Pulmonary Tuberculosis

Tuberculosis or commonly known as TB is an infectious disease that generally affects the

lungs, but can also affect other parts of the body.

Types of Tuberculosis

A. Active TB -
This is an illness in which the TB bacteria are rapidly multiplying and invading
different organs of the body. The typical symptoms of Active Tb variably include
cough, phlegm, chest pain, weakness, weight loss, fever, chills, and sweating at
night. A person with active pulmonary TB disease may spread TB to others by
airborne transmission of infectious particles coughed into the air.

B. Miliary TB-
is a form of active disease that occurs when Tb bacteria find their way into the
bloodstream. In this form, the bacteria quickly spread all over the body in tiny nodules
and affect multiple organs at once. This form of TB can be rapidly fatal.

C. Latent TB infection-
Many of those who are infected with TB do not develop overt disease. They
have no symptoms and their chest x-ray may be normal. The only manifestation of
this encounter may be reaction to the tuberculin skin test (TST) or interferon-gamma
release assay (IGRA).

Etiology

Pulmonary TB is caused by the bacterium Mycobacterium tuberculosis (M

tuberculosis). The bacteria causes formation of small tissue masses called tubercles. TB is
contagious. This means the bacteria are easily spread from an infected person to someone
else. You can get TB by breathing in air droplets from a cough or sneeze of an infected
person. The resulting lung infection is called primary TB.

Signs and Symptoms

The general symptoms of TB disease include feelings of

● sickness or unexplained weakness
● weight loss
● fever
● and night sweats

The symptoms of TB disease of the lungs also include

● coughing
● chest pain
● and the coughing up of blood.
Mode of Transmission

Tuberculosis is carried in airborne particles, called droplet nuclei, of 1– 5 microns in

diameter. The tiny infectious particles can be carried by air currents throughout a room or
building. It is spread from person to person through:
● breathing
● talking
● coughing
● sneezing

The germs can stay in the air for several hours. It’s possible to inhale them even
when the infected person isn’t in the room. But usually you have to be close to someone with
TB for a long period of time to catch it.
Pathophysiology
Diagnostic Procedures

● Patients History
● Lung auscultation
● TB skin test -
The TB skin test is also called the Mantoux tuberculin skin test (TST). It is
performed by injecting a small amount of fluid (called tuberculin) into the skin on the
lower part of the arm. A positive TB skin test or TB blood test only tells that a person
has been infected with TB bacteria. It does not tell whether the person has latent TB
infection (LTBI) or has progressed to TB disease. Other tests, such as a chest x-ray
and a sample of sputum, are needed to see whether the person has TB disease.
● Tuberculosis (TB) blood test, also called an Interferon Gamma Release Assay
or IGRA is a way to find out if you have Mycobacterium tuberculosis in your body.
● Chest x-ray -
An X-ray can detect damage in the lungs, which may indicate tuberculosis.
● Sputum culture -
A sputum culture is the primary test used to diagnose tuberculosis. The
healthcare provider asks the client to cough deeply to produce mucus from the lower
airways, which is called sputum. After the client spit the mucus into a container,
specialists examine the sample for bacteria.

The tuberculosis bacterium can be identified immediately in about two-thirds of

people who have the infection. In others, it can be identified only after the Mycobacterium
tuberculosis organism grows in the laboratory culture, for up to two months.

Nursing Management

● Review pathology of disease and potential spread of infection via airborne droplet
during coughing, sneezing, spitting, talking, laughing, singing.
● Identify others at risk like household members, close associates and friends
● Instruct the patient to cough or sneeze and expectorate into tissue and to refrain from
spitting. Review proper disposal of tissue and good hand washing techniques.
● Monitor temperature as indicated
● Identify individual risk factors for reactivation of tuberculosis
● Stress importance of uninterrupted drug therapy. Evaluate the patient's potential for
cooperation.
● Review importance of follow-up and periodic reculturing of sputum for the duration of
therapy.
● Encourage selection and ingestion of well-balanced meals. Provide frequent small
“snacks” in place of large meals as appropriate.
● Liver function studies: AST/ALT.
● Notify the local health department.

Medical Management
The 6-month regimen for the treatment of drug-susceptible pulmonary tuberculosis
can be used in most patients. It consists of four anti-TB drugs and is sometimes called the
RIPE regimen because of the medications.
 ● Rifampin
Rifampin inhibits the bacterial DNA-dependent RNA polymerase, which
appears to occur as a result of drug binding in the polymerase subunit deep within
the DNA/RNA channel, facilitating direct blocking of the elongating RNA

● Isoniazid
The antimicrobial activity of INH is selective for mycobacteria, likely due to its
ability to inhibit mycolic acid synthesis, which interferes with cell wall synthesis, thereby
producing a bactericidal effect.

● Pyrazinamide
Pyrazinamide (PZA) is an antimicrobial agent that is most commonly used for
treatment of active tuberculosis (TB) during the initial phase of therapy (generally the first
two months of treatment), in combination with other agents. The spectrum of PZA is
relatively narrow; it demonstrates clinically significant antibacterial activity only against
Mycobacterium tuberculosis and Mycobacterium africanum. The mechanism of action for
PZA is unknown. The parent compound enters the bacterium passively and is metabolized
via pyrazinamidase (PZase) within the cytoplasm to pyrazinoic acid; pyrazinoic acid is the
active form of the drug

● Ethambutol
Ethambutol is an antimycobacterial agent that is most commonly used in
combination with other drugs in the treatment of tuberculosis. The mechanism of action of
ethambutol is not completely known. There is evidence that the drug exerts its bacteriostatic
activity by virtue of inhibition of arabinosyl transferase, an enzyme that polymerizes
arabinose into arabinan and then arabinogalactan, a mycobacterial cell wall constituent.

Health Education for PATIENT:

1. Report the people that you have encountered and make sure they are tested.
2. Do not let visitors come to your house except for health care workers. Do not go visit
other people.
3. Do not go to public places.
4. Do not use public transportation.
5. Avoid close contact with others until your healthcare provider says it is okay.
6. Always wear a facemask.
7. Keep your hands clean.
8. When you cough or sneeze:
➢ Cover your mouth and nose with a tissue
➢ Put your used tissue in a closed bag and throw it away
➢ If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow,
not your hands.
➢ Wash your hands often with soap and warm water for 20 seconds.
9. Never miss your medical appointment.

How can we educate others about Tuberculosis?

 We can educate others by sharing the information that has already been verified for
them to have the right knowledge on how to deal with Tuberculosis if ever they know
someone who catches Tuberculosis.
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