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- 2. ANAMNESIS Here is a set of questions that are to be addressed in the case a
- 3. COMPLAINS If a patient has any of the following complains, consider him a “Tuberculosis Suspect”: 1.
- 4. COMPLAINS Tuberculosis patients may complain of general and respiratory symptoms. General Symptoms: ++ Loss of weight.
- 5. Cough
- 6. Pains in the chest
- 7. Dyspnea
- 8. Hemoptysis
- 9. Physical investigation
- 10. Physical investigation
- 11. TUBERCULOSIS SCREENING METHODS Tuberculosis screening methods should aim to detect Mycobacterium tuberculosis infected patients with. -
- 12. Tuberculin skin test Tuberculin includes purified protein derivative (PPD). PPD consist of proteins with small molecular
- 13. Delayed type hypersensitivity If patient has infected with mycobacterium tuberculosis – allergy to the tuberculin is
- 14. Delayed type hypersensitivity In persons infected with Mycobacterium tuberculosis, or BCG vaccinated, in response to the
- 15. Delayed type hypersensitivity In reaction antigen - antibody mononuclear cells are destroyed with entering bioactive substances
- 16. Delayed type hypersensitivity There is a different degree of inflammatory response at the site of tuberculin
- 17. Mass tuberculinodiagnostics targets: identification of newly MBT-infected persons ("Virage" of tuberculin tests); identify persons with hyperergic
- 18. TUBERCULIN PREPARATIONS To tuberculin preparations are related: PPD-L (purified protein derivative named after Linnikova), ATK-alttuberculin of
- 19. Mantoux test For routine tuberculinodiagnostics as the only tuberculin reaction used Mantoux test with 2 TU
- 20. Mantoux test In carrying out immunization schedule approved by the Health Ministry of Ukraine should take
- 21. Mantoux test For the Mantoux test one-gram disposable syringes are used only. Ampoule of medication wiped
- 22. Mantoux test results estimation Negative if only signs of needle puncture is presented or 2 mm
- 23. Mantoux test results estimation Doubtful – 2-4 mm of indurations or hyperemia of any size
- 24. Mantoux test results estimation Positive – 5-17 mm of indurations among children and adolescents and indurations
- 25. Mantoux test results estimation Hyperergic – indurations more than 17 mm among children and adolescents and
- 26. Mantoux test results estimation
- 27. Mantoux skin test “virage” the first positive reaction to the tuberculin after negative or doubtful; an
- 28. Differences between postvaccinal and infectious allergies In deciding whether this is related positive Mantoux test in
- 29. Differences between postvaccinal and infectious allergies Postvaccinal allergy has less intensity and it tends to weaken
- 30. Contraindications to Mantoux skin test - Skin diseases, acute and chronic infectious disease in acute phase,
- 31. False-Positive Reactions It may be positive TST in patients, who are not infected with mycobacterium tuberculosis.
- 32. False-Negative Reactions It may be negative TST in infected patients. The main reasons of these are:
- 33. Boosted Reactions and Serial Tuberculin Testing In most individuals, PPD skin test sensitivity persists throughout life.
- 34. Diaskintest Diaskintest – it`s a new screening skin test, it was founded by Russian scientists. It
- 35. Diaskintest Advantages More specific and sensitive test, there are no false positive reactions. Disadvantages It is
- 36. QuantiFERON-TB Gold and QuantiFERON-TB Gold PLUS General principles The QuantiFERON-TB Gold IT system uses blood collection
- 37. QuantiFERON-TB Gold and QuantiFERON-TB Gold PLUS Baseline epidemiological data Before performing the QuantiFERON-TB Gold IT test,
- 38. QuantiFERON-TB Gold and QuantiFERON-TB Gold PLUS
- 39. QuantiFERON-TB Gold and QuantiFERON-TB Gold PLUS Advantages: greater sensitivity; higher specificity; there are significantly less problems
- 40. T-SPOT test General principles T-SPOT (Oxford Immunotec, Abingdon, UK), unlike QuantiFERON-TB Gold, uses an enzyme-linked immunospot
- 41. T-SPOT test
- 42. T-SPOT test Baseline epidemiological data As for the QuantiFERON-TB Gold assay, baseline epidemiological data are necessary
- 43. T-SPOT test - The test result is ‘positive’ if (Panel A minus nil control) and/or (Panel
- 44. Screening fluorography In Ukraine screening fluorography examination is conducted every two years from 15 years. According
- 45. Screening fluorography “Obligatory contingents” include: Students of higher and specialized secondary educational institutions; Persons living in
- 46. Screening fluorography “high risk” group by medical and biological factors: Persons who were or are in
- 47. Screening fluorography “high risk” group by social factors: Persons without permanent residence (refugees, migrants to getting
- 48. Sputum samples collection In order to collect diagnostic material shall be used special containers: made from
- 49. Sputum samples collection The ideal situation is to establish special booths in the room for sputum
- 50. The quantity and quality of collected sputum estimating Satisfactory quality of material assumes presence in the
- 51. Ziehl-Neelsen staining method This method is based on the MBT resistance to acids, alkalis and alcohol.
- 52. Ziehl-Neelsen staining method
- 53. Storage of specimens In order to increase the cultural method results period between collecting the material
- 54. Storage of specimens Aseptic material should be sent to the laboratory immediately! For other materials if
- 55. Transportation of specimens For safe transportation of bacteriological material it should be packed in a waterproof,
- 56. Homogenisation and decontamination of specimens The frequency of contamination of cultures (number of not-growing cultures) in
- 57. CULTURE MEDIA There are 4 main groups of various culture media for diagnostic material sowing: -
- 58. Egg-based media The advantages of egg-based media: cost (the cheapest of all the media, used for
- 59. Agar-based media These media are prepared in slant tubes or plates and are less likely than
- 60. Liquid media Liquid media offer a considerable time advantage over solid media: 7–14 days in Middlebrook
- 61. Culture examination In evaluating culture results of diagnostic material is necessary to adhere the following rules:
- 62. Culture examination Estimating results register the following parameters: "The appearance of growth" - the date of
- 63. Characterization of M. tuberculosis colonies Cultures should be read within 5 to 7 days after inoculation
- 64. Colony growth quantitative estimation
- 65. BACTEC MGIT 960 system BACTEC MGIT 960 is a fully automated system for simultaneous incubation and
- 66. BACTEC MGIT 960 system Advantages of the method: the receiving culture twice reduces and determination the
- 67. BACTEC MGIT 960 system An important component of the system is Mycobacteria growth indicator tube with
- 68. BACTEC MGIT 960 system Firstly you should press «Tube enter» on BACTEC MGIT 960 display regimen
- 69. Identification of Mycobacterium tuberculosis Growth in different media In LJ medium MBT colonies are ivory have
- 70. Identification of Mycobacterium tuberculosis Detection of cord factor Nontuberculous mycobacteria grow diffusely in the form of
- 71. Biochemical tests of identification Niacin test Niacin produced by all mycobacteria, but M. tuberculosis as a
- 72. Biochemical tests of identification Determining ability to growth in the medium with nicotinamide M. tuberculosis is
- 73. Biochemical tests of identification Thermostability catalase Catalase in MBT is different. In virulent MBT it quickly
- 74. Drug susceptibility testing for Mycobacterium tuberculosis complex All available methods for determining the sensitivity of MBT
- 75. Drug susceptibility testing for Mycobacterium tuberculosis complex Methods of direct determination of sensitivity have a number
- 76. Indirect methods of determining the sensitivity of MBT When using indirect methods of determining the sensitivity
- 77. The proportion method on Löwenstein-Jensen medium The principle of the method is to determine the ratio
- 78. Indirect absolute concentrations drug susceptibility testing The method is performing by dosed seeding carefully prepared suspension
- 79. Drug susceptibility testing in liquid media (MGIT 960) The system BACTEC MGIT 960 AST allows determining
- 80. Investigation of the sensitivity of mycobacteria to medicinal preparations by the coefficient of resistance The principle
- 81. Absolute concentration method DST results counted in 3- 4 weeks of incubation in a thermostat, so
- 82. Nitrate reductase assay The nitrate reductase assay (NRA) is a technique based on the capacity of
- 83. GeneXpertMTB/RIF test Test system GeneXpertMTB/RIF is recommended by WHO for use in the diagnosis of tuberculosis
- 84. GeneXpertMTB/RIF test The principle of the PCR method is amplification - repeated increase in specific sections
- 85. GeneXpertMTB/RIF test Results in the detection of TB bacteria can be positive, negative or indeterminate. M.
- 86. GenoType test system The GenoType test is based on the DNA-streap technology. The whole procedure is
- 87. GenoType test system Indications to GenoType test: - HIV-infected patients with suspected TB. - Patients with
- 88. GenoType test system Results interpretation. M. tuberculosis identified. Resistance to rifampicin and isoniazid is established. It`s
- 89. GenoType test system Results interpretation. M. tuberculosis identified. Resistance to isoniazid and susceptibility to rifampicin established.
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