TUBERCLOSIS

Tuberculosis (TB) is an ancient human disease caused

by Mycobacterium tuberculosis. It is an airborne pathogen and
is extremely contagious. TB mainly affects the lungs, making
pulmonary disease, the most common presentation. However,
TB is a multi-systemic disease with a variable presentation. The
organ system most commonly affected includes the 
respiratory system, the gastrointestinal (GI) system, the
lymphoreticular system, the skin, the central nervous system,
the musculoskeletal system, the reproductive system, and the
liver.
•Tuberculosis is a preventable and treatable infectious disease
and is still one of the major contributors of morbidity and
mortality in developing countries where we are still struggling
to provide adequate access to care.
•TB was one of the top 10 causes of death worldwide in 2018
(being the leading killer of people with HIV and a major cause
of deaths related to antimicrobial resistance).
Tuberculosis (TB) is an inflammatory, infectious disease that is
spread by bacteria called mycobacterium tuberculosis.
Pulmonary tuberculosis is a systemic disease that most
commonly affects the lungs. Eventually, TB could spread to
other organ systems, which it then becomes extrapulmonary
tuberculosis. TB can be placed into the following two
categories: 
TYPES

•Primary Tuberculosis(Dormant or Latent) – Although a

person’s body can be infected with mycobacterium tuberculosis,
they may not be showing clinical signs and symptoms. Most
people have healthy immune systems that will never allow TB
to take over their bodies.
•Secondary Tuberculosis (Active) – This will develop after the
immune system of a person is lowered. Reinfection will occur
and the person will start to show clinical signs and symptoms.
•Tuberculosis is spread by airborne particles known as droplet
nuclei (spread when infected people sneeze, laugh, speak, sing,
or cough).
•In order to contract this disease, a person has to have prolonged
exposure with an infected person in an enclosed space.
•It is suspected that there could be a genetic component to
susceptibility and resistance, but that has yet to be proven.
•In some countries, it is common for bovine TB to be spread
through unpasteurised milk and other dairy products due to
cattle with tuberculosis.
The organism has several unique features compared to other
bacteria such as the presence of several lipids in the cell wall
including mycolic acid, cord factor, and Wax-D. The high lipid
content of the cell wall is thought to contribute to the following
properties of M. tuberculosis infection
Resistance to several antibiotics
Difficulty staining with Gram stain and several other stains
Ability to survive under extreme conditions such as extreme
acidity or alkalinity, low oxygen situation and intracellular
survival(within the macrophage)
A reason the bacteria is able to be dormant in someone for years
and is able to survive for months in sputum that is not exposed
to sunlight and is trapped within the body (primary TB). Once
the person’s resistance is lowered, the TB can become active
(secondary TB). This could be due to advancing age, alcoholism
, cancer, or immunosuppression.
 Clinical Presentation
A chronic cough, haemoptysis, weight loss, low-grade fever, and night sweats are
some of the most common physical findings in pulmonary tuberculosis.

Secondary tuberculosis differs in clinical presentation from the primary

progressive disease. In secondary disease, the tissue reaction and hypersensitivity
is more severe, and patients usually form cavities in the upper portion of the
lungs.

• Pulmonary or systemic dissemination of the tubercles may be seen in active

disease. Disseminated tuberculosis may also be seen in the spine, the central
nervous system, or the bowel
Signs & Symptoms
There are usually no symptoms of tuberculosis during the first year of exposure. This is when the disease would be the most
curable. Symptoms suggestive of TB include:
Productive cough that lasts longer than 3 weeks
Weight Loss
Fever
Night sweats
Fatigue
Malaise
Anorexia
Rales could be heard in the lobes of involvement in the lungs
Bronchial Breath Sounds
Dull chest pain, tightness, or discomfort
Dyspnea
• Haemoptysis (late-stage symptom)
Systemic Involvement

10%-15% of tuberculosis is extra-pulmonary. It can spread through the blood vessels from organ
to organ and/or the lymphatic system. Extra-pulmonary TB can involve the:[6]

Kidneys
Bone Growth Plates
Lymph Nodes
Meninges
Hip Joints – can cause avascular necrosis of the hip
Elbows
• Vertebrae (Pott’s Disease)
Medications
Isoniazid
Rifampin
Pyrazinamid
• Ethambutol
The recommended time for taking the
medication is 6-9 months. Blood work should be
performed monthly to check on the liver and
make sure it is handling the medicine okay.
Multidrug-Resistant Tuberculosis (MDR-TB)
• Tuberculosis (TB) can develop resistance to the antimicrobial drugs used
to cure the disease. Multidrug-resistant TB (MDR-TB) is TB that does not
respond to at least isoniazid and rifampicin, the 2 most powerful anti-TB
drugs. Inappropriate or incorrect use of antimicrobial drugs, or use of
ineffective formulations of drugs (such as use of single drugs, poor
quality medicines or bad storage conditions), and premature treatment
interruption can cause drug resistance, which can then be transmitted,
especially in crowded settings such as prisons and hospitals. Treatment
options are limited and expensive, recommended medicines are not
always available, and patients experience many adverse effects from the
drugs. In some cases even more severe drug-resistant TB may develop
TB Screening
• Approximately 33% of the world's population has latent tuberculosis infection
(LTBI). For this reason, screening for Mycobacterium tuberculosis infection is
essential for public health. People with LTBI are at risk for developing active
tuberculosis (TB) and becoming infectious.
• The greatest risk for progression occurs during the first two years of infection.
• The goal of testing for LTBI is to identify individuals who are at high risk of
developing active TB.
• The decision to test should presuppose a decision to treat if the result is positive.
• The tuberculin skin test (TST) and the interferon-gamma release assay (IGRA)
are the current methods for screening and are based on the measurement of
adaptive host immune response.
BCG Vaccine
• The Bacille Calmette-Guérin (BCG) vaccine has existed for 80 years
and is one of the most widely used of all current vaccines, reading
>80%of neonates and infants in countries where it is part of the
national childhood immunization programme.
• BCG vaccine has a documented protective effect against meningitis
and disseminated TB in children.
Mantoux tuberculin skin test
• The Mantoux tuberculin skin test is performed by having 0.1ml of
tuberculin purified protein derivative (PPD) injected into the inner
layer of the forearm. This will determine if the body’s immune
response has been activated by the presence of the bacillus. Upon
injection, the skin will elevate around 6-10 mm in diameter. 48 to 72
hours later, the person should have their skin test reaction read. A
positive test could reveal a palpable, swollen, hardened, or raised area
that should be measured in millimetres. Redness is not measured.