Deivasigamani, M C (2007) Clinical Profile of Pulmonary and Extra Pulmonary Tuberculosis: A Study of 210 cases. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Tuberculosis is a disease of great antiquity. The infectious agent, tubercle bacilli was discovered by Robert Koch in 1882. The disease primarily affects lungs and causes pulmonary tuberculosis. It can also affect Lymph nodes, Meninges, Intestine, bone, joints, skin and other tissues of the body. According to WHO estimates, around 1722 million people (one third of word population) are infected with Tubercle bacilli and 16 – 20 million cases of tuberculosis were reported worldwide in 2001.1 India accounts for nearly one third of global burden of tuberculosis.2 Despite efforts at early detection and treatment, tuberculosis remains a major public health problem in India. A total of 1.82 million of new cases and 4.17 lakhs of deaths were reported every year in India. Tuberculosis is a disease that affects various organs with variety of presentation and causes significant morbidity and mortality. This study is undertaken to analyse the various clinical presentations in patients with pulmonary tuberculosis and extra pulmonary tuberculosis attending TB clinic of Stanley Medical college Hospital. AIM OF THE STUDY: To analyze the clinical profile of newly diagnosed pulmonary and extra pulmonary tuberculosis in patients started on DOTS chemotherapy. PATIENTS AND METHODS: 1. Patients attending RNTCP (Revised National TB Control Programme) clinic at Government Stanley Medical College Hospital for DOTS therapy who were newly diagnosed to have Pulmonary and Extra pulmonary Tuberculosis were taken up for the study. 2. Patients under study were analyzed for clinical features like productive cough, non productive cough, fever, loss of appetite/ weight and hemoptysis. 3. The following investigations were done: • Sputum smear for AFB. • Chest X ray. • Mantoux Test. • Hemogram – TLC, DLC, ESR, Hb%. • Specific investigations for various types of Tuberculosis. SUMMARY: • 210 patients of newly diagnosed tuberculosis (pulmonary and extra pulmonary) who were started on DOTS chemotherapy, were analyzed. Pulmonary Tuberculosis occurred in 123(58.6%) and Extrapulmonary tuberculosis in 87(41.4%) patients. • There were 143 (68.1%) males and 67 (31.9 %) females. Mean age of presentation was 38.5 years and ranging between 13 to 80 years. • Among 123 pulmonary tuberculosis patients, 76.4% were males and 23.6% females. The male female ratio is 3.2 : 1. Mean age of occurrence was 42.96 years. • Clinical presentation of Pulmonary Tuberculosis were cough with sputum(86.2%), fever (61.8%), loss of appetite/ loss of weight (57.8%), Hemoptysis (22.8%) and chest pain / breathlessness(5.7%). • Out of 87 patients with Extrapulmonary tuberculosis 49 (56.3%) were males and 38 (43.7%) females. The male female ratio is 1.3: 1. Mean age of occurrence was 32.28 years. Most of the patients ( 78.2%) were in the age group of 13 – 40 years. • Tuberculous Lymphadenitis occurred in 41(19.5%) patients and accounted for 47.1% of Extrapulmonary tuberculosis. Most of these patients were in the age group of 13 – 30 years. 22(53.7%) were females and 19(46.3%) males. The male female ratio is 1: 1.2. • 90% of tuberculous lymphadenitis patients had isolated cervical node involvement, two (5%) patients had axillary node involvement along with cervical nodes and two (5%) had generalized Lymphadenopathy. • Pleural Tuberculosis occurred in 23(11%) patients, which accounted for 26.4% of extrapulmonary tuberculosis. 17(73.9%) were males and 6(26.1%) females. Male female ratio is 2.8:1. Peak incidence of pleural Tuberculosis is between 13 – 40 years of age. • Tuberculous Meningitis occurred in 7(3.8%) of tuberculous patients, which accounted for 8% of Extrapulmonary tuberculosis. • Spinal and Abdominal tuberculosis occurred in 5 (2.4%) patients. • Tuberculous pericarditis, tuberculoma, genital tuberculosis, tuberculous skin ulcer, erythema nodosum and tuberculous arthritis which occurred in one patient (0.9%) each. • 39.83% of pulmonary tuberculous patients were positive for sputum AFB and none of patients with extrapulmonary tuberculosis showed sputum/ specimen AFB positivity. • Positive mantoux reaction occurred in 27(12.9%) patients, of which 55.5% had pulmonary tuberculosis and 44.4% extrapulmonary tuberculosis. • Around 50% of pulmonary and extrapulmonary tuberculosis patients had ESR of more than 40 mm in 1 hour. • 76.5% of pulmonary tuberculous patients had upper zone/apical infiltrates. Fibrocavity and miliary pattern occurred in 18.7% and 1.7% respectively. CONCLUSIONS: Age groups between 20 – 50 years are highly vulnerable for development of tuberculous disease. • Males are more commonly affected in pulmonary tuberculosis than females. • Extrapulmonary tuberculosis commonly occurs in younger age groups (10-30 years). • Tuberculous Lymphadenitis and Pleural tuberculosis are the commonest forms of extrapulmonary tuberculosis. • Sputum AFB and Chest X ray are equally important in diagnosis of pulmonary tuberculosis. • Hitopathological evidence of tuberculous granuloma is the mainstay for diagnosing various types of Extrapulmonary tuiberculosis. • ESR and Mantoux reaction has only additive role in diagnosis of tuberculosis.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Pulmonary ; Extra Pulmonary Tuberculosis ; Clinical Profile ; Study of 210 cases. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 23 Mar 2018 04:09 |
| Last Modified: | 24 Mar 2018 05:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6449 |
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