Medical Evaluation in Diagnosing Tuberculosis 2008 Mayo 在结核2008梅奥诊断医学评价课件.pptVIP

Tuberculosis Evaluationin the Underserved Community John W. Wilson, MD Division of Infectious Diseases Mayo Clinic, Rochester Estimated TB incidence rate, 2006 Estimated HIV prevalence in new TB cases, 2006 Common Lack of Medical Resources in 3rd World Setting Typically unavailable or not done: Mycobacterial cultures Drug susceptibility/resistance testing Tuberculin skin testing High % positive – from TB infection and / or prior BCG vaccination Limited availability CXR – if hospital / clinic accessible 2nd-line TB drugs Directly Observed Therapy (DOT) Standard Components of TB/TLBI Evaluation in USA / UK Patient History Symptoms PMHx, comorbidities FHx and patient demographics Physical examination Radiologic evaluation CXR, CT Laboratory testing TST, QFN If available: CBC, LFTs, Tissue histology, cultures A New Approach to TB Investigation in Underserved Location:4 Steps to Success: The Host The Syndrome The Microbiology The Treatment 1st - Define the Host Defining the Host Immunocompetent vs. Immunosuppressed – **Especially HIV status Higher rates of primary TB disease More atypical pulmonary findings Higher rates of extrapulmonary disease dissemination Other medical comorbidities: Diabetes Adult vs. Child Living status: community vs., hospital, jail, shelter etc. Other cases of TB reported, pattern of spread? Adult: Reactivation Pulmonary TB More common presentation in immunocompetent, HIV-neg. adults Typical Symptoms - nonspecific: Dry, NP cough Chest pain, pleurisy Hemoptysis Dyspnea Hoarseness Constitutional symptoms: (malaise, feverish, sweats, weight loss) Predilection for upper lung zones CXR of Pulmonary TB Disease – ReactivationTypically in Immunocompetent Adult Location: apical and/or posterior segment of RUL; apicoposterior segment of LUL or superior segment of either lower lobe Infiltrate: fibronodular, irregular with variable coalescence and cavitation Cavities: thick, moderately irregular walls Volume loss: progressive