Introduction:

Tuberculosis (TB) is an infectious disease caused by the bacterium

*Mycobacterium tuberculosis*. It primarily affects the lungs (pulmonary
TB) but can also involve other organs (extrapulmonary TB), such as
lymph nodes, bones, joints, and the central nervous system.

Characteristics:

● **Microbiology**: *Mycobacterium tuberculosis* is a slender,

rod-shaped bacterium with a complex cell wall structure rich in
mycolic acids. This unique cell wall composition gives it
characteristic features such as acid-fastness (resistance to
decolorization with acid-alcohol after staining) and resistance to
environmental stressors and antimicrobial agents.
● **Slow Growth**: Tuberculosis bacteria have a slow growth rate,
requiring specific culture conditions with special media (e.g.,
Lowenstein-Jensen medium) and prolonged incubation periods
(weeks to months) for detection in the laboratory.

Classification:

**Species**: The primary human pathogen is *Mycobacterium

tuberculosis*. Other related species include *Mycobacterium bovis*
(causing TB in cattle and occasionally in humans) and *Mycobacterium
africanum* (causing TB in some parts of Africa). Additionally,
*Mycobacterium avium* complex and other non-tuberculous

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mycobacteria (NTM) can cause TB-like diseases in immunocompromised
individuals.

Epidemiology:

● **Global Impact**: TB remains one of the top infectious disease

killers worldwide, with millions of new cases and deaths annually.
● **Transmission**: Spread occurs through inhalation of airborne
droplets containing *Mycobacterium tuberculosis* from infected
individuals who have active pulmonary TB. Factors contributing to
transmission include close and prolonged contact, crowded living
conditions, poor ventilation, and immunosuppression (e.g., HIV
infection).
● **High-Risk Groups**: Vulnerable populations include people living
with HIV/AIDS, children, elderly individuals, and those with
compromised immune systems.

Pathogens:

**Clinical Manifestations**:

● **Pulmonary TB**: Most common form, characterized by

symptoms such as chronic cough (often productive), bloody sputum,
chest pain, fatigue, weight loss, night sweats, and low-grade fever.
Physical examination may reveal signs like crackles or decreased
breath sounds.
● **Extrapulmonary TB**: Can affect virtually any organ system,
presenting with specific symptoms related to the affected site.

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 Examples include lymphadenitis (enlarged lymph nodes), skeletal
TB (bone pain, joint swelling), meningeal TB (headache, altered
mental status), and abdominal TB (abdominal pain, ascites).

Mode of Transmission:

*Mycobacterium tuberculosis* is transmitted primarily through airborne

droplets expelled when an infected person coughs, sneezes, speaks, or
sings. Transmission requires inhalation of aerosolized droplets containing
viable bacilli, which can remain suspended in the air for extended periods
in enclosed spaces.

Clinical Signs and Symptoms:

● **Pulmonary TB**: Symptoms typically develop gradually and may

include persistent cough (>2 weeks), hemoptysis (coughing up
blood), chest pain, fatigue, unintentional weight loss, night sweats,
and low-grade fever. Advanced disease may lead to respiratory
failure.
● **Extrapulmonary TB**: Symptoms vary depending on the affected
site but may include localized swelling, pain, neurologic deficits, and
systemic symptoms like fever, malaise, and weight loss.

Lab Diagnosis:

● **Microscopy**: Acid-fast staining (e.g., Ziehl-Neelsen stain) of

sputum or other clinical specimens to visualize acid-fast bacilli
(AFB).

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 ● **Culture**: Growth on specialized media (e.g., Lowenstein-Jensen,
Middlebrook 7H10/7H11 agar) with incubation for several weeks to
confirm the presence of *Mycobacterium tuberculosis* and
determine drug susceptibility.
● **Molecular Tests**: Polymerase chain reaction (PCR) assays to
detect specific DNA sequences of *Mycobacterium tuberculosis*,
including rapid molecular tests for drug resistance (e.g., Xpert
MTB/RIF)

Preventive Measures:

● **Vaccination**: Bacille Calmette-Guérin (BCG) vaccine is used in

some countries to prevent severe forms of childhood TB, although its
effectiveness against pulmonary TB in adults varies.
● **Infection Control**: Measures include improving ventilation in
indoor settings, using respiratory protection (e.g., N95 masks) for
healthcare workers, and implementing screening and isolation
protocols in healthcare facilities.
● **Treatment of Latent TB**: Prophylactic treatment with isoniazid
(INH) for individuals with latent TB infection (LTBI) to prevent
progression to active disease.

Treatment:

● **Antimicrobial Therapy**: Treatment regimens involve multiple

antibiotics to which *Mycobacterium tuberculosis* is susceptible.
Standard initial therapy includes a combination of four drugs:

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 isoniazid (INH), rifampicin (RIF), pyrazinamide (PZA), and
ethambutol (EMB) for 2 months, followed by INH and RIF for 4–7
months.
● **Directly Observed Therapy (DOT)**: Ensures adherence to
treatment and reduces the risk of drug resistance through
supervised administration of medications.
● **Management of Drug-Resistant TB**: Requires longer treatment
durations (up to 18–24 months) with second-line antibiotics, often
involving drugs with more significant side effects and challenges in
administration.

In summary, tuberculosis caused by *Mycobacterium tuberculosis* is a

complex infectious disease with a broad spectrum of clinical
manifestations and challenges in diagnosis and treatment. Effective
control requires comprehensive public health strategies, including early
detection, appropriate treatment, infection prevention, and addressing
social determinants of health to reduce transmission and improve
outcomes globally.