INTERNATIONAL MEDICAL SCHOOL

BACHELOR’S IN MEDICAL SCIENCE

SUBJECT/CODE: PATHOPHYSIOLOGY OF RESPIRATORY
SYSTEM/QPT20302P
Lab 3: LOWER RESPIRATORY DISEASE
LECTURER NAME: DR.MOHANAD RAHMAN

NAME: ILHAASHINI KRISHNAN

IC NUMBER: 010301-05-0546
ID NUMBER: 012021090323
DATE OF SUBMISSION: 27TH October 2022
INTRODUCTION

Tuberculosis is an airborne disease caused by Mycobacterium Tuberculosis. Mycobacterium

Tuberculosis is a rod-shaped bacteria. It also releases mycolic acid to prevent itself from

engulfing macrophages. Mycobacterium tuberculosis is spread from an infected person’s

respiratory secretions to another person. (Minesh Khatri, MD,2017)

When a person inhales droplet nuclei carrying tubercle bacilli, the tubercle bacilli migrate to

the lungs, where they are deposited in the alveolar sacs. In alveoli, bacteria attach to the

mucosa of alveoli. The bacteria start attacking the tissue. The bacteria will secrete a strong

acid called mycolic acid that prevents itself from being engulfed by the macrophage. The

bacteria covers itself with mycolic acid. Therefore, the pathogens cannot be killed by the WBC.

After that, the bacteria will escape and increase in number. The bacteria will damage the cells

in the lungs and the dead cells, called necrosis. Mycolic acid damages the wall of alveoli and

also the wall of blood capillaries. The blood enters the alveoli. There will be the formation of

pus which is semisolid. The cheesy pus is also called caseation. The cheesy pus stuck into

the lungs and was hard to remove. The fibroblast covers the pus with fibrous tissue form

granuloma. The WBC becomes huge because it contains a lot of bacteria, and it becomes

huge called Langhan’s giant multinucleated cell. A latent TB infection is detected in the patient.

After two years, the giant cell will move out of the lung and enter the bloodstream, causing

extrapulmonary TB. This could occur right away following the infection, years later, or not at

all. Pulmonary TB refers to the condition that results when the TB bacteria escape from the

granuloma and infect the person's lungs. The upper portion of the lower lobe or the lower

portion of the upper lobe is frequently the location of the Gohn Focus, which is the primary site

of TB infection in the lungs. (Minesh Khatri, MD,2017)

DISCUSSION
Milliary Tuberculosis

Granuloma

Cheezy Pus
Bleeding
Giant cells

Necrosis

Fibrous tissue

Miliary Tuberculosis is a fatal form of the disseminated disease due to the hematogenous

spread of tubercle bacilli to the lungs, other organs. After two years of TB,the milliary tb will

be developed.Histologically,The milliary TB has thick cheesy pus at the centre of the

granuloma. The granuloma Is surrounded by fibrous tissue. It also many dead cells called

necrosis. There is higher amount of bleeding in the milliary TB.The giant cells can be seen

more in Milliary TB than the primary TB. We can see many infected alveoli surrounding the

granuloma.

Tuberculosis

Granuloma

Bleeding

Necrosis

Cheezy Pus

Fibrous tissue
Tuberculosis is the primary infection which can occur in 2-3 weeks.Histologically,The cheezy

pus is present at the centre of the granuloma.The granuloma is surrounded by the fibrous

tissue.There is also some dead tissue called necrosis.There will be also some bleeding occur

in the alveoli.In this case,we can still found some uninfected alveoli and this condition is not

severe.We can also observe that there is lack number of giant cells because the tb bacteria is

not increase in number yet.If left untreated TB will develop into milliary TB where the giant

cells will leave the lungs and enter the bloodstream and infect other organs such as

brain,kidney and liver.

CONCLUSION

1. Identify the diagnosis of early and Latent Mycobacterium tuberculosis infection.

A small amount of a substance known as pure protein derivative (PPD) will be injected under

the skin of your forearm by a medical professional for the TST. You must visit the doctor or

other healthcare professional after two to three days so they may examine the injection site.

After two days, a red spot will appear at the injection site if the person has TB. Delayed

hypersensitivity to the antigen by the T cells, means the person not necessarily has the

disease but has been exposed to the bacterium.

2. Describe the manifestation of chest examination in case of tuberculosis patient.

One of the manifestation of chest examination of tuberculosis patient are decreased breath

sounds.Chest pain also occur in case of tuberculosis patient.They cannot breath sufficiently

because oxygen cannot enter the alveoli due to alveoli filled with cheezy pus.Patient may

experience chest tightness.When the body lack of oxygen,the body starving for oxygen but it

does not work.This is called tachypnea.At the same time,the heart will pump rapidly in order

to supply more oxygen to the body.This condition called tachycardia.

REFERENCES

• Minesh Khatri, MD on June 27, 2020, Tuberculosis, WebMD, Retrieved from

https://www.webmd.com/lung/understanding-tuberculosis-basics on 11th September

2022.

• Cleveland Clinic, Tuberculosis, Retrieved from

https://my.clevelandclinic.org/health/diseases/11301-tuberculosis

• C. Michael Gibson, M.S., M.D., Tuberculosis physical examination,WikiDoc, Retrieved

from

https://www.wikidoc.org/index.php/Tuberculosis_physical_examination#:~:text=Physi

cal%20examination%20findings%20depend%20on,breath%20sounds%2C%20tachy

pnea%20and%20tachycardia.