following 200 mg 3 times a week for 24 weeks (a total of 2+24 weeks=26 weeks)
Linezolid 1200 mg orally daily for 26 weeks, if required adjust the dose
Indicated for Tuberculosis drug-resistant :
600
mg
Orally or IV
daily
as part of an appropriate combination regimen including pyridoxine; reduction in dose 300-450 mg once daily or 600 mg for patients who develop toxicity, 3-4 times per week may be used.
400mg orally/intravenous every day
Latent tuberculosis infection
:
>30kg:300mg orally every day for nine months
3-month regimen
900mg orally weekly once for three months
Active tuberculosis disease
5mg/kg orally/intramuscularly every day.Do not exceed 300mg every day
10mg/kg orally twice a week. Do not exceed 600mg/day
15 - 25
mg/kg
Tablet
Orally
once a day
60
days
15 - 30
mg/kg
Orally
once a day
4 g orally 3 times a day
Sprinkle granules over acidic foods or mix them with acidic liquids
The recommended treatment for pulmonary tuberculosis is the administration of rifampin 600 mg/isoniazid 300 mg (equivalent to 2 capsules) orally once a day
This fixed dosage has been proven to be therapeutically effective after the patient has been gradually adjusted to the individual components
Administer 10 mg/kg intravenously every five days for a total of 12 injections May be repeated after one month and simultaneously use with tryparsamide
Indicated for Multidrug-Resistant Pulmonary Tuberculosis:
Administer 100mg twice a day for 24 weeks.
Indicated for pulmonary multidrug resistant tuberculosis (MDR-TB) :
Age: ≥ 5 years
Weeks 1-2 (Weight ≥ 30 kg): 400 mg orally daily for 2 weeks
Weeks 3-24 (Weight ≥ 30 kg): 200 mg 3 times a week with at least 2 days between each dose
Weeks 1-2 (Weight 15-<30 kg): 200 mg orally daily 2 weeks
Weeks 3-24 (Weight 15-<30 kg): 100 mg 3 times a week with at least 2 days between each dose
Indicated for Tuberculosis drug-resistant :
600 mg Oral/IV daily as part of an appropriate combination regimen including pyridoxine; reduction in dose to 300 to 450 mg once daily or 600 mg for patients who develop toxicity, 3 to 4 times per week may be used.
Latent tuberculosis infection
:
10-15mg/kg orally every day
3-month regimen
<2 years: Not recommended
>12 years: 900mg orally weekly once for three months
Active tuberculosis disease
10-15mg/kg orally every day. Do not exceed 300mg every day
10-20mg/kg orally twice a week. Do not exceed 600mg/day
15 - 25
mg/kg
Tablet
Orally
once a day
15 - 25
mg/kg
Tablet
Orally
once a day
15 - 30
mg/kg
Tablet
Orally
once a day
200-300 mg/kg daily orally divided into 2-4 equal dosages; should not exceed more than 10 g daily
Sprinkle granules over acidic foods or mix them with acidic liquids
Refer to adult dosing
https://www.ncbi.nlm.nih.gov/books/NBK441916/
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. It most commonly affects the lungs but can also affect other parts of the body, such as the bones, lymph nodes, and brain. TB is transmitted through the air when an infected person speaks, coughs, or sneezes, and other people inhale the bacteria.
Symptoms of TB may include a persistent cough, chest pain, fatigue, weight loss, and fever. If left untreated, it can be life-threatening. It can be treated with a combination of antibiotics, but it is important to complete the full course of treatment to prevent the development of drug-resistant TB.
According to the World Health Organization (WHO), TB is one of the top 10 causes of death worldwide and the leading cause of death from a single infectious agent. In 2020, an estimated 10 million people developed TB, and 1.4 million died.
It is most prevalent in countries with high rates of HIV infection, poverty, and inadequate healthcare systems. The highest burden of TB is in the South-East Asia and Western Pacific regions, followed by the African region. Despite progress in reducing the global burden of TB, the disease remains a significant public health threat.
The WHO’s End TB Strategy aims to end the global TB epidemic by 2030 through a combination of measures, including expanding access to diagnosis and treatment, improving infection control, and developing new tools and strategies to prevent and control the disease.
The pathophysiology of tuberculosis involves the infection and colonization of the body by the bacterium Mycobacterium tuberculosis. When a person inhales droplets containing M. tuberculosis, the bacteria can enter the respiratory tract and begin to replicate. In most cases, the immune system can contain the infection and prevent it from spreading.
However, in some cases, the bacteria can evade the immune system and establish an infection in the lungs, known as active TB disease. M. tuberculosis is a slow-growing bacterium that can survive within the body for long periods. It can form clusters known as tubercles, which contain a mixture of bacteria, immune cells, and other materials. These tubercles can form in various parts of the body, including the lungs, bones, and lymph nodes.
In the early stages of infection, the immune system may be able to contain the bacteria and prevent them from spreading. However, if the immune system becomes compromised, the bacteria can multiply and cause active disease. Symptoms of TB may include a persistent cough, chest pain, fatigue, weight loss, and fever.
Mycobacterium tuberculosis is a type of bacterium that causes tuberculosis. It is a member of the M. tuberculosis complex, which includes other types of mycobacteria, such as M. africanum, M. bovis, and M. microti. M. tuberculosis is a slow-growing, obligate-aerobic bacterium that can survive in extreme conditions and is resistant to many antibiotics due to its high lipid content in the cell wall.
It is transmitted through the air when an infected person speaks, coughs, or sneezes, and other people inhale the bacteria. It is most commonly found in the lungs but can also affect other body parts. TB can be treated with a combination of antibiotics, but it is essential to complete the entire course of treatment to prevent the development of drug-resistant TB.
Tuberculosis is a severe and potentially life-threatening infection caused by the bacterium Mycobacterium tuberculosis. It can spread to other parts of the body, such as the bones, lymph nodes, and brain, and cause serious complications. If left untreated, TB can also lead to drug-resistant strains of the bacterium, which are more challenging to treat.
People with HIV are particularly at risk for complications from TB, as their compromised immune systems make it more difficult to fight off the infection. TB can also cause malnutrition and pose risks to pregnant women and their unborn babies. However, the outcome can be improved with timely and appropriate treatment, which is why people with TB need to complete the full course of therapy to ensure that the infection is fully eradicated and to prevent the development of drug-resistant TB.
Clinical History
Patients with secondary tuberculosis exhibit distinct clinical manifestations compared to primary progressive disease. In secondary tuberculosis, the immune response and hypersensitivity reactions are heightened, leading to a more severe tissue reaction. Consequently, these patients frequently develop cavities primarily located in the upper regions of the lungs.
A chronic cough is a finding associated with secondary tuberculosis. This persistent cough is often accompanied by coughing up of blood, which indicates lung tissue damage. Furthermore, patients with secondary tuberculosis commonly experience unintended weight loss. In addition to weight loss, secondary tuberculosis patients often suffer from low-grade fever.
This persistent mild elevation in body temperature results from the immune system’s efforts to combat the infection. Moreover, night sweats are a common complaint in secondary tuberculosis. These nocturnal episodes of excessive sweating can disrupt sleep and contribute to the overall debilitation experienced by the patients.
Physical Examination
Patients with secondary tuberculosis exhibit distinct clinical manifestations compared to primary progressive disease. In secondary tuberculosis, the immune response and hypersensitivity reactions are heightened, leading to a more severe tissue reaction. Consequently, these patients frequently develop cavities primarily located in the upper regions of the lungs. A chronic cough remains a prevalent symptom among the hallmark physical findings associated with secondary tuberculosis.
This persistent cough is often accompanied by hemoptysis, the coughing up of blood, which can be alarming and indicate lung tissue damage. Furthermore, patients with secondary tuberculosis commonly experience unintentional weight loss due to the metabolic demands imposed by the infection and the accompanying inflammatory response.
In addition to weight loss, secondary tuberculosis patients often suffer from low-grade fever. This persistent mild elevation in body temperature results from the immune system’s efforts to combat the infection. Moreover, night sweats are a common complaint in secondary tuberculosis. These nocturnal episodes of excessive sweating can disrupt sleep and contribute to the overall debilitation experienced by the patients.
Differential Diagnoses
Pneumonia
Histoplasmosis
Sarcoidosis
Malignancy
The primary treatment for TB involves a combination of antibiotics. The most commonly used drugs include isoniazid, rifampin, ethambutol, and pyrazinamide. These drugs are typically taken daily or several times a week for six to nine months, although the duration may vary depending on the type and severity of the infection.
TB treatment consists of two phases – the intensive phase and the continuation phase. During the intensive phase, patients receive a combination of four drugs for about two months to kill the bacteria and reduce their numbers rapidly. Following the intensive phase, the continuation phase involves a reduced drug regimen to eliminate any remaining bacteria and prevent relapse. To ensure adherence to the medication regimen and minimize the development of drug-resistant strains, it is recommended that TB patients receive DOT.
This involves healthcare providers or trained individuals directly observing patients taking their prescribed medications. Throughout the treatment process, regular monitoring is crucial. Patients undergo periodic check-ups, including physical examinations, sputum tests, and chest X-rays, to assess treatment progress and determine if any adjustments to the medication regimen are necessary.
Compliance with the full course of treatment is vital to achieve a successful outcome. In cases of drug-resistant TB, treatment can be more complex and prolonged. Drug-resistant strains require alternative medications or second-line drugs, which are often more expensive and can have more significant side effects. Treatment duration for drug-resistant TB can range from 20 months to 24 months, and in some cases, surgery may be required.
https://www.ncbi.nlm.nih.gov/books/NBK441916/
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