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Clinical Tuberculosis Diagnosis & Treatment

Clinical Tuberculosis Diagnosis & Treatment


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About the Book

• Written for defining a practical approach to every aspect of tuberculosis in 50 chapters.
• Covers all the aspects of tuberculosis ranging from epidemiology, diagnosis, practical approach to the treatment of pulmonary as well as common extra-pulmonary tuberculosis including HIV.
• Explains practical approach to MDR-TB and XDR-TB.
• Covers chapters on prevention & control of TB in India.
• Pharmacokinetics of anti-tuberculosis including doses, regimens, adverse effects has been highlighted.
• Special chapters on case-based approach to treatment of tuberculosis in special situation.
• Chapters on TB in children, TB in elderly, non-tuberculous mycobacteria and infection control in TB are also included.
• Chapters have been written in the background of current literature and practical experience gained from day-to-day dealing with different patients suffering from tuberculosis.
• Undergraduate, postgraduate medical students, practitioners and program managers in TB control will find this book a practical guide.

About the Author

Rajendra Prasad MD DTCD FAMS FCCP (USA) FNCCP FCAI FIAB FIMSA DSC (Honoris Causa) Nikhil Gupta MD



Table of Contents:
1. Landmarks in Tuberculosis Treatment 1 2. Case Definitions in Tuberculosis 8 • Case Definitions 8 • Disease Classification 9 • Types of Tuberculosis Patients 11 • Directly Observed Treatment 11 • Directly Observed Treatment Plus 12 • Treatment Outcomes of DOTS 12 • Drug Resistant Tuberculosis 13 • Treatment Outcomes in DOTS-Plus 14 • HIV Setting Case Definitions 16 3. Epidemiology of Tuberculosis 18 • Epidemiological Indices 18 • Global Burden of Tuberculosis 22 • Tuberculosis Burden in India 24 4. Clinical Presentation of Tuberculosis 33 • Congenital Tuberculosis 33 • Primary Tuberculosis 34 • Post-primary Tuberculosis 39 5. Miliary Tuberculosis 47 • Pathogenesis 47 • Pathology 48 • Diagnosis 49 • Treatment 50 • Complications 50 6. Endobronchial Tuberculosis 52 • Epidemiology 52 • Pathophysiology 53xiv Clinical Tuberculosis: Diagnosis and Treatment • Natural History 54 • Diagnosis 55 • Differential Diagnosis 59 • Treatment 60 • Endobronchial Tuberculosis in Special Situations 61 7. Lower Lung Field Tuberculosis 69 • Definition 69 • Prevalence 70 • Pathogenesis 70 • Clinical Features 70 • Investigations 71 • Associated Medical Conditions 74 • Management 74 8. Hemoptysis 77 • Pseudo or Spurious Hemoptysis 78 • Grades of Hemoptysis 78 • Recurrent Hemoptysis 78 • Etiology of Hemoptysis 78 • Hemoptysis with Normal Chest X-ray 80 • Mechanism of Bleeding 80 • Pathogenesis of Hemoptysis in Tuberculosis 81 • Diagnosis of Hemoptysis 81 • Treatment of Hemoptysis 85 9. Diagnostic Techniques in Tuberculosis 90 9A: Diagnosis of Latent Tuberculosis Infection 90 • Tuberculin Skin Test 90 • Interferon-g Assays 94 9B: Radiology 97 • Imaging Modalities 97 • Imaging in Pulmonary Tuberculosis 97 • Sequelae and Complications of Tuberculosis 106 • Radiographic Follow-up Schedule 107 9C: Bacteriology 109 • Direct Demonstration by Staining Technique 109 • Mycobacterial Culture in the Diagnosis of Tuberculosis 110 • Drug Susceptibility Testing 113 • Newer Tools Under Development 115 9D: Histopathology 119 9E: Polymerase Chain Reaction (PCR) 121 9F: Serology 124 • Antibody-based Tests 124 • Antigen-based Tests 128 • Serology in Diagnosing Pulmonary TB in Patients with HIV Infection 129Contents xv • RoleofSerologyinDiagnosingTuberculosisinChildren 130 • Role of Serology in Diagnosing Extrapulmonary TB 130 9G: Fiberoptic Bronchoscopy 134 • Indications 134 • Specimen Collected 134 • Result 135 • Precautions 136 • Drawback 136 9H: Others 138 • Fine Needle Aspiration Cytology 138 • Radioactive Bromide Particles Test 138 • Adenosine Deaminase Assay 138 • Tuberculostearic Acid Estimation 138 10. Differential Diagnosis of Pulmonary Tuberculosis 140 • Pneumonia 140 • Fungal Diseases 141 • Parasitic Disease 142 • Bronchiectasis 143 • Lung Abscess 144 • Allergic Bronchopulmonary Aspergillosis 145 • Pulmonary Edema 147 • Lung Cancer 147 • Sarcoidosis 152 • Occupational Lung Diseases 154 • Pulmonary Infarction 154 • Congenital Conditions 154 • Cardiovascular Diseases 154 11. Complications of Tuberculosis 156 • Hemoptysis 156 • Fungus Ball 157 • Bronchiectasis 159 • Tuberculosis Endobronchitis and Tracheitis 159 • Spontaneous Pneumothorax 160 • Calcification 160 • Tuberculous Laryngitis 160 • Tuberculous Enteritis 161 • Open Negative Syndrome 161 • Scar Carcinoma 162 • Physiological Changes 162 • Amyloidosis 163 • Chronic Respiratory Failure 164 • Chronic Cor Pulmonale 164xvi Clinical Tuberculosis: Diagnosis and Treatment 12. Post-tubercular Obstructive Airway Impairment 169 • Pathophysiology 169 • Diagnosis 171 • Treatment 172 13. Antitubercular Drugs Used in Newly Diagnosed Patients of Tuberculosis and their Adverse Effects 174 • Isoniazid 174 • Rifampicin 178 • Ethambutol 180 • Pyrazinamide 181 • Streptomycin 183 • Thioacetazone 184 • Management of Common Adverse Effect 185 14. Antitubercular Drug Used in Previously Treated Patients of Tuberculosis and their Adverse Effect 189 • Kanamycin 189 • Amikacin 194 • Capreomycin 200 • Ethionamide and Prothionamide 202 • Cycloserine 205 • Para-aminosalicylic Acid (PAS) 208 • Levofloxacin 210 • Moxifloxacin 212 • Ofloxacin 215 • Clofazimine 217 • Thiacetazone 218 • Clarithromycin 219 • Linezolid 221 • Imipenem/Cilastatin 222 • Amoxicillin Clavulanate 223 15. How Does Tuberculosis Treatment Work? 225 • Bacteriological Factors 225 • Environmental Factors 226 • Pharmacological Factors 227 16. Basic Concepts in Treatment of Tuberculosis 229 • Role of Special Diet and Rest 229 • Role of Hospitalization 230 • Single Drug Therapy versus Multiple Drugs 230 • Single versus Divided Doses 230 • Optimum Duration of Treatment 231 • Fixed Dose Combinations (FDCs) versus Separate Drugs 231Contents xvii • Daily versus Intermittent Therapy 233 • Monitoring of Progress of Chemotherapy 234 • Causes of Failure of Chemotherapy 235 • Role of Surgery in Pulmonary Tuberculosis 236 17. Anti-tubercular Drug Doses and Regimens for Adults and Children 240 18. Duration of Treatment in Tuberculosis 245 • Sputum Positive Pulmonary Tuberculosis 245 • Sputum Smear-negative Pulmonary Tuberculosis 245 • Standard Conventional Long-term Nonrifampicincontaining Regimen 245 19. Treatment of Tuberculosis in Special Conditions— Pregnancy, Liver and Renal Disease 248 • Pharmacokinetics of Antitubercular Drugs 248 • Treatment of Tuberculosis in Pregnancy and Lactation 250 • Treatment of Tuberculosis in Renal Insufficiency 251 • Treatment of Tuberculosis in Liver Diseases 254 20. Treatment of Tuberculosis in Special Conditions—Pregnancy, Liver and Renal Diseases—Case-based Approach 259 • Treatment of Tuberculosis in Pregnancy and Lactation 259 • Treatment of Tuberculosis in Renal Insufficiency 260 • Treatment of Tuberculosis in Liver Disease 261 21. Treatment of Extrapulmonary Tuberculosis 263 • Tuberculous Lymphadenitis 264 • Pleural Effusion 265 • Tuberculous Meningitis (TBM) 266 • Bone and Joint Tuberculosis 267 • Miliary Tuberculosis 268 • Tuberculous Pericarditis 269 • Abdominal Tuberculosis 269 • Genitourinary Tuberculosis 270 • Ocular Tuberculosis 270 • Upper Respiratory Tract Tuberculosis 271 • Cutaneous Tuberculosis 271 22. Corticosteroids in Tuberculosis 276 • Indications of Corticosteroids in Tuberculosis 276 • Dose and Duration of Corticosteroids 281xviii Clinical Tuberculosis: Diagnosis and Treatment 23. Management of Retreatment Cases in Tuberculosis 284 • Relapse 284 • Defaulters or Treatment after Default 285 • Failure 286 • Poor Adherence to Treatment 286 • Drug Resistant Tuberculosis 287 • Prevention of Retreatment Cases 293 24. Drug Resistant and Multidrug Resistant Tuberculosis: Current Status 297 • Definition 297 • Types of Drug Resistance 298 • Prevalence of MDR-TB: Global 298 • Trends in MDR-TB: Global 302 • Prevalence of MDR-TB: India 303 • HIV Infection and Multidrug Resistant Tuberculosis 306 • Risk Factors of MDR-TB 308 • Sources and Causes of MDR-TB 308 • Control of MDR-TB 309 25. Drug Resistant and Multidrug Resistant Tuberculosis: Management 313 • Definition 313 • Mechanism of Drug Resistance 313 • Genetic Basis of Drug Resistance 314 • Virulence and Drug-resistant Strains 314 • Impact of Drug Resistance on the Outcome of Chemotherapy 315 • Diagnosis of Drug Resistant and Multidrug Resistant Tuberculosis 315 • Treatment of Drug Resistant and Multidrug Resistant Tuberculosis 319 • Outcome of Treatment 329 26. Multidrug Resistant Tuberculosis: Case-based Management 335 • Case I 335 • CASE II 337 • CASE III 337 • CASE IV 340 • CASE V 340 • CASE VI 343Contents xix 27. Multidrug Resistant Tuberculosis—Monitoring of Treatment and Adverse Drug Reaction 345 • Pretreatment Screening and Evaluation 345 • Monitoring Progress of Treatment 345 • Monitoring for Adverse Effects During Treatment 347 • Management of Adverse Effects 348 28. Multidrug Resistant Tuberculosis—Management in Special Situation 354 • M/XDR-TB in Pregnancy 354 • M/XDR-TB in Breastfeeding 355 • M/XDR-TB in Contraception 356 • M/XDR-TB in Children 356 • M/XDR-TB in Diabetes Mellitus 358 • M/XDR-TB in Renal Insufficiency 358 • M/XDR-TB in Liver Disorders 358 • M/XDR-TB in Seizure Disorders 359 • M/XDR-TB in Substance Dependence 360 • M/XDR-TB in Patients with Psychosis 360 29. Multidrug Resistant Tuberculosis Contacts: Management 363 • Management of Symptomatic Adult 363 • Contacts of Patients with MDR-TB 363 • Management of Symptomatic Pediatric 364 • Contacts of Patients with MDR-TB 364 • Chemoprophylaxis of Contacts of DR-TB Index Cases 365 30. Multidrug Resistant and Extensively Drug Resistant Tuberculosis: Prevention 367 • General Guidelines for the Prevention of MDR- and XDR-TB 368 31. Extensively Drug Resistant Tuberculosis: Current Status and Management 374 • Definition 374 • Epidemiology 375 • Factors Responsible for XDR-TB 377 • Diagnosis 377 • Treatment 378 • Monitoring of Treatment 380 • Outcomes of Treatment 381 • Role of Surgery 382 • HIV and XDR-TB 382 • XDR-TB in Pediatric Patients 383 • XDR-TB in Pregnancy 384xx Clinical Tuberculosis: Diagnosis and Treatment • WHO Response Strategies for XDR-TB Control of XDR-TB 386 32. Bacillus Calmette-Guerin (BCG) 390 • Basis of Giving BCG 390 • Types of BCG Vaccine 391 • Dose and Site of Vaccination 391 • Routes of Vaccination 391 • Efficacy and Safety 391 • Contraindications to BCG Vaccination 392 • Normal Reaction after BCG Vaccination 392 • Complications 393 • Various Strategies for the Development of Newer Tuberculosis Vaccines 396 33. Chemoprophylaxis in Tuberculosis 402 • Chemoprophylaxis in Tuberculosis 402 • Treatment Regimens and Duration 404 • Chemoprophylaxis Under Revised National Tuberculosis Control Program 404 • Chemoprophylaxis for Drug Resistant Tuberculosis 405 • Limitations of Chemoprophylaxis 405 • Place of Secondary Chemoprophylaxis in Tuberculosis Control 405 34. Tuberculosis Control in India: DOTS 408 • Landmarks of Tuberculosis Control in India 409 • Revised National Tuberculosis Control Program Strategy 411 • Revised National Tuberculosis Control Program Structure 412 • Diagnosis Under Revised National Tuberculosis Control Program (RNTCP) 412 • Treatment Regimen Used in Revised National Tuberculosis Control Program (RNTCP) 415 • Achievements of Revised National Tuberculosis Control Program 420 • Others Priority Initiatives in Revised National Tuberculosis Control Program 421 • Impact of Revised National Tuberculosis Control Program 424 • Challenges for Revised National Tuberculosis Control Program 424 • Problems of Revised National Tuberculosis Control Program 425 35. Tuberculosis Control in India: DOTS Plus 427 • Framework 427 • Case Finding Strategy 428Contents xxi • Enrolment into DOTS-Plus Program 429 • Confirmed MDR-TB Case 430 • Drug Resistant Tuberculosis Center 431 • Pre-treatment Evaluation 432 • Counseling 432 • Monitoring Progress During Treatment 433 • Category IV Regimen 434 • Drug Dosages and Administration 434 • Treatment Duration 435 • Regimen for XDR-TB 436 • Duration of Regimen for XDR-TB 436 • Treatment Interruption and Default 437 • Treatment Outcomes 438 • Providing Patient and Family Counseling 439 • Monitoring for Early Detection of Adverse Reactions 440 • Role of DR-TB Committee in the 440 • Management of Adverse Reactions 440 • Adherence 441 • Follow-up of the Non-adherent Patient 441 • DOTS-Plus Plan 442 36. Tuberculosis and HIV 444 • Epidemiology 444 • Impact of HIV on Tuberculosis 445 • Impact of Tuberculosis on HIV 446 • Diagnostic Difficulties in Persons with HIV/TB 446 • Coinfection 446 • Revised WHO Clinical Staging of HIV/AIDS for Adults and Adolescents with Confirmed HIV Infection 446 • Diagnosis of Pulmonary Tuberculosis 448 • Extrapulmonary Tuberculosis 450 • Investigations 452 • Treatment of Tuberculosis in HIV Positive Patients 454 • Adjuvant Corticosteroids in Extrapulmonary TB 455 • Highly Active Antiretroviral Therapy 455 • Interactions of Antituberculosis 456 • Therapy and Antiretroviral Therapy 456 • Immune Reconstitution Syndrome 458 • HIV and Drug Resistant TB Drug Interactions of Second Line Drugs and ART 459 • Recurrence of Tuberculosis after Completion of Tuberculosis Treatment 460 • Treatment of TB and HIV—WHO Recommended Collaborative TB/HIV Activities 460xxii Clinical Tuberculosis: Diagnosis and Treatment 37. Interaction between Antitubercular and Antiretroviral Drugs 465 • Antiretroviral Therapy for the Treatment of HIV Infection 465 • Pharmacokinetic Issues in the Treatment of HIV-related Tuberculosis 469 • Interaction between Antiretroviral and Antitubercular Drugs 469 • Drug-Drug Interactions in the Treatment of HIV and Drug Resistant-TB (DR-TB) 471 38. Tuberculosis and Diabetes 473 • Epidemiology 473 • Effect of Diabetes on Pulmonary Tuberculosis 474 • Effect of Pulmonary Tuberculosis on Diabetes 475 • Clinical Features and Course of Tuberculosis in Diabetics 475 • Roentgenographic Aspects of Tuberculosis in Diabetics 476 • Multidrug Resistant Tuberculosis (MDR-TB) and Diabetes 477 • Effect of Antituberculosis Drugs on Blood 477 • Glucose Level and OHA in Tubercular Diabetics 477 • Principles of Management 477 39. Tuberculosis and Pregnancy 480 • Effect of Pregnancy on Tuberculosis 480 • Effect of Tuberculosis on Pregnancy and Childbirth 481 • Diagnosis of Tuberculosis in Pregnant Woman 481 • Treatment of Pregnant Woman with Active Tuberculosis 482 • Treatment of Tuberculosis in Lactating Woman 483 • Isoniazid Prophylaxis in Pregnant Woman 484 • Isoniazid Prophylaxis for Infant Born to Woman with Active Tuberculosis 484 40. Tubercular Pleural Effusion 487 • Epidemiology 487 • Pathogenesis 487 • Clinical Manifestations 488 • Clinical Manifestations in HIV Positive Patients 489 • Diagnosis 489 • Natural History of Untreated Tuberculous Effusion 496 • Treatment 496 • Response to Treatment 498 41. Tubercular Empyema 504 • Etiopathogenesis 504 • Clinical Features 505Contents xxiii • Diagnosis 506 • Treatment 506 42. Tubercular Lymphadenitis 511 • Epidemiology 511 • Pathogenesis 512 • Clinical Features 512 • Diagnosis 513 • Treatment 515 43. Tuberculosis in Children 518 • Epidemiology 518 • Clinical Presentation of Tuberculosis 520 • Postprimary Extrapulmonary Tuberculosis 520 • Diagnosis of Childhood Tuberculosis 520 • Treatment of Tuberculosis in Children 522 44. Tuberculosis in Elderly 527 • Epidemiology 527 • Reasons for Reactivation 528 • Clinical Features 528 • Diagnosis 530 • Investigations in Tuberculosis in Elderly 530 • Treatment 531 45. Tuberculosis Abdomen 533 • Pathogenesis 533 • Clinical Features 534 • Investigations 538 • Treatment of Abdominal Tuberculosis 543 46. Tuberculosis of Kidney and Urinary Tract 547 • Epidemiology 547 • Pathophysiology 548 • Clinical Features 548 • Diagnosis of Tuberculosis of Kidney and Urinary Tract 551 • Treatment 556 47. Genitourinary Tuberculosis in Male 559 • Epidemiology 559 • Pathogenesis 559 • Clinical Features 560 • Investigations 561 • Treatment 563 48. Genitourinary Tuberculosis in Female 566 • Epidimiology 566xxiv Clinical Tuberculosis: Diagnosis and Treatment • Pathogenesis 567 • Clinical Presentation of Female Genital Tuberculoisis 568 • Diagnosis 568 • Treatment 571 49. Non-tubercular Mycobacteria 573 • Epidemiology 573 • Mode of Infections 574 • Classifications of NTM 575 • Distribution 576 • Clinical Presentations 576 • Diagnosis 577 • Features of NTM 580 • Treatment 582 50. Infection Control in Tuberculosis 587 • Mode of Infection in Tuberculosis 587 • The Difference between TB Infection and TB Disease 588 • Standard Precautions 589 • Hierarchy of Infection Control to Reduce Risk of Transmission of Respiratory Pathogens 589 • Managerial Activities for National, State, Hospital Administration, and Local Health Officials 590 • Administrative Control Strategies for Healthcare Facilities 591 • Environmental Control Measures 594 • Protection of Healthcare Workers and Staff 595 • Multidrug Resistant TB 596 • Drug Rehabilitation Centers and Corelations Institutions 597 Index 599


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Product Details
  • ISBN-13: 9789351522218
  • Publisher: Jaypee Brothers,medical Publishers Pvt. Ltd.
  • Publisher Imprint: Jaypee
  • Edition: 1
  • Language: English
  • Weight: 855 gr
  • ISBN-10: 9351522210
  • Publisher Date: 2015
  • Binding: Paperback
  • Height: 241 mm
  • No of Pages: 644
  • Width: 159 mm


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