TB Diagnostics

Chest X-Ray

Typical Chest Xray

Patient 1

• 18 year old female• Somalian • UK 6 months

• Non productive cough and Chest Pain

Patient 1 contd.

Outcome of Patient 1

• TB should always be actively excluded in anyone with suggestive symptoms and epidemiological risk (e.g. from high prevalence country)

Patient 2

• 17 years, Bangladeshi female

• Outbreak of TB at school

• Cough, Haemoptysis

Patient 3

• 79 year old • Polish• Living in Garage• Diagnosed in A+E

Patient 3 contd.

• Malnourished• Intermittent Treatment

Further Difficulties – Patient 4

• Sudden onset of cough, breathlessness and foul phlegm

• Pleural thickening on each side due to prior asbestos exposure

• Sputum grew Klebsiella

• DIAGNOSIS:

Bacterial chest infection

Patient 4 contd.

• Fever ↑, Weight Loss, WBC↑, CRP ↑, so referred for VATS

• ↑ Pleural Fluid

Patient 4 contd.

• HIV+ does not mean you won’t get TB again

• Normal inflammatory response is different, subtle appearance

• CXR can change quickly

Patient 5

• Mobile XRay screening unit

• Strongly positive Mantoux test

• CHAOTIC patient

Patient 5 contd.

• DNA X 6 (bronchoscopy)

• Abdominal pain ↑, weight loss ↑, fevers ↑

• Refused empirical treatment

• Refused CT scan because of IV access

• Refused Biopsy because of IV access

• U/S showed TB changes but still no organisms…

Patient 5 contd.

• 4 months later - sputum grew TB

• Biopsy showed granuloma changes

• Now has extensive disease and treatment is difficult