TUBERCULOSIS
INTRODUCTION
• Tuberculosis (TB) is one of the most prevalent
infections of human beings and contributes
considerably to illness and death around the world.
• It is spread by inhaling tiny droplets of saliva from the
coughs or sneezes of an infected person.
• it is a slowly spreading, chronic, granulomatous
bacterial infection, characterized by gradual weight
loss.
• Tuberculosis is infectious disease primarily affecting
the lung
• It may spread to any part of the body including
meninges, kidney, bones and lymphnodes.
TYPES
Pulmonary tuberculosis
Avian tuberculosis ( microbacterium avium ;of birds)
Bovine tuberculosis (mycobacterium bovis;of cattle)
Miliary tuberculosis / disseminated tuberculosis
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INCIDENCE
• With the increased incidence of AIDS, TB has become
more a problem in the U.S., and the world.
•Itis currently estimated that ½ of the world's
population is infected with Mycobacterium tuberculosis
(3.1 billion)
•By Tuberculosis 5,000 people die a day
•2.3 million die each year
ETIOLOGY
•Mycobacterium tuberculosis
•Droplet nuclei (coughing,sneezing,laughing)
•Exposure to TB
RISK FACTORS
❑ Close contact with some one who have active TB.
❑ Immuno compromised status
(elderly,cancer)
❑ Drug abuse and alcoholism
❑ People lacking adequate health care
❑ Pre existing medical conditions (diabetes mellitus,
chronic renal failure)
❑ Immigrants from countries with higher incidence of
TB.
❑ Institutionalisation(long term care facilities)
❑ Living in substandard conditions
❑ Occupation (health care workers)
PATHOPHISIOLOGY
• initial infection or primary infection.
• entry of micro organism through droplet nuclei
• bacteria is transmitted to alveoli through airways
• deposition and multiplication of bacteria
• bacilli are also transported to other parts of the body
through blood stream.
•phagocytosis by neutrophils and macrophages
•accumulation of exudate in alveoli
•broncho pnemonia
•new tissue masses of live and dead bacilli are
surrounded by macrophages which form a protective
mass around granulomas
granulomas then transforms to fibrous tissue mass
and central portion of which is called ghon tubercle
• the material (bacteria and macrophages) becomes
necrotic forming cheesy mass
• mass becomes calcified and becomes colagenous scar
• bacteria become dormant and no further progression
of active disease
(active disease or re infection)
• inadequate immune response
• activation of dormant bacteria
• Ghon tubercle ulcerates and releasing cheesy material
into bronchi
• Bacteria then become airborne resulting in further
spread of infection
• Ulcerated tubercle heals and becomes scar tissue
• Infected lung become inflammed
• Further devolopment of pneumonia and tubercle
formation
• Unless the process is arrested it spreads downwards
to
the hilum of lungs and later extends to adjacent areas.
CLINICAL MANIFESTATION
CONSTITUTIONAL SYMPTOMS
Anorexia
Low grade fever EXTRA PULMONARY SYMPTOMS
Night sweats Pain
Fatique Inflammation
Weight loss
PULMONARY SYMPTOMS
Dyspnea
Chest tightness
Non productive cough
Mucopurulent sputum with hemoptpysis
Chest pain
History collection
Physical examination
Clubbing of the fingers or toes (in people with
advanced disease)
Swollen or tender lymph nodes in the neck or other
areas.
Fluid around a lung (pleural effusion)
Unusual breath sounds (crackles)
If miliary TB; a physical exam may show:
swollen liver
swollen lymph nodes
swollen spleen
Tests may include:
Biopsy of the affected tissue (rare)
Bronchoscopy
Chest CT scan
Chest x-ray
Interferon-gamma release blood test such as the
QFT-Gold test to test for TB infection
Sputum examination and cultures
Thoracocentesis
Tuberculin skin test (also called a PPD test)
COMPLICATIONS
Bones - Spinal pain and joint destruction may result
from TB that infects your bones (TB spine or potss
spine)
Brain (meningitis)
Liver or kidneys
Heart (cardiac tamponade)
Pleural effusion
TB pneumonia
Serious reactions to drug therapy
(hepatotoxicity; hypersentivity)
PREVENTION
❑ ISOLATION
❑ Ventilate the room
❑ Cover the mouth
❑ Wear mask
❑ Finish entire course of medication
❑ Vaccinations
