THE ROLE OF MEDICAL IMAGING IN DIAGNOSING TUBERCULOSIS, A CASE STUDY AT SHEHU MUHAMMAD KANGIWA MEDICAL CENTER [S.M.K.M.C]

THE ROLE OF MEDICAL IMAGING IN DIAGNOSING TUBERCULOSIS, A CASE STUDY AT SHEHU MUHAMMAD KANGIWA MEDICAL CENTER [S.M.K.M.C]

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ABSTRACT

A research was conducted to know the role of medical imaging in diagnosing tuberculosis, were 30 questionnaires are shared to the department of x-ray at shehu Muhammad kangiwa medical center[S.M.K.M.C],and all the questions were answered and returned appropriately. 73.3% of respondents says they know what tuberculosis is and they were suffering from it, and 33.3% go for X-ray examination. The application of x-ray almost immediately, following the discovery of x-rays by willhem Conrad roentgen, the chest radiograph is the most common examination to be used as one of the initial step to diagnose pulmonary diseases including respiratory infections such as Tuberculosis. Tuberculosis is a contagenious infection that usually attacks the lungs by droplets , if someone coughs , sneezes or talks tiny droplets of saliva or mucus are expelled into the air which can be inhaled by another person. Improving the quality of  radiograph at this level will also lead to improvement of diagnosis of diseases other than TB and that of traumatic injuries.    

CHAPTER ONE

1.0              INTRODUCTION

The clinical application of x-rays began almost immediately, following the discovery of x-rays by Wilhelm Conrad roentgen in 1985. Since then, diagnostic x-ray examinations have been greatly improved and the method have been widely disseminated.

The chest radiography is the most common examination to be used as one of the initial steps to diagnose pulmonary diseases including respiratory infection such as Tuberculosis [TB]. The role of chest radiograph for Tuberculosis patients has gained increasing importance especially as HIV associated with Tuberculosis and childhood TB are less likely to show positive smears, However it is unfortunate that even the most basic x-ray examination in many developing countries are scarcely available and/or the quality of chest radiography is often unacceptable for diagnosing Tuberculosis patients.

 Many faulty diagnoses by chest radiograph may be associated with inappropriate radiological techniques and applications, and that improvements of imaging quality of chest radiograph benefit not only the patients affected by TB but also those suffering from other pulmonary diseases.

In term of detection and treatment of pulmonary Tuberculosis, patient poor imaging quality may be more harmful to patients than having the patient not diagnosed through x-ray examination at all.

Improving the quality of radiography at this level will also lead to improvement of diagnosis diseases other than TB and that of traumatic injuries. Therefore, TB control program and their partners should participate actively in both country-led and global efforts action across all major areas of health systems, including policy, human resources, financing, management, service delivery and information systems.

1.1       BACKGROUND OF THE STUDT

Tuberculosis [TB] describes an infectious disease that has plagued the human race since Neolithic times. TB is a contagious infection that usually attacks the lungs. It can also spread to the other parts of body, like the brain and spine.

The two organisms that cause Tuberculosis are MYCOBACTERIUM TUBERCULOSIS and MYCOBACTERIUMBOVIS. In the 19th century patients were isolated in SANATORIA and gives treatments such as injecting air into chest cavity. Attempts were made to decrease lung size by surgery called thoracoplasty.

During the first half of the 20th century no effective treatment was available.

Streptomycin was the first antibiotic to fight TB, and was introduce in 1946, and Isoiazed [Laniazid, Nydrazid], originally and antidepressant medication, become available in 1952.

Mycobacterium Tuberculosis is rood-shaped and slow-growing bacterium. Mycobacterium Tuberculosis is cell wall has high acid content, which makes it hydrophobic resistance to oral fluids.

Mycobacterium Tuberculosis kills millions of people yearly worldwide in 1995, 3 million people died from Tuberculosis [mike lion, 1996], more than 90%of TB cases occurs in developing nations that have poor hygiene and health care resources and high numbers of people infected with HIV.

TB cases have increase since 1985, most likely due to the increase in HIV infection.

Tuberculosis continues to be a major health problem worldwide. In 2008, the world health organization [WHO] estimated that one third of the global population was infected with TB bacteria.

Each person with untreated active TB will infect on average 10-15 people each year.

In 2009 TB rate in the united state was 3.8 cases per 100, 00, population, a slight decrease from the prior year. In 2018 there were 4,000 TB cases in Kaduna Nigeria.

With the spread of AIDs, Tuberculosis continues to lay waste to large population. The emergence of drug-resistant organisms threatens to make this disease one again incurables.

In 1993, the WHO declared Tuberculosis a global emergency.

·         SYMPTOMS:

 The symptom of Tuberculosis includes the following.

-          Fever

-          Lost of appetite

-          Night sweats

-          Coughing up with blood

-          Difficult in breathing

-          Weakness of the body

NOTE: Without treatment, TB can spread to other parts of the body through blood stream.

-          The bone: There may be spinal pain and joint destruction.

-          The brain: It can lead to menengities.

-          The liver and kidney: It can impair the waste filtration functions and lead to blood in the urine.

-          The heart: It can impair the hearts ability to pump blood, resulting in cardiac temponade, a condition that can be fatal.

·         DIAGNOSIS

To check for TB, a doctor will use a stethoscope to listen to the lungs and check for swelling in the lymph nodes. They will also ask about symptoms and medical history as well as assessing the individual risk of exposure to TB.

The most common diagnostic test for TB is a skin test where a small injection of PPD Tuberculin, an extract of TB bacterium is made just below the inside forearm. The injection site should be checked after 1-3 days and if a hard red bump has swollen up to a specific size then it is likely that TB is present.

The other test that are available to diagnose TB is blood test, chest x-ray, sputum test can all be use to test for the presence of TB bacteria.   

·         CAUSES:

All causes of TB are passed from person to person via droplet. When someone with TB infection coughs, sneezes, or talk, tiny droplet of saliva or mucus are expelled into the air which can be inhaled by another person.

The risk factors for TB include the following.

-          HIV infection.

-          Low socioeconomic status.

-          Alcohol intake.

-          Homelessness.

-          Crowded living condition.

-          Disease that can weaken the immune system.

·         TREATMENT:

The majority of TB cases can be cured when the right medication is available and administer correctly. The precise type and length of antibiotic treatment depend on a persons age, overall health potential resistance to drugs whether the TB is latent or active, and the location of infection i.e the lung, brain, kidneys.

Today doctors treat people with TB outside hospital.

Doctors will prescribe several special medications that patient most take for six month.

-          People with latent TB may need just one kind of antibiotic, where as people with active TB will often require a prescription of multiple drugs. Antibiotics are usually required to be taken for a relatively long time. The standard length time for a cource of TB antibiotic is about 6 months.

Tuberculosis medication may be toxic to the liver, and although side effects are uncommon, when they do occur they can be quite serious.

Tuberculosis treatment takes long because the disease organisms grow very slow and unfortunately die very slow. [Mycobacterium Tuberculosis is a very slow growing organism and may take up to six weeks to grow.

The most common cause of treatment failure is patient failure to comply with the medication regimen. This may lead to the emergency drug resistant organisms. Patient most take his or her medication even if his feeling better.

                                           

Fig 1 Normal Chest X-Ray PA View

       

Fig 2 Primary Tuberculosis X-Ray

                   

Fig 4 Post Primary T.B Affected Patient

     

Fig 3 Post Primary Tuberculosis X-Ray

   

1.2       STATEMENT OF THE PROBLEM

The role of radiological examination have been limited especially in tuberculosis control until now due to some drawbacks such as observer, error-over or under reading and disagreement between readers. Chest radiograph is highly sensitive technique for diagnosing pulmonary TB in immune competent individuals, even though it is unspecific, since TB has no pathopnomonic signs. The Role of Chest Radiograph in Diagnosis of TB Depend on the available resources and on TB prevalence in the population.

1.3       AIMS

-          To know the role of medical imaging in diagnosing tuberculosis

-          To provide a simple way to assess the quality of chest radiograph.

-          To provide high quality imaging to who will be examined by x-ray.

1.4       OBJECTIVES

-          To achieve good quality of radiological chest examination.

-          To know the risk associated with a delayed or miss TB diagnosis.

-          To ensure that a non TB disease has not been miss diagnosed and left untreated.

1.5       RESEARCH QUSTIONS

-          Can chest x-ray detect Tuberculosis?

-          How dose Tuberculosis present on an x-ray film?

-          Can chest x-ray detect a latent Tuberculosis?

1.6       RESEARCH HYPOTHESIS

-          Chest x-ray shows advanced pulmonary Tuberculosis. There are multiple high areas [opacities] for instance in the left hand side of the chest x-ray it clearly shows that the opacities are located in the upper area of the lungs toward the back.

-          Yes chest x-ray are usually an indicator of tuberculosis but other cannot confirm the diagnosis.

1.7       SIGNIFICANCE OF THE STUDY 

The significance of the study is to know the role of chest radiograph, and to know the available resources and Tuberculosis prevalence in the population.

1.8       SCOPE AND LIMITATION

·         SCOPE: The scope of the study is only to the role of medical imaging in diagnosing Tuberculosis using shehu muhammad kangiwa medical center as a resource center for information and data.

·         LIMITATION: This study is limited to the x-ray department of shehu Muhammad kangiwa medical center.

1.9       DEFINATION OF TERMS

·                     TUBERCULOSIS: Tuberculosis is an infectious disease that usually affect the lungs.

·                     MYCOBACTERIUM TUBERCULOSIS: Is a species of pathogenic bacteria in the family of mycobacteriaceae and the causative agent of tuberculosis.

·                     MEDICAL IMAGING: Is the technique and process of creating visual representation of the interior of a body for clinical analysis and medical intervention, as well as visual representation of the function of some organs and tissues.

· &n


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