TUBERCULOSIS

Dr. B.Chakradhar MD
Assistant Professor
Dept Of Respiratory Medicine
INTRODUCTION
 TB - CHRONIC infectious disease -MYCOBACTERIUM
TUBERCULOSIS

 Other Mycobacteria – MYCOBACTERIUM AFRICANUM &

MYCOBACTERIUM BOVIS

 LUNG – Main Organ effected

 Except – HAIR & NAIL

 Cavity – Source – Sputum Positive

 1 Bout = 3000 droplet nuclei

 Individual Risk – 2 Factors

 Concentration of droplet nuclei in air

 Length of time air is breathed

NTM – immuno-compromised individuals

 EPIDEMIOLOGY
 1990 – Global Emergency

 DOTS – 1994 - “STOP TB”

 3 Major Threats

 Poor social conditions

 Immune compromise
 Emergence of drug resistance
HISTORY
 Cardinal event – implantation of MTB

 Lung – Portal of entry

CLASSIFICATION
 Based on Sequence of Events

 Primary TB – NO Previous exposure

 Progressive Primary TB – Primary is Self-Limiting, later

leading to Larger Lesions

 Post Primary TB – Endogenous/Exogenous

CLASSIFICATION
 Based on Location

 Localized Disease

 Pulmonary TB
 Extra-pulmonary TB
 Disseminated TB
 PRIMARY TB
 Primary Complex – Lesion at the primary site of involvement,
draining lymphatics & inflamed regional lymph node – L3

 Lung – Ghon’s Focus – Ghon’s Complex

 Primary TB – Widely Disseminated infection

 Healing – Fibrosis & Calcification

PROGRESSIVE PRIMARY
TB
 Progressive Primary TB – extension of inflammatory process

 Lung - TB Pneumonia

 Pre-chemo therapeutic era - Galloping consumption or

Pneumonia alba ( white pneumonia )

 HIV
 Caseation – Liquefaction – Expectoration – Cavity

 Mediastinal & Tracheobronchial Lymphnodes – Obstruction

 Complete – Epituberculosis

 Incomplete – Ball-value – Obstructive emphysema

 Circulation – Miliary & Meningeal TB

 Cicatrization, Scar formation, Calcification

 Repeated episodes of extension – healing & fibrosis – ONION

SKIN or COIN LESION
POST PRIMARY TB
 Primary – Post Primary

 Extensive caseation, necrosis & cavitation

 Endo - Reactivation & Exo - Reinfection

 Old age, Malnutrition, Malignant, HIV, AIDS,

Immunosuppressive drugs & Inter-current infections

 Reactivation – any site

 Post primary – Apical & Posterior segments of UL or Superior
segment of LL

 TB Cavity – site of growth – optimal temperature, abundance

of oxygen, nutrients from cell wall – OPEN TB

 Early – Thick walled, smooth inner surface, lack of air fluid,

surrounded by consolidation

 Chronic – Thin wall, spherical

PATHOLOGY
 Consequence of interplay b/w bacillus & host immunity

 LUNG ( PTB ) – indeed primary site of infection

 EPTB – consequence or accompaniment of PTB

 Except – HAIR & NAIL

HISTO PATHOLOGICAL

 Granuloma – Histo-pathological Hallmark of TB

 Granulomatous inflammation in TB
GRANULOMA
 Granuloma – Focal, compact collection of inflammatory cells –
MONO NUCLEAR

 Persistent non – degradable product or organism

 Hypersensitivity

 Immunological mechanism – LYMPHOCYTE

 Interplay – agent, macrophage, T cell, B cell, immune
complexes of biological mediators

 Enzymes & Cytokines

 Centrally – MACROPHAGE – phagocytosis

 Cytoplasm – large, pale, eosinophilic, foamy

 Epitheloid cells
 Multinucleated Giant cells

 Langhans

 Foreign body

 Confluent granulomas
 Granuloma – fibrosis, hyalinization, calcification &
ossification

 TB – Necrotizing Epitheloid Cell GRANULOMA

GRANULOMATOUS
INFLAMMATION
 Confluent necrotizing epitheloid cell granuloma

 Exudative ( soft granulomas )

 Proliferative ( hard granulomas )

 Number, Size, Extent – no of infecting bacilli, mode of spread

& amount of tuberculo-protein
 Exudative – Meninges & Peritoneum

 Eosinophils - GIT

 Cheese like necrosis

 Caseum – low oxygen tension, low pH, local accumulation of

fatty acids – inhibit replication
 Lesion is ACTIVE

 1839 – JN SCHONLEIN

 1869 – RICHARD MORTON

Predisposing Factors
 IDD - CMI – HIV & AIDS

 Immuno-suppressive therapy

 Immuno-modulator drugs

 Malignant neoplasm

 Silicosis

 LT Corticosteroids
 Poorly controlled DM

 CRF, HD

 CTD

 Organ transplantation

 IV Drug abuse

 Smoking
SYMPTOMS
 Constitutional

Tiredness
Headache
Fever
Weight loss
Night sweats
Loss of apetite
 Respiratory

COUGH – dry or productive

Scanty
Mucoid, muco-purulent or blood tinged
Haemoptysis
Chest pain
Breathlessness – extensive disease or complications
SIGNS
 Anaemia

 Cachexia

 Tachycardia

 Digital clubbing

 Enlarged LN
 PEM

 Low BMI

 Cracked POT sound

 BBS – TBS, CBS, ABS

DIAGNOSIS
 TST

 Hematology

Anaemia
Leucocytosis, Leucopenia
Purpura
Leukaemoid reaction
PCV
 Radiology

CXR – PA, Lateral, Apical-lordotic, Oblique

CT – HRCT, CECT
RADIOGRAPHIC FEATURES
 Parenchymal consolidation

 Tuberculoma

 Miliary TB

 Lymphadenopathy

 Airway involvement

 Pleural effusion
 FOB

 Diagnostic Mycobacteriology
DIFFERENTIAL DIAGNOSIS
 Infections

Bacterial pneumonia
Lung abscess
Fungal & miscellaneous

 Bronchogenic carcinoma

 Bronchiectasis
 Bronchial asthma

 Sarcoidosis

 Pneumoconiosis

 CVD

 Others – Hyper-thyroidism, DM
QUESTIONS???
THANK YOU
TREATMENT of TB & DR - TB

CONTINues