{"presentation":{"slides":[{"elements":[{"x":5.446623093681917,"y":6.479481641468682,"width":90.41394335511983,"height":23.758099352051836,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"

It is crucial to make efforts to establish microbiological confirmation in presumptive Extrapulmonary Tuberculosis (EPTB) cases. <\/span><\/p>\n\n

Appropriate specimens from the Extrapulmonary (EP) site are collected and depending on the specimen type and availability of facilities,<\/strong><\/span> the specimens are sent for:<\/span><\/p>\n\n

\n<\/ol>\n"},"subContentId":"e580c741-0897-4e38-aa2a-03936a21381f","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":64.79481641468682,"width":91.50326797385621,"height":30.23758099352052,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
The diagnostic algorithm<\/strong><\/span> (see the figure on next slide) to be followed for EPTB cases depends on 2 main factors:<\/span><\/p>\n\n
\n\t
Availability of appropriate specimens from the EP site<\/span><\/li>\n\t
Availability of CBNAAT (preferred test)<\/span><\/li>\n<\/ol>\n"},"subContentId":"32d3fe88-7b4d-4928-8d47-e20e9621ebe8","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":22.875816993464053,"y":32.39740820734341,"width":67.53812636165577,"height":26.997840172786177,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64dccc9fc5aad.png","mime":"image\/png","copyright":{"license":"U"},"width":1719,"height":226},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"3902086f-fb23-4e12-897f-199d74626d3c","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":22.875816993464053,"y":36.717062634989205,"width":18.51851851851852,"height":19.43844492440605,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Cartridge-based Nucleic Acid Amplification Testing (CBNAAT)<\/span><\/p>\n"},"subContentId":"0faf50f7-08a1-40d4-ab61-ef2c1c4d4e32","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":44.66230936819172,"y":36.717062634989205,"width":19.607843137254903,"height":21.598272138228943,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Culture and Drug Susceptibility Testing (C&DST) for M. tuberculosis <\/em><\/span><\/p>\n"},"subContentId":"4fcfbf04-534f-46cf-906f-1a17882743da","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":67.53812636165577,"y":41.03671706263499,"width":15.250544662309368,"height":12.958963282937365,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Histopathological examination<\/p>\n"},"subContentId":"dc5a6157-0f90-45f4-ad5c-5698c006a747","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":8.714596949891067,"y":34.557235421166304,"width":10.893246187363834,"height":21.382289416846653,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64dccd58cacf9.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"c88b9271-dbfa-4ae0-97c6-ccb73ed5c04d","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":37.03703703703704,"y":88.55291576673866,"width":29.411764705882355,"height":8.639308855291576,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Figure: Diagnostic Algorithm of EPTB<\/span><\/p>\n"},"subContentId":"deafdfea-684a-4edd-b1b3-dd3ab283196d","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":8.714596949891067,"y":8.639308855291576,"width":82.78867102396515,"height":78.61771058315335,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-6422d13d8500a.png","mime":"image\/png","copyright":{"license":"U"},"width":1392,"height":671},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"188f94be-ea88-40ea-8ab5-77dd1097079b","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":4.357298474945534,"y":4.319654427645788,"width":91.50326797385621,"height":56.15550755939525,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
\n\t
\n\t
If an appropriate specimen from the EP site is available,<\/strong><\/span> specimens from the presumed sites of involvement must be tested with CBNAAT.<\/span><\/p>\n\t<\/li>\n\t
\n\t
CBNAAT detects MTB and RIF status <\/span><\/strong>and helps to identify microbiologically confirmed EPTB cases.<\/span><\/p>\n\t<\/li>\n\t
\n\t
If CBNAAT is not available<\/span><\/strong>, the specimen is sent for Liquid Culture (LC) at the C&DST lab. If the LC is positive, it is identified as a microbiologically confirmed EPTB case.<\/span><\/p>\n\t<\/li>\n\t
\n\t
If there is high clinical suspicion of TB even after a negative culture result, other diagnostic tools are used to clinically diagnose EPTB (usually with a specialist). If these tests indicate TB, they may be treated as clinically diagnosed EPTB or else arrive at an alternate diagnosis.<\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"af685aa5-4d29-4483-a5fe-8c5b86ba11a2","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":62.634989200863934,"width":90.41394335511983,"height":25.91792656587473,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Clinical Diagnosis of EP-TB<\/strong><\/span><\/p>\n\n
<\/p>\n"},"metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"c4244b00-70b1-409b-8b8d-6061501b4979"},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":5.446623093681917,"y":71.27429805615552,"width":8.714596949891067,"height":17.278617710583152,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64dcce300fc44.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"dd760e47-4fed-489f-af11-5168b1042149","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":15.250544662309368,"y":71.27429805615552,"width":80.61002178649238,"height":21.598272138228943,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
If an appropriate specimen from the EP site is not available, in the presence of high clinical suspicion of TB, other modalities of diagnosis are used in consultation with a specialist. If with other diagnostic modalities, TB diagnosis still cannot be established, the specialist may explore an alternate diagnosis. <\/span><\/p>\n"},"subContentId":"23f93b1c-33ba-462b-bdf5-92098fc05337","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":5.446623093681917,"y":10.799136069114471,"width":89.32461873638344,"height":30.23758099352052,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
A clinical diagnosis of EPTB is made if a consultative decision is made to administer a full course of anti-TB drugs in spite of the situations listed above.<\/span><\/p>\n\n
Chest X-ray (CXR), Ultrasonography, Computerised Tomography (CT) scan, Magnetic Resonance Imaging (MRI) <\/strong><\/span>and biochemical examinations are supporting tests that can be used to help arrive at a diagnosis.<\/span><\/p>\n"},"subContentId":"20fafe5b-e046-4cc6-bfa3-25e6937db40a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":42.48366013071895,"y":43.196544276457885,"width":11.002178649237473,"height":21.598272138228943,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64dccf62069db.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"ab530d5b-aab9-4186-a2c6-2e914c7afe8f","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":59.912854030501094,"y":43.196544276457885,"width":10.893246187363834,"height":21.598272138228943,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64dccf6f2004d.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"2fb0ce0f-86c3-44dd-a9d5-10f68ceffa25","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""},{"x":23.965141612200437,"y":45.35637149028078,"width":11.002178649237473,"height":21.598272138228943,"action":{"library":"H5P.Image 1.1","params":{"decorative":false,"contentName":"Image","file":{"path":"images\/file-64dccf7cb4176.png","mime":"image\/png","copyright":{"license":"U"},"width":512,"height":512},"expandImage":"Expand Image","minimizeImage":"Minimize Image"},"subContentId":"42f79240-20f1-4c25-b42c-bdeb5508a37f","metadata":{"contentType":"Image","license":"U","title":"Untitled Image"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}},{"elements":[{"x":3.2679738562091507,"y":8.657300215982723,"width":91.50326797385621,"height":41.03671706263499,"action":{"library":"H5P.AdvancedText 1.1","params":{"text":"
Resources<\/strong><\/span><\/p>\n\n
\n\t
\n\t
Training Modules (1-4) for Programme Managers and Medical Officers, 2020<\/a>.<\/span><\/p>\n\t<\/li>\n\t
\n\t
Technical Operational Guidelines, Chapter 3: Case Finding and Diagnosis Strategy, NTEP<\/a>.<\/span><\/p>\n\t<\/li>\n<\/ul>\n"},"subContentId":"c5ddf5e5-884b-4e31-8379-6b3a6a3d3178","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"alwaysDisplayComments":false,"backgroundOpacity":0,"displayAsButton":false,"buttonSize":"big","goToSlideType":"specified","invisible":false,"solution":""}],"slideBackgroundSelector":{}}],"keywordListEnabled":true,"globalBackgroundSelector":{},"keywordListAlwaysShow":false,"keywordListAutoHide":false,"keywordListOpacity":90},"override":{"activeSurface":false,"hideSummarySlide":false,"summarySlideSolutionButton":true,"summarySlideRetryButton":true,"enablePrintButton":true,"social":{"showFacebookShare":false,"facebookShare":{"url":"@currentpageurl","quote":"I scored @score out of @maxScore on a task at @currentpageurl."},"showTwitterShare":false,"twitterShare":{"statement":"I scored @score out of @maxScore on a task at @currentpageurl.","url":"@currentpageurl","hashtags":"h5p, course"},"showGoogleShare":false,"googleShareUrl":"@currentpageurl"}},"l10n":{"slide":"Slide","score":"Score","yourScore":"Your Score","maxScore":"Max Score","total":"Total","totalScore":"Total Score","showSolutions":"Show solutions","retry":"Retry","exportAnswers":"Export text","hideKeywords":"Hide sidebar navigation menu","showKeywords":"Show sidebar navigation menu","fullscreen":"Fullscreen","exitFullscreen":"Exit fullscreen","prevSlide":"Previous slide","nextSlide":"Next slide","currentSlide":"Current slide","lastSlide":"Last slide","solutionModeTitle":"Exit solution mode","solutionModeText":"Solution Mode","summaryMultipleTaskText":"Multiple tasks","scoreMessage":"You achieved:","shareFacebook":"Share on Facebook","shareTwitter":"Share on Twitter","shareGoogle":"Share on Google+","summary":"Summary","solutionsButtonTitle":"Show comments","printTitle":"Print","printIngress":"How would you like to print this presentation?","printAllSlides":"Print all slides","printCurrentSlide":"Print current slide","noTitle":"No title","accessibilitySlideNavigationExplanation":"Use left and right arrow to change slide in that direction whenever canvas is selected.","accessibilityCanvasLabel":"Presentation canvas. Use left and right arrow to move between slides.","accessibilityProgressBarLabel":"Choose slide to display","containsNotCompleted":"@slideName contains not completed interaction","containsCompleted":"@slideName contains completed interaction","slideCount":"Slide @index of @total","containsOnlyCorrect":"@slideName only has correct answers","containsIncorrectAnswers":"@slideName has incorrect answers","shareResult":"Share Result","accessibilityTotalScore":"You got @score of @maxScore points in total","accessibilityEnteredFullscreen":"Entered fullscreen","accessibilityExitedFullscreen":"Exited fullscreen","confirmDialogHeader":"Submit your answers","confirmDialogText":"This will submit your results, do you want to continue?","confirmDialogConfirmText":"Submit and see results","slideshowNavigationLabel":"Slideshow navigation"}}

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STEPS: Diagnostic Algorithms in NTEP

Integrated DR-TB Algorithm

Diagnostic Algorithm for EPTB

Diagnostic Algorithm for Pediatric TB