灰指甲初期症状一般先表现在12个指课件.pptVIP

Anergy Do not rule out diagnosis based on negative skin test result Consider anergy in persons with no reaction if HIV infected Overwhelming TB disease Severe or febrile illness Viral infections Live-virus vaccinations Immunosuppressive therapy. Anergy skin testing no longer routinely recommended Boosting Some people with LTBI may have negative skin test reaction when tested years after infection Initial skin test may stimulate (boost) ability to react to tuberculin Positive reactions to subsequent tests may be misinterpreted as a new infection Diagnosis of TB Evaluation for TB Medical history Physical examination Mantoux tuberculin skin test Chest radiograph Bacteriologic or histologic exam Symptoms of Pulmonary TB Productive, prolonged cough (duration of $3 weeks) Chest pain Hemoptysis Systemic Symptoms of TB Fever Chills Night sweats Appetite loss Weight loss Easy fatigability Medical History Symptoms of disease History of TB exposure, infection, or disease Past TB treatment Demographic risk factors for TB Medical conditions that increase risk for TB disease Mantoux Tuberculin Skin Test Preferred method of testing for TB infection in adults and children Tuberculin skin testing useful for Examining person who is not ill but may be infected Determining how many people in group are infected Examining person who has symptoms of TB Chest Radiograph Abnormalities often seen in apical or posterior segments of upper lobe or superior segments of lower lobe May have unusual appearance in HIV-positive persons Cannot confirm diagnosis of TB Arrow points to cavity in patients right upper lobe. Specimen Collection Obtain 3 sputum specimens for smear examination and culture Persons unable to cough up sputum, induce sputum, bronchoscopy or gastric aspiration Follow infection control precautions during specimen collection Smear Examination Strongly consider TB in patients with smears containing acid-fast bacil