A child presents symptoms suggestive of tuberculosis, namely a respiratory infection with a productive cough. Microscopic examination of the child's sputum reveals no acid-fast rods. however, examination of gastic washings reveals the presence of both acid-fast and non-acid-fast bacilli. do you think the child has active tuberculosis? explain.

I have a persistent cough but it only happens when I felt hot. sometimes it also occurs during sleeping. I've had this about more than a month. I have no loss of my appetite and no loss weight too. I can eat a lot. But this cough really keep me in confuse because for sometime, i cough for the whole day. I've done the x-ray but nothing interesting in there. Have also a lot of kind of medicine

Symptoms are:
1. Cough that is worse in the morning hours; hemoptysis (blood in the sputum) can accompany cough
2. Mild fever, headace, chills, night sweats
3. Chest pain from pleurisy
4. Breathlessness
5. Swollen glands
6. Feeling unwell, fatigue
7. Signs of pnemonia

I think you dont have tuberculosis, maybe just an allergy on air thats why you cough when exposed to it. if you already consulted a doctor and still not getting well after taking his medicine prescription, then its time to change your doctor

Cough deep. Get sputum examined for Acid fast bacteria. that confirms T.B. Evening rise of temperature, dry cough,and loss of weight are other symptoms.

Please see the webpages for more details on Tuberculosis. Please consult a chest physician for second medical opinion.

It could be heat induced asthma.

Tuberculosis is a chronic infectious disease in 90% of cases affect the pulmonary system, and in 10% – and other organ systems (central nervous system, heart, eyes, skin, organs of the abdominal cavity, bones and joints, Uro-genital system etc.).
in the past, disease was a problem in the population of poor countries. Today, tuberculosis is widespread in almost all developed countries in the world.
The germ of tuberculosis is Mikobakterium tuberkulozis (Koch’s bacterium), which is characterized by considerable resistance in the external environment, especially long remained separated in sputum of patients, even after their drying.
Most people who become infected with TB bacteria are able to “fight” with them and stop their growth – bacteria remain to live in the body of an infected person, but not active. after a while it can be activated by itself. This condition is called hidden tuberculosis infection – people with a hidden infection not identified the disease symptoms and can not infect others.
Sources of infection may be tuberculosis humans and animals (mainly cattle, less pigs, poultry, etc.) and their products.
Penetration of the infection most often occurs in the airways. Coughing, sneezing, conversation sick pay tuberculosis bacilli into the air. Airborne by coughing and expectoration people in the vicinity could be infected directly by airborne means. in the sputum of patients contains millions of bacteria. Infection can be prenese by dust in the rooms and streets where tuberculosis bacteria remain viable for a long time.
Infection with tuberculosis is possible dietary: by consuming milk from diseased cows or products made from it; consumption of raw or inadequately cooked infected eggs, for use nanedostatachno heat-treated meat from sick birds and pigs.
it is possible, though rare, infection with tuberculosis to become a contact time in the damaged skin and mucous membranes, which is typical for people with occupations related to farming.
Direct contact with someone with tuberculosis;
Smoking and alcohol abuse;
Comorbidities, such as: chronic nonspecific lung diseases (chronic bronchitis, silicosis bronhoektazii), diabetes ulcers of the stomach, mental illness, and other allergic conditions;
Lack of vaccination against tuberculosis or poor implementation of same;
Reduced resistance capabilities of the organism as a result of: spent infections (measles, whooping cough, flu and flu-like conditions, etc..) Malnutrition (especially protein deficiency in food) ihipovitaminozi, unsanitary working conditions and lifestyle, puberty, pregnancy and lactation;
Carriers of HIV.
Symptoms include:
Cough that can last weeks, beginning in a slight cough and progresses in the disease process and increases the cough becomes wet;
Expectoration – the sick pay mainly morning phlegm, sometimes mixed with blood;
Fever – the patients have fever for an extended period of time (even months). it is possible that the disease can proceed without fever;
Sweating – it was plenty, especially at night;
Chest pain – they occur in most patients between the shoulder blades in the shoulder and lateral chest while enhancing breathing and cough;
Anorexia – it leads to weight reduction;
Shortness of breath – this feature is characteristic of advanced stages of disease;
Fatigue and frustration – these symptoms continue longer.
Tuberculosis can occur completely asymptomatic in about 15% of cases. in adults often resembles pneumonia or other infectious disease.
The worst problem – and the easiest to solve – is bad diagnosis. Over 80% of all cases are concentrated in 22 countries, 9 of which are in Africa, 11 in Asia and Russia. Nearly 40% of all cases in these countries remain untreated. it is estimated that 1.4 million people suffer from both HIV / AIDS and tuberculosis, but only a quarter of them were found. HIV increased 20-fold Russian tuberculosis.
Most types of TB can be cured with drugs for 10 euros, if diagnosed in time. in patients who are late to start treatment, microbes can develop resistance to most common drugs. Treatment can cost thousands of dollars and take two years, with no guarantee of success. “Without significant investment in technology and opportunities for prevention, diagnosis and treatment, sustained virus strain may become dominant in the coming decades,” warns the study.

A cough is the main symptom, but you may also get a fever, night sweats adn probably weight loss.

Symptoms of active TB may include:

* Ongoing cough that brings up thick, cloudy, and sometimes bloody mucus (sputum) from the lungs.
* Fatigue and weight loss.
* Night sweats and fever.
* Rapid heartbeat.
* Swelling in the neck (when lymph nodes in the neck are infected).
* Shortness of breath and chest pain (in rare cases).

Sometimes, when you are first infected, the disease is so mild you don't know you have it. This is also true for people with latent TB because they have no symptoms.

No symptoms – in early phases; also if they only have latent TB infection
Early infection symptoms:
Fever,Chills,Sweating,Night sweats,Flu-like symptoms,Gastrointestinal symptoms,Weight loss,No appetite,Weakness,Fatigue.

Symptoms of chronic lung infection (pulmonary tuberculosis):
Persistent cough,Chest pain,Coughing up bloody sputum,Shortness of breath,Breathing difficulty,Recurring bouts of fever,Weight loss,Progressive shortness of breath,
a bad cough that lasts longer than 2 weeks,pain in the chest,coughing up blood or sputum (phlegm from deep inside the lungs)

well,T.B is a systemic disease & may affect all body systems like meningies ,pericardium,renal system,colon …etc.
large population infected with T.B & passed unnoticed,then under special condition this dorment illness becomes active with severe symptoms.

*symptoms:
1-cough
2-night sweating
3-wieght loss&anorexia
4-fever
5-malaise with general weakness
#in more advanced cases there will be:
1-hemoptysis(coughing bloody sputum)
2-pleural effusion(fluid in pleural cavity)
3-pleurisy

all these symptoms are suggestive for T.B which need to be investigated.

*investigation:
1-multiple sputum samples examination for Acid fast Bacilli
2-chest x-ray:which reveals the presence of a patch which may indicate consolidatin,cavitation or fibrosis.
3-other techniques.

treatment of T.B comprises a combination of drugs for 6 months.

*treatment:
1-initial phase:lasts two months on 3-4 drugs:
a.rifampicin
b.isoniazid
c.pyrazinamide
#if resistance possible we add ethambutol.
2-continuation phase:lasts four months on 2 drugs:
a.rifampicin
b.isoniazid
#also we give pyridoxine throughout all the treatment period.
#steroid may be indicated in case of meningeal or pericardial disease.

Tuberculosis is a brutal illness. A tiny microorganism called tubercle bacillus causes it,hence it named tuberculosis. This germ enters into body through the nose mouth, and the windpipe, and stay down in tile lungs. It increases by millions and produces small raised spots called tubercles.

Tuberculosis symptoms:Loss of power, color and weight:

   Tuberculosis may take place anywhere in the body but, more usually, it affects the lungs, intestines, bones, and glands. Pulmonary tuberculosis (tuberculosis of the lungs) is by far the most ordinary type of tuberculosis. It has a tendency to consume the body and the patient loses force, color, and weight.

Temperature rise, persistent cough, breathing troubles and body pain:

Other symptoms are a rise in temperature, particularly in the evening, a constant cough and hoarseness, obscurity in breathing, pain in the shoulders, heartburn, chest pain, and blood in the sputum.

Tuberculosis causes:

Lowered resistance of the body:Poorer resistance of the body system is the main cause of this disease. Lowered resistance can result from intake of improper and insufficient foods or diets, and living in ill-ventilated houses.

Inappropriate lifestyle, Smoking, drinking and stress:

Other causes include exposure to cold, loss of sleep, adulterated air, a sedentary life, overwork, use of tobacco, liquor and other unsafe drinks. these factors made the ground for the development of germs of various kinds, including tubercle bacillus. these germs may be present in the body but are quite safe for those who are endowed with vitality and natural resistance.

Home Remedies for Tuberculosis:

Tuberculosis treatment with Milk Diet:

The chief healing agent needed for the treatment of tuberculosis is calcium. Milk is only the richest food base for the supply of natural calcium to the body and should be taken liberally. in fact an exclusive milk diet is measured valuable in tuberculosis. However, a preliminary fast for three days, comprising of raw juices, if possible, orange juice, is important before the milk diet is begun. The method is to take half a glass of orange juice diluted with an identical amount of water every two hours from 8 a.m. to 8 p.m. For the full milk diet, the patient must take a glass of milk every two hours from 8 a.m. to 8 p.m. on the first day, followed by a glass and a half each hour on the nextday. thereafter, the amount can be gradually enlarged until the patient takes a glass every half an hour. normally, six litres of milk should be taken daily. in the case of women, five litres should be enough. Raw milk, that is, milk, which has not been pasteurised, creates the best results, offers it is clean and pure. Milk must be reserved cool and away from dust, flies, odors, and sunlight. It should be softly stimulated before use to guarantee an even sharing of cream. It should be sipped very slowly so as to be thoroughly mixed with saliva which dilutes it and, to a great extent, supports itsdigestion. nearly eight to six weeks of a full milk diet is essential for the victory of the treatment. A substantial amount of rest is essential with a milk diet and the patient should lie down for about two hours twice a day.

Tuberculosis treatment with Custard Apple:

Custard apple is considered as one of the most precious remedies for tuberculosis. It is said to have the qualities of rejuvenating drugs. Ayurvedic practitioners made fermented liquor called sitaphalasava from this fruit, when in season, for use as a remedy in the treatment of this disease. The pulp of two custard apples and twenty-five seedless raisins should be simmered in water on a slow fire. when about one-third of the water is left, it should be filtered, and then mixed with two teaspoons of crushed sugar candy, and a quarter teaspoon each of the powder of cardamom, cinnamon, and certain other condiments.

Tuberculosis treatment with Indian Gooseberry:

The Indian gooseberry is precious remedy for tuberculosis. A tablespoon each of fresh amla juice and honey, mixed jointly, should be taken every morning in treating this disease.its normal use will support vigour and vitality in the body within a few days

Tuberculosis treatment with Pineapple:

Pineapple juice is helpful in the treatment of tuberculosis. It has been found to be useful in dissolving mucus and aiding revival. This juice was used often in the past in treating this disease when it was more ordinary than it is at present. one glass of pineapple juice is advisable daily

Tuberculosis treatment with Banana:

Bananas are measured helpful in tuberculosis. The juice of the plantain or the normal cooking bananas works miracles in tile treat of tuberculosis. It assert to have cured patients in a higher stage of this disease with frequent cough, plentiful expectoration and high fever in two months, by this treatment

Tuberculosis treatment with Orange:

Oranges are helpful in the treatment of tuberculosis. A glass of orange juice must be mixed with a pinch of salt and a tablespoon of honey and taken every day by the patient. due to its salty action in the lungs, it eases expectoration and defends the body from minor infections.

Diet for Tuberculosis:

Keep away from devitalizing foods and strong tea, coffee etc.The patient must avoid all devitalizing foodstuff such as white bread, white sugar, and refined cereals; puddings and pies; tinned and sealed foods.

Other Tuberculosis treatment:

Take total rest and avoid stress:

The patient should totally rest his mind and body. any sort of stress will delay healing.

Exposure to fresh air and sunlight:

Fresh air is always significant in curing the disease, and the patient should pay out most of the time in the open air and sleep in a well-ventilated room. Sunshine is also necessary as tubercle bacilli are killed quickly by exposure to the sun’s rays

Avoid strain and have mental distraction:

Other helpful steps towards curing the disease are avoidance of strain, slow massage, deep breathing, and a light occupation to make sure of mental distraction.

Reference HealthOnclick

devika – About the Author:

Knowledge and Persistence leads to successI have always been fascinated by the question ,why some people can and others can’t? I spent years trying to figure this out. at first it was mainly for myself. I remember growing up with little confidence and under the impression that others were more capable than I was. The fact was that this impression was true. It was true because i believed it.

Tuberculosis  Complete DRUGS – ATT (ANTITUBERCULAR TREATMENT)  TREATMENT with Resistant and MDR Tubercular Treatment in All Cases

Complete RUGS – ATT (ANTITUBERCULAR TREATMENT)  TREATMENT

Case definitions:

• 1. Tuberculosis suspect : any person with symp­toms or signs suggestive of tuberculosis like cough more than 2 weeks.
• 2. Case of tuberculosis: A patient in whom tuber­culosis is confirmed bacteriologically
• 3. Definite case of tuberculosis : A patient with positive culture for M. tuberculosis complex or patient with 2 sputum smears showing AFB

Complete RUGS – ATT (ANTITUBERCULAR TREATMENT)  TREATMENT

History of treatment – Definitions for diagnosis:

• 1. New -A patient who has never taken antituber­cular treatment or taken for less than a month.
• 2. Relapse -A patient treated for TB and declared cured, or full treatment taken but smear or cul­ture for tuberculosis is positive.
• 3. Treatment after failure – A patient given an again, after failed previous treatment
• 4. Treatment after default – If a patient, bacterio­logically positive, interrupts treatment for 2 moths or more and starts an again.
• 5. Transfer in – A patient transferred from another TB centre for continuation of treatment.
• 6. other – any other case like chronic case, spu­tum positive at the end of repeat treatment.
• Sometimes pulmonary and extra pulmonary relapse cases may be smear-negative.

Complete RUGS – ATT (ANTITUBERCULAR TREATMENT)  TREATMENT

RUGS – ATT (ANTITUBERCULAR TREATMENT) there are 3 main properties of antituberculous drugs:

• 1. Bactericidal action
• 2 Sterilizing activity
• 3-To prevent resistance.

The first line agents consist of Isoniazid, Rifampin, Pyrazinamide, Ethambutol.

• These drugs are given orally, once a day.
• Peak level is at 4 hours and effect lasts for 24 hours. Second line drugs have lower efficacy and more toxicity. These are streptomycin, kanamycin, amikacin, capreomycin, ethionamide, cycloserine, and PAS(Paraamino salicylic acid).
• Other drugs are Ofloxacin, Levofloxacin, Gatifloxacin, Moxifloxacin, Clofazimine, thiacetazone, amoxycillin and linezolid.
• Isoniazid and Rifampicin are strong bactericidal drugs. Pyrazinamide and streptomycin are also bactericidal Streptomycin is bactericidal against rapidly multiply­ing tubercle bacilli.
• Rifampicin is the most potent sterilizing drug. Ethambutol and thiocetazone prevent resistance to drugs.

Standard Treatment Regimens:

Treatment is started with:

• 1 st–  intensive phase for 2 months and
• 2 nd– continuation phase for 4 – 6 months.

Intensive phase consists of Isoniazid, Rifampicin,  Pyrazinamide, and EthambutoL. This intensive phase results in rapid killing of tubercle bacilli.

• In two weeks the infectious patient becomes non­infectious, symptoms subside.
• If patient is smear positive he becomes smear nega­tive in two months.

Continuation phase consists of lesser drugs for longer time.

• This makes the patient disease-free and prevents re­sistance and relapse.
• Patients with large bacillary load (which means smear­positive or HIV-infected patients),’ are given short course chemotherapy with four drugs during initial phase and two drugs during continuation.
• Patients negative for HIV and smear negative tuber­culosis are given rifampicin, isonex, pyrazinamide and ethambutol.
• Ethambutol may not be given in young children and primary tuberculosis.

Retreatment Regimen:

• For patients with smear or culture positive tuberculo­sis, 5 drugs in initial phase and 3 drugs in continua­tion phase should be given.
• Rifampicin, Isonex, Ethambutol are given throughout the treatment.

Standard code for Anti- TB regimens:

• Each antitubercular drug has an abbreviation as fol­lows:
• Rifampicin – R
• Isoniazid – H
• Pyrazinamide – Z
• Streptomycin – S 
• Ethambutol – E
• Thioacetazone – T.

Any regimen consists of :

1. Initial phase
2. Continuation phase

• The number before a phase is duration of that phase in months.
• Letters in brackets indicate the names of drugs.
• A subscript after the letters in brackets indicates num­ber of doses per week. Eg. 2 (HRZE) / 4 (HR)3
• This means that initial phase of 2 months consists of Isoniazid, Rifampicin, Pyrazinamide, Ethambutol. the

TB Diagnostic TB Patients


Category

• New smear positive patients; New smear negative PTB with extensive parenchymal involvement;
• Severe concomitant HIV disease or severe forms of EPTB
• Previously treated sputum smear-positive PTB :
• - relapse;

treatment after interruption; treatment failure

• New smear negative PTB (other than in Category I); Less severe forms of EPTB
• Chronic and MDR – TB cases (still sputum positive after supervised re-treatment)

Treatment Regimen in Special Conditions

 Pregnancy:

• Streptomycin is unsafe. it is hepatotoxic to fetus and so should not be used in pregnancy.

Breastfeeding :

• All drugs are safe. Baby can be given Isoniazid during infectious stage of mother and for 3 months after that.

Oral contraception:

• Rifampicin interacts with oral contraceptives and de­creases their efficacy.

Liver disease:

• Isoniazid, Rifampicin and Pyrazinamide can cause hepatitis.
• Rifampicin is least toxic, but can cause cholestatic jaundice.
• Pyrazinamide is most hepatotoxic.
• Patients with chronic liver disease should not take Pyrazinamide.
• In chronic liver disease patient can take isoniazid and rifampicin with streptomycin and etham­butol for 8 months.
• In acute he(?atitis, treatment should be delayed till hepatitis resolves otherwise streptomycin and etham-
• continuation phase is of 4 months consisting of Iso­niazid and Rifampicin given 3 times / week.

TB treatment regimens

1. Initial phase (Daily Continuation phase
2. or 3 times weekly) (Daily or 3 times weekly)a

• Specially designed standardized or individualized regimens are suggested for this category
• ethambutol can be given for 3 months and when hepatitis is resolved, isoniazid and rifampicin may be given.
• If acute hepatitis does not resolve for many months then only Streptomycin and Ethambutol should be continued for 12 months.

Renal Failure:

• In renal failure, Isoniazid, Rifampicin and Pyrazina­mide can be given in normal doses.
• Pyridoxin should be given with Isoniazid to prevent peripheral neuropathy if renal failure patients.
• Streptomycin and Ethambutol are avoided or given in low doses.
• Thiocetazone should not be used.
• Patients with renal failure should be on 2 HRZ / 4 HR.

HIV infected patients:

• Thiocetazone is not given. Rest of the drugs can be given.

Chronic and MDR (Mutli-Drug Resistant) TB :

• Chronic tuberculosis is a patient with tuberculosis who. is sputum-positive after standard treatment with es­sential drugs given for complete duration.
• MDR TB is a patient who is Multi-Drug Resistant, i.e. who has active tuberculosis with bacilli resistant to at least Rifampicin and Isoniazid.

Minor

• Anorexia, nausea, abdominal pain Joint pains.
• Burning sensation in the feet
• Orange j red urine
• Pyrazinamide Isoniazid

Major

• Itching, skin rash Deafness (no wax on auroscopy) Dizziness (vertigo and nystagmus) Jaundice (other causes excluded) hepatitis
• Confusion (suspect drug induced acute liver failure if jaundice present)
• Visual impairment (other causes excluded)
• Shock, purpura, acute renal failure
• Thioacetazone (SHRZ) Streptomycin
• Isoniazid, Pyrazinamide, rifampicin
• Reserved drugs for tuberculosis are Amikacin, Kapriomycin, Ciprofloxacin, Cycloserine, Ethionamide, Kanamycin, Ofloxacin, p-aminosalycilic acid.

Management

• Continue anti-TB drugs, check drug doses Give drugs with small meals or last thing at night
• Aspirin
• Pyridoxine 100 mg daily
• Reassurance, Patients should be told when starting treatment that this commonly happens and is normal.

Stop responsible drug(s) stop anti-TB drugs

• Stop streptomycin use ethambutol
• Stop anti-TB drugs
• Urgent liver function tests and prothrombin time

Management of Drug Induced Hepatitis:

• Isoniazid, Pyrazinamide, Rifampicin, and rarely Etham­butol can damage the liver.
• When a patient develops hepatitis during tubercular treatment, all an should be stopped till liver func­tion tests become normal, or an is not given for 2 weeks after jaundice has disappeared. Rifampicin can give rise to jaundice without hepatitis and symptoms.
• For patients with drug-induced hepatitis Streptomy­cin, and Ethambutol may be given.

Anti Tuburculous Drug

Isoniazid

• • Highly bactericidal
• · given orally (1M also available)
• · Dose 5 mgjkg or 300 mgjday
• · Preventive dose 300 mgjday for 6 months
• · Contraindications – Active liver disease,

Hypersensitivity.

• In malnutrition, alcoholics, and diabetics, patient should be given pyridoxine 10 mgjday with Isoniazid.

Adverse Effects :

• Peripheral neu ropathy Optic neuritis
• Toxic psychosis Generalized convulsions Hepatitis.

Side effects :

• Nausea
• Vomiting Dizziness
• Blurred vision Slurring of speech Seizures.

Rifampicin –

• Strong bactericidal drug
• Should be given 30 minutes before meals Dose is 10 m k or 150 – 600 mg daily
• The drug causes red coloration of urine, tears, saliva, sweat, sputum and contact lenses. Contraindications:
• Hypersensitivity Liver dysfunction.

Adverse effects :

• Gastro-intestinal disturbances Fever
• Flu-like syndrome Thrombocytopenia Skin rashes Exfoliative dermatitis Oliguria
• Dyspnoea
• Hemolytic anaemia
• Hepatitis (which may be fatal).

Pyrazinamide

• Weak bactericidal, potent sterilizing activity. Dose – 30 mgLkgLQay.

Contraindications :

• Hypersensitivity Hepatic impairment.

Adverse effects :

• Gastrointestinal disturbances Increased serum transaminases Hyperuricemia
• Gout
• Arthralgia.

Streptomycin it is bactericidal.

• Given by deep intramuscular injection.
• Dose – 15 mg/kg/day or 750 mg – 1 gm /day. Contraindications :
• Hypersensitivity Auditory nerve deafness Myasthenia gravis
• Should not be used in pregnancy as it causes deafness and nephrotoxicity in the fetus.

Adverse effects :

• Injection abscess Hypersensitivity
• Impairment of vestibular function – Headache, vomiting, vertigo and tinnitus
• Nephrotoxicity
• Hemolytic anaemia
• Aplastic anaemia
• Agranulocytosis
• Thrombocytopenia
• Streptomycin should not be given to patients who are to receive neuromuscular blocking agents during anaesthesia.

Ethambutol –

• Its role is to prevent emergence of resistant strains. Dose – 15 mgLl<g/daL

Contraindication:

• . Hypersensitivity
• .• Optic neuritis
• Creatinine clearance < 50 ml/min.

Adverse effects :

• Optic neuritis – Visual impairment and loss of colour vision
• Blindness
• Peripheral neuritis