内科学课件：肺结核.ppt

What will happen if treatment delayed? – gibbus formation (acute angulation of spine with or without neurological damage) The physical appearance – Potts disease of spine - gibbus 25 male African. Expanding non painful lesion in neck - Cervical lymph node TB progressing to abscess (beware deep extension – collar stud abscess) TB node in neck with deep extension 35 female African – systemically well - hand and foot lesions present for 6 months – MTB grown on biopsy by plastic surgeons (HIV neg) Astute radiologist should enable the appropriate further investigation Often associated with delay in diagnosis – any chronic discharging lesion must be considered possibly TB Renal tuberculosis (may have few or no symptoms) leading to autonephrectomy 30 middle eastern asylum seeker - abdo pain, fever, sweats – CT scan - peritoneal TB confirmed on biopsy – may mimic malignancy miliary TB on MRI scantuberclomas on CT scan 谢谢 * * The WHO tuberculosis control strategy, directly-observed treatment, short course (DOTS), is based on strong political commitment and four technical elements. These are case finding by sputum smear microscopy examination; short-course chemotherapy with directly-observed treatment; regular uninterrupted supply of drugs; and a monitoring system for programme supervision and evaluation. Different approaches have been applied to introduce and extend DOTS nationwide.  The success of the DOTS strategy depends on the implementation of a five-point package: government commitment to a National Tuberculosis Programme; case detection through case-finding by sputum smear microscopy examination of TB suspects in general health services; standardised short-course chemotherapy to, at least, all smear-positive TB cases under proper case management conditions; regular uninterrupted supply of all essential anti-TB drugs; monitoring system for programme supervision and evaluation. * The goals of treatment are to ensure cure without relapse, to prevent death, t