儿科学-培训课件PPT
儿科学-培训课件PPT,儿科学,培训,课件,PPT
Pulmonary tuberculosis (PTB)GUANGZHOU WOMEN AND CHILDRENS MEDICAL CENTER Zeng fansenEtiologyMycobacterium tuberculosisTransitions in Childhood Tuberculosis Not infected(50-70%)Infected(30-50%)Diseased(10-30%)Within 2 years(50%)Lifelong(50%)Latent TB(70-90%)Never develop active disease(90%)Contact with smear positive index case Common clinical types of pulmonary TB in childrenPulmonary TBTB of trachebronchial lymphnodesPrimary complexAcute miliary TB of the lungs Primary pulmonary TBThe main types of pulmonary TB in children 1.Primary complex:mostly seen in younger childrenBacilli multiplies and spread via lymphatics causing lymphadenopathyPrimary complex:dumbbell shape lesions lung lesion,lymphangitis and lymphadenopathy Radiographs could show lung parenchymal disease,lymph node enlargement1.Primary complexDumbbell shape lesions:Lung lesion,Lymphangitis,Lymphadenopathy1.Primary complexDumbbell shape lesions:Lung lesion,Lymphangitis,LymphadenopathyEnlargement of lung lymph nodes and mediastinal lymph nodesCan cause compression2.TB of trachebronchial lymphnodes2.TB of trachebronchial lymphnodesEnlargement of lung lymph nodes and mediastinal lymph nodes2.TB of trachebronchial lymphnodesA consequence of primary or post primary disease(3-6ms later)Hematogenous disseminationNodules measuring 2-3 mm in diameterMore in lower lung zones Perhaps the only radiographic finding that maybe highly suggestive of tuberculosis in infants and children Easy to concurrent tuberculosis meningitis3.Acute miliary TB of the lungs3.Acute miliary TB of the lungsMillet sample nodules3.Acute miliary TB of the lungsMillet sample nodulesTB toxemiaRespiratory symptomssymptoms(various)low heat,fatigue,anorexia,night sweats,angularCough,expectoration,hemoptysis,chest pain,breathing difficultiesClinical manifestationsLung signs is not obviouslung raleSlow onsetHistoryTB toxemiaPPDLaboratory testsDiagnosisTB contactBCG ContagionEtiologyImmunological testsESRImageexaminationGastric juice for mycobacterium tuberculosisPCRcultureTB-AgTB-Ab TB activity Chest X-rayChest CTLaboratory tests:BronchoscopyObservelesionsGastric juice for mycobacterium tuberculosis123Acute bacterial pneumoniaCavitary lung abscess Response to antimicrobial drugsFever caused by some other diseasesDifferential diagnosisHistoryResponse to antibioticsGermicultureImaging featuresDifferential diagnosis:Surgical therapySupport therapyChemotherapyTherapyIntensive PhaseContinuation PhaseIsoniazid RifampinPyrazinamide Streptomycin2 monthsIsoniazid Rifampin4 monthsTreatment:Short-term chemotherapyPhases of treatment:The intensive phaseusually covers the first 2 months of treatment.During this phase,most of the bacilli will be killed.The continuation phase usually lasts 4-6 months,depending on the treatment regimen.This phase is intended to eliminate the remaining dormant bacilli.These dormant bacilli decrease constantly as treatment intake progresses.Case report 14-month Asian girl 3 weeks cough and unwell Admitted to local hospital With mild feverWithout chest signsWhat investigations would you do?1history234Diagnostic information:Family historyPPD testNo improvement to antibioticsImaging diagnosisImaging diagnosisThank you!
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