Dr. Richard Long, MD, FRCPC - The Early Diagnosis of Pulmonary Tuberculosis

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The Early Diagnosis of Pulmonary
Tuberculosis Richard Long, MD The Circle of
Care, 8th Alberta TB Symposium March 22nd and
23rd, Edmonton AB
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Declaration of Conflict of Interest(This is a
mandatory requirement for all speakers at Faculty
of Medicine and Dentistry University of Alberta
Undergraduate, Graduate, Postgraduate or
Continuing Education events)
I, Richard Long declare that in the past 3 years declare that in the past 3 years
I have received manufacturer funding from the following companies I have received manufacturer funding from the following companies I have received manufacturer funding from the following companies No

I have done consulting work for the following companies I have done consulting work for the following companies I have done consulting work for the following companies No

I have done speaking engagements for the following companies I have done speaking engagements for the following companies I have done speaking engagements for the following companies None

I or my family hold individual shares in the following I or my family hold individual shares in the following I or my family hold individual shares in the following None


pharmaceutical or medical/dental equipment pharmaceutical or medical/dental equipment pharmaceutical or medical/dental equipment pharmaceutical or medical/dental equipment
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Suspecting Pulmonary TB

7.
Is there an upper

lung zone infiltrate (cavitary
or non-cavitary) on CXR is

the leucocyte
count normal is
there
an anemia of chronic disease?

6. Is there a high risk medical

condition?
5. Has there been a
failure to respond to broad
spectrum antibiotics?
4. Are symptoms subacute or
chronic? 3. Is there a relative absence
of dyspnea? 2. Are there
pulmonary symptoms (cough, sputum, hemoptysis,
chest pain) in combination with
constitutional symptoms (fever, night
sweats, weight loss, fatigue)?
Probability of TB
1. Is there an epidemiologic risk (TB contact
high risk population group)?
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No. of Features
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• 1. Is there an epidemiologic risk (for example is
  there a history of TB contact is the patient
  from a high risk population group)?

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Annual Age and Sex-Adjusted Tuberculosis Case
Rates Per 100,000 Person-Years For Status
Indians, Canadian-born Others and Foreign-born,
Canada,1989-2008
Int J tuberc Lung Dis 2012 (In Press)
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Immigration Trends in Canada

Year
Percent of Immigrants from Europe and
Asia/Africa to Canada by Time Period (Source
Citizenship and Immigration Canada. Canadian
Statistics Immigrant Population.
05/12/03.ltwww.statcan.ca/english/Pgdb/demo25.htm
gt)
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Territory size shows the proportion of worldwide
tuberculosis cases found there.
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Jill Stanton, 2011
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• 2. Are there pulmonary symptoms (cough, sputum,
  hemoptysis, chest pain) in combination with
  constitutional symptoms (fever, night sweats,
  weight loss, fatigue)?

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• 3. Is there a relative absence of dyspnea?

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FEV1 101 ( pred)
FVC 96 ( pred)
FEV1/FVC 80.6 ( pred)
DCO 80 ( pred)
PaO2 88 (mm Hg)
PaCO2 34 (mm Hg)
pH 7.45
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• 4. Are the symptoms subacute or chronic?

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• 5. Has there been a failure to respond to
  broad-spectrum antibiotics?

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• 6. Is there a high risk medical condition?

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• 7. - Is the total leucocyte count normal.
• - Is there an anemia of chronic disease?
• - Is there an upper lung zone infiltrate
  (cavitary or non-cavitary) on CXR.

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1 DISTRIBUTION Commentary (i) airspace interstitial process involving the apical-posterior segment of the upper lobe and/or the superior segment of the lower lobe, (ii) may be bilateral if not the contra-lateral lung may be used for comparison.



2 CAVITATION Commentary (i) at site of airspace/interstitial disease (present in 50 of cases), (ii) usually round (the broncho-cavitary junction behaves as a check-valve) and thick walled, (iii) may be multiple, (iv) air-fluid levels are uncommon.
3 VOLUME LOSS Commentary (i) local, at the site of disease, with relative preservation of total lung volume, (ii) shift of upper mediastinum, retraction of ipsilateral hilum, (iii) bronchiectasis, iv) fibrotic lesions alone are usually sharply defined and irregular, (v) possible pleural thickening.
4 ENDOBRONCHIAL SPREAD Commentary (i) acinar shadows - multiple poorly defined nodules 4-10 mm in diameter, (ii) at site of disease, in the dependent lung or in the contra-lateral lung, (iii) lesions are not discrete as in interstitial lung disease.
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Public Health Consequences (Secondary Cases) of
Smear Positive Pulmonary TB According to CXR
Category and Close Contact group
Type 1 secondary cases are identified by
conventional epidemiology and confirmed by
molecular epidemiology Type 2 secondary cases
are identified by conventional epidemiology but
are unconfirmed by molecular epidemiology
(culture-negative) Type 3 secondary cases are
identified by molecular epidemiology and linked
to the source case spatially and temporally
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If you suspect pulmonary TB

• Submit Sputum for AFB smear and Culture ASAP!