Management Of Skin Itching And Rash

The approach depends on whether the patient is receiving thioacetazone. In populations with a high TB HIV prevalence, thioacetazone is the drug most likely to cause skin reactions. Try to determine if the skin reaction was present before anti-TB drugs were started, as many HIV-positive patients have itchy skin lesions as a result of HIV infection. 10.7.1 Treatment regimen includes thioacetazone If a patient starts to itch, and there is no other obvious cause (e.g. scabies), stop the anti-TB...

Pulmonary TB suspects

In the majority of cases, PTB suspects attend as outpatients for the diagnosis of TB. In some cases it is necessary to admit PTB suspects to hospital. If possible admit them to a separate ward from other patients. There are often no facilities to separate PTB suspects from other patients. At least try to keep PTB suspects in a part of the ward away from other patients. Staff should also encourage PTB suspects to spend daylight hours outside the ward if the weather is good. Sputum for smear...

The Role Of The Expanded Programme On Immunization

BCG is not the only immunization in the EPI that may help to protect a child against TB. Measles and whooping cough lower a child's resistance to TB. So whenever you treat a child for TB, check his or her immunization record. If the child has not received scheduled immunisations, encourage the mother to bring him or her for immunizations, once symptoms of TB have resolved. WHO has collaborated with UNICEF in establishing guidelines for immunization. The recommendation is that individuals with...

IoTb management of hepatitis

Most anti-TB drugs can damage the liver. Isoniazid and pyrazinamide are most commonly responsible. Ethambutol is rarely responsible. When a patient develops hepatitis during anti-TB treatment, the cause may be the anti-TB treatment or something else. It is often difficult to find out. Try to rule out other possible causes before deciding that the hepatitis is drug-induced. Hepatitis presents with anorexia, jaundice and often liver enlargement. If you diagnose drug-induced hepatitis, stop the...

Ask the mother of a child with suspected TB for the childs road to health card growth card If the card is available

In the absence of these clues, TB is less likely. However, always take a clear history and examine the child carefully. There may be clues to other diagnoses, such as asthma or an inhaled foreign body. Note the nutritional state of the child and look for signs of HIV infection (see Chapter 7). Examine the chest.There may be unexpected findings, such as consolidation or pleural effusion. A child with these abnormalities who does not look acutely unwell (e.g. no signs of respiratory distress such...

Clinical Spectrum Of Hivrelated Disease

In general, pathogens may be high-grade or low-grade. High-grade pathogens may be pathogenic in healthy individuals with normal immune status. Low-grade pathogens are usually pathogenic in persons with immunodeficiency. The pathogens that cause disease and the type of clinical disease they cause depend on the degree of progression of HIV infection and the associated extent of immunosuppression. High-grade pathogens (e.g. the pneumococcus, non-typhoid salmonellae and M. tuberculosis) can cause...

Pericardiocentesis

This is only safe under the following conditions a) echocardiography has confirmed a moderate to large pericardial effusion b) the operator is experienced. Therapeutic pericardiocentesis is necessary if there is cardiac tamponade (acute life-threatening cardiac impairment). In populations with high TB HIV prevalence,TB is the most likely treatable cause of pericardial effusion. It may be safer for the patient to start presumptive anti-TB treatment than to undergo diagnostic pericardiocentesis....

The Decision To Start Tb Treatment In Children

The decision to start TB treatment in a child is an active process, which involves weighing up the clinical evidence and investigation findings, careful thought, and often a period of observation. For children with confirmed TB or for whom there is a high likelihood of TB, there is no need to hesitate about starting treatment. If the diagnostic evidence is weak and the child is older and not acutely ill, there is no need for anxiety or urgency about starting treatment.Wait and see If, however,...

Diagnosis Of Pulmonary Tuberculosis In Children

The source of transmission of TB to a child is usually an adult (often a family member) with sputum smear-positive PTB. Cases of TB in children usually represent between 10 and 20 of all TB cases. The frequency of childhood TB in a given population depends on the following the number of infectious cases, the closeness of contact with an infectious case, the age of children when exposed to TB, and the age structure of the population. Children rarely have sputum smear-positive TB and so it is...

Hypoadrenalism

Cytomegalovirus can cause necrotizing adrenalitis. This is difficult to distinguish from TB of the adrenal glands or pseudoadrenal crisis (rifampicin).Treatment is with steroid supplements. Soft-tissue infections, e.g. pyomyositis, and sinusitis These are common in HIV-positive patients. They are diagnosed and treated in the usual way. I2*UM PREVENTION OF HIV-RELATED OPPORTUNISTIC INFECTIONS There are some general measures that may help in reducing exposure to selected pathogens in HIV-positive...

Use Of Antitb Drugs In Special Situations

* Streptomycin during pregnancy can cause permanent deafness in the baby. * Do not give streptomycin in pregnancy. Use ethambutol instead. * Isoniazid, rifampicin, pyrazinamide and ethambutol are safe to use. * Second-line drugs such as fluoroquinolones, ethionamide and protionamide are teratogenic, and should not be used. * All anti-TB drugs are compatible with breastfeeding. * Rifampicin, isoniazid and pyrazinamide are safe and can be given in normal dosages. Patients with severe renal...

An Expanded Framework For Effective Tuberculosis Control

WHO has declared that TB is a global emergency, because TB is out of control in many parts of the world.The following are the main reasons why TB is out of control a) governments in many parts of the world have neglected the disease b) inadequate TB control programmes have led to an increased burden of disease (inadequately treated TB patients live longer with chronic disease and infect other people) and the emergence of drug-resistant TB c) high rates of population growth have contributed to...

Sepsis And Concomitant Tb

Sepsis can occur as a coinfection with TB. An inadequate clinical response after treatment of sepsis, e.g. pneumonia, may be due to the presence of concomitant HIV-related TB. DISTINGUISHING OTHER HIV-RELATED PULMONARY DISEASES FROM PULMONARY TB This is a common, and often difficult, diagnostic problem. Several diseases in HIV-positive individuals may present in a similar way, with cough, fever, sometimes chest signs, and CXR shadowing. Pneumonia is the most frequent and important differential...

Background Information On Tuberculosis And

This chapter provides background information on tuberculosis (TB), human immunodeficiency virus and acquired immunodeficiency syndrome, and the interaction between them. TB is a bacterial disease caused by Mycobacterium tuberculosis (and occasionally by Mycobacterium bovis and Mycobacterium africanum).These organisms are also known as tubercle bacilli (because they cause lesions called tubercles) or as acid-fast bacilli (AFB).When sputum containing tubercle bacilli is stained with certain dyes...

Diagnosis of HIV infection in adults

With 6.1 Clinical recognition of HIV infection in TB patients 91 6.2 HIV 6.2.1 HIV antibody 6.2.2 Tests to detect the virus itself 93 6.2.3 Objectives of HIV antibody testing in TB patients 94 6.2.4 Strategy for HIV antibody testing in TB patients 94 6.2.5 Diagnosis of HIV infection in individual TB patients 95 6.3 HIV counselling 95 7 Diagnosis of HIV infection in children with 99 7.1 Clinical recognition of HIV infection in children with TB . 99 7.2 HIV 8 Standardized tuberculosis case...

Persistent headache

Headache Chart

The flow chart below shows the management approach to the TB HIV patient with headache.The following features may accompany headache reduced level of consciousness, confusion, convulsions. It is possible, but rare,for TB meningitis to develop after a TB patient has already started anti-TB treatment. For example, a cerebral tuberculoma could rupture into the subarachnoid space releasing TB bacilli not yet killed by anti-TB drugs. A commonly recommended treatment regimen for TB meningitis is as...