Comparison of Two Clinical Case Definitions in Detecting ...
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Transcript of Case detecting
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Tuberculosis:Tuberculosis:
case detectingcase detecting
Lecturer: Ph.D.Lecturer: Ph.D.
M.G.DolynskaM.G.Dolynska
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Main ways of the new casesMain ways of the new cases
revealingrevealing PassivePassive
Obligate diagnostical minimum (clinical,Obligate diagnostical minimum (clinical,radiological examination, direct smearradiological examination, direct smearmicroscopy)microscopy)
ActiveActive
Screening XScreening X--ray examination for adultsray examination for adultsScreening Mantoux test for childrenScreening Mantoux test for children
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ZiehlZiehl -- Nielsen stainingNielsen staining
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ZNZN--stainingstaining
Advantages Disadvantages Advantages Disadvantages CheapnessCheapness
SimplicitySimplicity
QuicknessQuickness
Low sensitivityLow sensitivity
Lack of viability andLack of viability and
drug sensitivitydrug sensitivityevaluationevaluation
Inability to detectInability to detectmycobacteria typesmycobacteria types
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Cultural testCultural test
LewensteinLewenstein--YensenYensen
Middlebrook setMiddlebrook set BACTEC setBACTEC set
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CultureCulture
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Cultural methodsCultural methods
Advantages Disadvantages Advantages Disadvantages High sensitivityHigh sensitivity
Drug resistanceDrug resistance
evaluationevaluation
Possibility of typingPossibility of typing
Taking timeTaking time
ExpensivenessExpensiveness
Hazard to theHazard to thepersonnelpersonnel
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Mantoux skin test with 5TU (Seibert) interpretationMantoux skin test with 5TU (Seibert) interpretation
Induration 5 mmInduration 5 mm Children in close contact with known or suspectedChildren in close contact with known or suspected
contagious cases of tuberculosis diseasecontagious cases of tuberculosis disease Children suspected to have tuberculosis disease becauseChildren suspected to have tuberculosis disease because
ofof ffindings on chest radiograph consistent with active orindings on chest radiograph consistent with active orpreviously active tuberculosispreviously active tuberculosis
Clinical evidence of tuberculosis diseaseClinical evidence of tuberculosis disease Children receiving immunosuppressive therapy or withChildren receiving immunosuppressive therapy or with
immunosuppressive conditions, including HIV infectionimmunosuppressive conditions, including HIV infectionInduration 10 mmInduration 10 mm
Children at increased risk of disseminated disease:Children at increased risk of disseminated disease: Those younger than 4 years of ageThose younger than 4 years of age Those with other medical conditions, includingThose with other medical conditions, including
Hodgkins disease, lymphoma, diabetes mellitus,Hodgkins disease, lymphoma, diabetes mellitus,chronic renal failure, or malnutritionchronic renal failure, or malnutrition
From American Academy of Pediatrics. Tuberculosis.From American Academy of Pediatrics. Tuberculosis.
In: Red book: 2003 report ofIn: Red book: 2003 report of the committee on infectious diseases. 25ththe committee on infectious diseases. 25th edition. Elkedition. ElkGrove (IL): Pickering LK; 2003Grove (IL): Pickering LK; 2003..
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Mantoux skin test with 5TU (Seibert) interpretationMantoux skin test with 5TU (Seibert) interpretation
((continuationcontinuation))
Children with increased exposure to tuberculosis disease:Children with increased exposure to tuberculosis disease: Those born, or whose parents were born, in highThose born, or whose parents were born, in high--prevalenceprevalence
regions of the worldregions of the world
Those frequently exposed to adults who are HIVThose frequently exposed to adults who are HIV--infected,infected,homeless, users of illicit drugs, residents of nursing homes,homeless, users of illicit drugs, residents of nursing homes,incarcerated or institutionalized, or migrant farm workersincarcerated or institutionalized, or migrant farm workers
Those who travel to highThose who travel to high--prevalence regions of the worldprevalence regions of the worldInduration 15 mmInduration 15 mm
Children 4 years of age or older without any risk factorsChildren 4 years of age or older without any risk factors
From American Academy of Pediatrics. Tuberculosis.From American Academy of Pediatrics. Tuberculosis.In: Red book: 2003 report ofIn: Red book: 2003 report of the committee on infectious diseases. 25ththe committee on infectious diseases. 25th edition. Elkedition. Elk
Grove (IL): Pickering LK; 2003Grove (IL): Pickering LK; 2003
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Mantoux skin test procedureMantoux skin test procedure
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Result appreciationResult appreciation
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Result appreciationResult appreciation
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Hyperergic tuberculin reactionHyperergic tuberculin reaction
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PCRPCR--testtest
1.1. Probe processingProbe processing(DNA purification)(DNA purification)
2.2. DNA meltingDNA melting3.3. Primers hybridizationPrimers hybridization
4.4. Complement DNAComplement DNA
chains buildingchains building
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Radiological examination:Radiological examination:purposespurposes
Case detectingCase detecting
Differential diagnosisDifferential diagnosis
TreatmentTreatment controlcontrol
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Radiological examination:Radiological examination:
main approachesmain approaches Screening (fluoroscopy, roentgenoscopy)Screening (fluoroscopy, roentgenoscopy)
Additional examinationAdditional examination tomographytomography
Movement observingMovement observing -- radioscopyradioscopy
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Routine clinical examinationRoutine clinical examination
Complaints:Complaints:
General:General:
Fatigue, malaise, weakness, sweating, feverFatigue, malaise, weakness, sweating, fever
Local:Local:
Cough with mucous sputum, hemophtysisCough with mucous sputum, hemophtysis
Chest painChest pain DyspnoeDyspnoe
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Routine clinical examinationRoutine clinical examination
Anamnesis:Anamnesis:
Diseases onset:Diseases onset:
SuddenSudden
InsidiousInsidious
WavyWavy
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Respiratory tract examinationRespiratory tract examination
Percussion: dull sound, tympanic soundPercussion: dull sound, tympanic sound
Auscultation: weakened breathing, dry orAuscultation: weakened breathing, dry ormoisture ralesmoisture rales
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Routine clinical examinationRoutine clinical examination
Anamnesis:Anamnesis:
Social and professional historySocial and professional history
At risk:At risk:
Low incomeLow income
Profession: industry workers, miners, healthProfession: industry workers, miners, healthcare workerscare workers
Family history: TB contactFamily history: TB contact
Personal history: diseases, substances abusingPersonal history: diseases, substances abusing
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Routine blood testRoutine blood testNormal Normal TuberculosisTuberculosis
HbHb
LeukocytesLeukocytes
eosinophileosinophilband neutrophilband neutrophil
segm. Neutrophilsegm. Neutrophil
lymphocytelymphocyte
monocytemonocyte
ESRESR
120120--160g/l160g/l
4,04,0 -- 9,09,0
0,50,5 -- 5%5%11 -- 6%6%
4747 -- 72%72%
1919 -- 37%37%
33 -- 11%11%
22 -- 1515 mm/hourmm/hour
(up to 15)(up to 15)
(up to 30(up to 30mm/hour)mm/hour)