Tuberculosis

Pearly disease, Consumption, Phthisis, Scrofula

Dr. Krishna Khadka

Assistant Professsor
M.V.Sc (Veterinary Pathology)
IAAS, Paklihawa Campus
Definition
• Tuberculosis (TB) is a chronic contagious, infectious,
granulomatous disease of mammals including human, caused by
acid-fast bacilli of the genus Mycobacterium, characterized by
progressive development of primary nodular granulomas known
as tubercles (caseous nodules) in lungs and pulmonary lymph
nodes and disseminated caseous nodules in internal organs.

• Any body tissue can be affected but lesions are frequently

observed in lymph nodes (particularly of head and thorax),
lungs, intestine, liver, spleen, and pleura.
Etiology
• Three main types of tubercle bacilli are recognized: human, bovine,
and avian, respectively, M. tuberculosis , M. bovis , and M.
aviumcomplex ( M. avium ).

• The 3 types differ in characteristics and pathogenicity.

• M. bovis can cause progressive disease in most warm-blooded

vertebrates, including humans.
Epidemiology:
1. Distribution: The disease is worldwide distributed.

1. Animal susceptible:
• The disease affects all species of vertebrates. Cattle, buffaloes, pigs and
humans are highly susceptible. Sheep, goats, camels and equines are
sporadically affected.
Factors effect on susceptibility:
• The disease is more common in dairy cattle due to the
long life span of dairy cattle. Also, the incidence of the
disease is high in old animals.
• It is of low prevalence in cattle kept on pasture. The
indoor housed animals are at high risk of the infection due
to aerosol transmission.
• Stress factors as repeated pregnancy, lactation, debilitating
factors (poor feeding, chronic disease), close housing and
poor ventilation.
Transmission:
• Source of infection:
▫ Infected cattle are the main source of infection for other cattle.
▫ Organisms are excreted in the exhaled air, in sputum, feces, milk, urine, vaginal
and uterine discharges, and discharges from open peripheral lymph nodes.
• Mode of transmission:
▫ Commonly entry is affected by inhalation or ingestion.
▫ Inhalation is the almost invariable portal of entry in housed cattle
▫ by ingestion is possible at pasture when feces contaminate the feed and
communal drinking water
▫ The drinking of infected milk by young animals
▫ Other uncommon routes of infection include intrauterine infection at coitus, by
the use of infected semen
▫ intramammary infection by the use of contaminated teat siphons
Pathogenesis
• Tuberculosis spreads in the body by two stages:
primary complex and
post-primary dissemination.
1. Primary complex formation
• Primary focus in cattle and human is lungs and intestinal
tract in poultry
• Lesion is found at point of entry or mesentric lymph node
• Visible primary focus develop within 8 days of entry of
organism
• 2 wks later calcification of lesion starts
• Then necrotic focus is surrounded by granulation tissue and
lymphocytes
• Ultimately formation of tubercles.
2. Post primary dissemination
millet seed like
• Varies considerably in rate and route
• May take in the form of acute milliary tubercles in
which discrete nodular lesion are found in various
organ
Clinical signs
-Fluctuating temperature
– Erratic appetite
–Progressive emaciation
– Rough hair coat
– Chronic cough due to bronchopneumonia
– Intestinal ulceration and diarrhea
– Enlargement of lymph node
Specific signs:
• Pulmonary involvement:
▫ Pulmonary involvement is characterized by a chronic cough due to
bronchopneumonia.

▫ In the advanced stages when much lung has been destroyed, dyspnea with
increased rate and depth of respiration becomes apparent.

▫ Involvement of the bronchial lymph nodes may cause dyspnea because of

constriction of air passages, and enlargement of the mediastinal lymph node.
• Alimentary tract involvement:
▫ Rarely tuberculous ulcers of the small intestine cause diarrhea.
▫ Retropharyngeal lymph node enlargement causes dysphagia and noisy
breathing due to pharyngeal obstruction.

• Genital system:
▫ There is tuberculous metritis, there may be infertility, or conception may be
followed by recurrent abortion late in pregnancy, or a live calf is produced
which in most cases dies quickly of generalized tuberculosis.
▫ Rare cases of tuberculous orchitis are characterized by the development of
large, indurated, painless testicles.
• Lymphatic involvement:
▫ There is chronic painless swelling in the affected lymphnodes as submaxillary,
prescapular, prefemoral and supramammary. These lesions may be unilateral
or bilateral. The affected lymph node may be containing fistula or discharging
duct.
• Brain involvement:
• In young calve; tuberculosis meningitis with nervous manifestation may
develop.

• Skin involvement:
• Skin lesions appear as nodules similar to small hard cauliflower on skin of the
neck, shoulder and upper forelegs.
GROSS FINDINGS
– Consolidation of lungs
– Nodules of tubercle present in lungs containing cheesy mass
– On cutting of tubercle, a gritty sensation and gritting sound
is felt
– Granulomatous lesions in spleen, lymph nodes, liver and
intestine.
– Tubercle on pleura and mesentery ---pearly disease.
 Pulmonary tuberculosis

Large multifocal to confluent caseating granulomas are present in the pulmonary

parenchyma. Note the caseous (“cheesy,” pale yellow-white) appearance of the granulomas,
which is typical of bovine tuberculosis
Granulomatous nodules beneath the intestinal
mucosa
Lymph node with numerous caseous granules

The normal architecture of the lymph node has been completely obliterated by
multiple caseating granulomas, typical of Mycobacterium bovis lesions.
MICROSCOPIC FINDINGS
– Tubercles consist of central area of caseation necrosis surrounded by
a layers of giant cells and macrophages, a layers of lymphocytes and a
thin layers of fibroblasts.

– Demonstration of acid fast staining bacilli in the giant cells and

macrophages.
Tuberculosis granuloma(lung
histopathology)
Diagnosis
Field diagnosis:
• It is depend on history of area where TB is endemic or not,
• clinical signs such as progressive emaciation and chronic cough
• postmortem lesions
• zoonotic implications
• In living animal TB can be diagnosed by allergic field tuberculin test.
Tuberculin test
• 0.1 ml of Tuberculin reagent is administered intra-dermally in neck.
In positive case area appears red, hot and painful with swelling and
thickening of the site (>4mm) after 72 hrs
Laboratory Diagnosis:
• Samples: nasal discharges, sputum, trachobronchial and gastric lavage,
discharges of the reproductive tract, lymph nodes, thoracic and
abdominal fluid, milk, urine, feces and samples from organs (liver, kidney,
lung and reproductive organs), blood, serum.
• Procedures:
1. Direct microscopic examination for tissue and organ smear after staining with Ziehl
Neelsen acid fast stain.
2. Isolation and identification of the organism: the organism grows on Lowenstein
media at 37°C for 6 w. Identification of the colonies can be done on the basis of
culture characteristics, morphology, staining and biochemical reaction. It is
important to know that detection of the organism is not sufficient by culture. Also,
negative culture results do not mean that the animal is free of infection.
3. Serological examination:
Various serological examinations can be applied such as ELISA (gives some false
positive results but it picks up some carriers that missed by SID),
FAT (of great value in detection of some cases that gave false negative results with
tuberculin but it failed to detect high number of tuberculous cattle),
the gamma interferon test (it detects specific lymphokines produced by lymphocytes
due to the response to the organism and can be used with SID).

4. Lung radiograph: it can be used to detect the lung nodules.

5. PCR: It is rapid and sensitive. It can detect even one tubercle bacillus in the
suspected material.
•Differential Diagnosis
– Paratuberculosis
– Coligranuloma