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Hospitals
OBJECTIVES
1. Identify presumptive Tuberculosis
2. Assess and examine presumptive
TB case
3. Decide if a patient have TB
4. Refer patient to a hospital TB
clinic/desk
OPD
ER
WARDS
RADIOLOGY/X-RAY DEPT.
PHARMACY
SOCIAL SERVICE
LABORATORY
PRIVATE DOCTORS WITHIN THE
HOSPITAL
TB-
PRESUMPTIVE
any person whether adult or child with signs and or
symptoms suggestive of TB whether Pulmonary or Extra
Pulmonary or those with chest x-ray findings suggestive of active
TB.
1. Adults (15 y/o and above) who has any of the ff:
a. Cough of atleast 2 weeks duration with or without the
following symptoms:
Significant
Fever
Bloody
sputum (hemoptysis)
Chest/black pains not referable to any musculoskeletal
disorders
Easy fatigability or malaise
Night sweats
Shortness of breath or DOB
unexplained
Unexplained fever of 2 weeks or more after common causes
such as malaria or pneumonia have been r/o.
Loss of weight /failure to gain weight/weight faltering/loss of
appetite
Failure to respond to 2 weeks of appropriate antibiotic txt for
lower RTI
Failure to regain previous state of health 2 weeks after a
viral infection or exanthema. Ex. Measles
Fatigue, reduce playfulness, or lethargy
may
have Any of
the following:
Gibbus, especially of recent onset (resulting
from vertebral TB)
Non-painful enlarged cervical lymphadenopathy
with or without fistula formation.
Neck stiffness or nuchal rigidity and or
drowsiness suggestive of meningitis that is not
responding to antibiotic treatment
Pleural effusion
Pericardial effusion
Distended abdomen (ex. Big liver and spleen)
with ascites
Non-painful enlarged joint
Signs or tuberculin hypersensitivity
massive hemoptysis.
All presumptive TB patient should undergo DSSM
except the following situation:
Mentally incapacitated as decided by specialist
or medical institution
Debilitated or bedridden
Children unable to expectorate
Patients unable to produce sputum despite
sputum induction
b. TB Culture and Drug Susceptibility Test (DST)
a routine diagnostic test for Drug resistant TB
cases under the NTP.
- Used for TB prevalence surveys, drug
resistance surveillance, research and other
special cases.
STEP III DECIDE IF PATIENT HAVE TB
Classification of TB based on anatomical site
a. Pulmonary TB (PTB) involves the lung parenchyma.
b. Extra Pulmonary TB (EPTB) involves larynx, pleura, lymph
nodes, abdomen, GUT, skin, joints and bones, meninges
Classification of TB based on bacteriological status
a. Bacteriology confirmed a TB patient from whom a
biological specimen is positive by smear microscopy, culture
or rapid diagnostic test (Xpert MTB/RIF).
b. Clinically diagnosed patient who does not fulfill the criteria
for bacteriological confirmation but has been diagnosed with
active TB by a clinician or other medical practitioner who has
decided to give the patient a full course of TB treatment. It
includes cases diagnosed on the basis of x-ray abnormalities
or suggestive histology and extra pulmonary cases without
laboratory confirmation.
STEP IV REFER
PATIENT TO
HOSPITAL TB CLINIC
(INTERNAL
REFERRAL)
Objectives: