TBC

a. Definition
TBC a multisystemic disease with myriad presentations and manifestations, is
the most common cause of infectious disease–related mortality worldwide. The
disease is becoming more common in many parts of the world. In addition, the
prevalence of drug-resistant TB is increasing worldwide.

b. Etiology
Mycobacteria, such as M tuberculosis, are aerobic, non–spore-forming,
nonmotile, facultative, curved intracellular rods measuring 0.2-0.5 μm by 2-4 μm.
Their cell walls contain mycolic, acid-rich, long-chain glycolipids and
phospholipoglycans (mycocides) that protect mycobacteria from cell lysosomal attack
and also retain red basic fuchsin dye after acid rinsing (acid-fast stain).

c. Pathophysiology
Mycobacteria are highly antigenic, and they promote a vigorous, nonspecific
immune response. Their antigenicity is due to multiple cell wall constituents,
including glycoproteins, phospholipids, and wax D, which activate Langerhans cells,
lymphocytes, and polymorphonuclear leukocytes.
When a person is infected with M tuberculosis, the infection can take 1 of a
variety of paths, most of which do not lead to actual TB. The infection may be cleared
by the host immune system or suppressed into an inactive form called latent
tuberculosis infection (LTBI), with resistant hosts controlling mycobacterial growth at
distant foci before the development of active disease. Patients with LTBI cannot
spread TB.
The lungs are the most common site for the development of TB; 85% of
patients with TB present with pulmonary complaints. Extrapulmonary TB can occur
as part of a primary or late, generalized infection. An extrapulmonary location may
also serve as a reactivation site; extrapulmonary reactivation may coexist with
pulmonary reactivation.
d. Diagnostic test
 Bacteriology examination :
From sputum, pleural fluid or liquor cerebrospinal.
Sputum collection : sputum specimen collected in the spot, morning, spot
(SPS), or 3 sputum specimen from 3 consecutive days (for admitted patients)
 Radiology examination
Obtain a chest radiograph to evaluate for possible TB-associated pulmonary
findings (demonstrated in the images below). A traditional lateral and
posteroanterior (PA) view should be ordered. In addition, an apical lordotic
view may permit better visualization of the apices and increase the sensitivity
of chest radiography for indolent or dormant disease.
 Special examination
BACTEC, Polymerase chain reaction (PCR), Enzym linked immunosorbent
assay (ELISA)

e. Treatment And Medication

The purpose of tuberculosis medication is for healing the patient, prevent
motality, prevent relapse, lower the transmission rate and prevention of drug
resistance. After 2 months of therapy (for a fully susceptible isolate), pyrazinamide
can be stopped. Isoniazid plus rifampin are continued as daily or intermittent therapy
for 4 more months. If isolated isoniazid resistance is documented, discontinue
isoniazid and continue treatment with rifampin, pyrazinamide, and ethambutol for the
entire 6 months. Therapy must be extended if the patient has cavitary disease and
remains culture-positive after 2 months of treatment.