Pathophysiology of

Tuberculosis

Pratik Godhani
Pharmacy Management.
 Introduction
• Tuberculosis (TB) is a communicable infectious disease caused
by Mycobacterium tuberculosis. It can produce latent
infection as well as progressive, active disease.
• M. tuberculosis is transmitted from person to person by
coughing or sneezing or close contacts of TB patients.
• WHO
– 13 million chronic active cases + 9.3 million new cases
– (3.4 million cases in India only)
– T.B. occurs at rate of one per second.
• Market of Anti tuberculosis drugs and vaccines by 2011 is
expected to reach 670 million USD.
• Mycobacterium tuberculosis is spread by small airborne
droplets, called droplet nuclei, generated by the coughing,
sneezing, talking, or singing of a person with pulmonary or
laryngeal tuberculosis.
• Introduction of M tuberculosis into the lungs leads to infection
of the respiratory system.
• However, the organisms can spread to other organs, such as
the lymphatics, pleura, bones/joints, or meninges, and cause
extrapulmonary tuberculosis.
PATHOPHYSIOLOGY
 Droplet nuclei with
bacilli are inhaled, enter
the lung, and deposit in
alveoli.

Macrophages and T
lymphocytes act together
to try to contain the
infection by forming
granulomas.

In weaker immune systems, the

wall loses integrity and the
bacilli are able to escape and
spread to other alveoli or other
organs.
CLINICAL PRESENTATION
 Early infection :
Immune system fights infection. Infection generally proceeds
without signs or symptoms.
Patients may have fever, paratracheal lymphadenopathy, or
dyspnea. Infection may be only subclinical and may not advance to
active disease.

Early primary progressive :

Immune system does not control initial infection.
Patients often have nonspecific signs or symptoms (eg, fatigue, weight
loss, fever).
Nonproductive cough develops. Diagnosis can be difficult: findings on
chest radiographs may be normal and sputum smears may be negative
for mycobacteria.
 Late primary progressive:
Cough becomes productive.
More signs and symptoms as disease progresses. Patients
experience progressive weight loss, rales, hemoptysis.
Findings on chest radio -graph are normal, may show
cavity.Diagnosis: cultures of sputum.

Latent:
Mycobacteria persist in the body.No signs or symptoms occur.
Patients do not feel sick. Patients are susceptible to reactivation of
disease.
Infection can reappear when immunosuppression occurs.
DIAGNOSIS
 TEST NAME DESCRIPTION
RADIOGRAPHY Patchy or nodular infiltrates and Cavitation in the apical
areas of the upper lobes or the superior segment of the
lower lobes.
SPUTUM CULTURE IDENTIFY M.Tuberculosis (4-7 days with HPLC)
POLIMERASE CHAIN Identify M. tuberculosis, (1-2 hrs)
REACTION
TUBERCULIN SKIN TEST
QUANTIFERON- TB TEST Measure immune reactivity to M.tuberculosis (12-14 hrs)
Chest radiograph shows
presence of Cavitation in
affected part of Lung
 TUBERCULIN SKIN TEST

• Infection with M. tuberculosis produces a delayed

hypersensitivity skin reaction to certain components
of bacterium(purified protein derivatives – PPD)
• Administer 0.1 ml volume containing 5 TU of PPD
into top layers of skin of the forearm
• Reading after 48-72 hours of injection.
• Observe presence or absence of induration (localized
swelling).
• Positive Tuberculin Skin Test:

Diameter (mm) Considered positive for …

Persons at high risk for tuberculosis:
Patients with chronic diseases (e.g., infection with human
≥5 immunodeficiency virus)
Persons with recent exposure to tuberculosis
Employees of hospitals and long-term care facilities
Persons at risk for tuberculosis:
Injectable drug users, Persons in close living conditions
≥10 Persons born in countries with high prevalence of
Tuberculosis,
Persons with following clinical conditions : silicosis;
diabetes mellitus; chronic renal failure; some hematologic
disorders (e.g., leukemias and lymphomas);
≥15 Persons with no risk factors for TB
THANK YOU