• SPECIAL PATHOLOGY PATHOLOGICAL CHANGES IN DISEASE CONDITIONS OF

SELECTED SYSTEMS:
RESPIRATORY SYSTEM
PULMONARY INFECTIONS: PNEUMONIA, LUNG ABSCESS,
PULMONARY TUBERCULOSIS 
CHRONIC OBSTRUCTIVE PULMONARY DISEASE:
CHRONIC BRONCHITIS, EMPHYSEMA,
BRONCHIAL ASTHMA, BRONCHIECTASIS 
TUMORS OF LUNGS
Ms. Dilpreet sohi
M.SC. (MHN)
PULMONARY TUBERCULOSIS
 INCIDENCE

• Most of those infected (90%) have asymptomatic latent TB. There is a 10 % lifetime chance
that LTBI will lead to TB disease, if latent untreated, will kill more than 50 % of its victims.
TB is one of the top four infectious killing diseases in the world. TB kills 1 million, and
malaria kills 2-3 millions.
 ETIOLOGICAL FACTORS

Mycobacterium tuberculosis is a slow growing aerobic bacterium that undergoes division

after every 16-20 hours. It is a small rod-like acid fast bacillus.

Exposer to TB

Droplet infections ( coughing, sneezing speaking or spit)

Drug abuse or alcoholism

Smoking
 MODE OF TRANSMISSION
• TB is spread by aerosol droplets expelled by people with a TB diseases of the lungs when they
cough, sneeze, speak or spit. Each droplet is 5- micrometre and contains 1 to 3 bacilli um.

• Routes :-

Inhalation:- from open cases of TB through droplets or direct sputum.

Ingestion of infected unpasteurized milk, i.e bovine tubercle bacilli from diseased cows or ingestion
of infected sputum of open case of TB

Inoculation of organism into skin

Transplacental:- rarely there can be congenital tuberculosis from infected mother to fetus through
placental route.
PATHOPHYSIOLOGY
 PULMONARY TUBERCULOSIS TEST AND DIAGNOSIS

Sputum microscopy: for Acid fast bacilli (AFB) this is the most important pulmonary
tuberculosis test when PTB is suspected. In areas of high TB endemicity, a positive AFB
smear is highly suggestive of Pulmonary Tuberculosis. 3 samples are usually collected over
two days such as one sample at the spot, then in the morning of the next day and then a third
sample when the patient sees the doctor during the day (spot-morning-spot samples)

Chest X-ray: chest radiology in pulmonary tuberculosis typically shows apical fibrosis;
there may be cavitations, fibrosis, pleural effusion etc.

Full Blood Count (FBC): there may be Lymphocytosis and anemia

Erythrocyte Sedimentation Rate (ESR): this will be elevated. Normal ESR in males
is calculated by dividing the age of the patient by 2 (that is ESR= age/2); Normal ESR
in females is calculated by adding 10 to the age and then dividing the sum by 2 (that
is, [age+10]/2)

Tuberculin skin test: this must be interpreted with caution putting into consideration
the associated morbidities and health status of the patient. This has been extensively
explained in this article about Tuberculin skin test. It is based on a delayed
hypersensitivity reaction following previous exposure to the tubercle bacilli. The
tuberculin skin test could be Mantoux test (which is still in use), Heaf test no longer in
use or Tine test no longer in use too.
Polymerase Chain Reaction (PCR) based tests for Pulmonary tuberculosis using

GeneXpert MTB/RIF. This can also be used to test for Rifampicin resistance.

Biopsy of various organs such as lymph node

Liver function tests to check for AST, ALT, and Bilirubin levels

Culture: using solid media such as Lowenstein Jensen media or liquid media such

as BACTEC