tuberculosis B S K KANTH INTRODUCTION Mycobacterium tuberculosis
![tuberculosis. B. S. K. KANTH tuberculosis. B. S. K. KANTH](https://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-1.jpg)
tuberculosis. B. S. K. KANTH
![INTRODUCTION Mycobacterium tuberculosis is responsible for most cases of tuberculosis. Mycobacterium bovis causes oropharyngeal INTRODUCTION Mycobacterium tuberculosis is responsible for most cases of tuberculosis. Mycobacterium bovis causes oropharyngeal](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-2.jpg)
INTRODUCTION Mycobacterium tuberculosis is responsible for most cases of tuberculosis. Mycobacterium bovis causes oropharyngeal and intestinal tuberculosis. Tuberculosis is second leadind infectious cause of death in world.
![PATHOGENESIS Source of Infection: open case of tuberculosis In INDIA , an average open PATHOGENESIS Source of Infection: open case of tuberculosis In INDIA , an average open](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-3.jpg)
PATHOGENESIS Source of Infection: open case of tuberculosis In INDIA , an average open case of tuberculosis infect an average of 25 contacts before death (or)cure.
![Contd… Mode of Infection: *direct inhalation of aerosolised bacilli contained in droplet nuclei of Contd… Mode of Infection: *direct inhalation of aerosolised bacilli contained in droplet nuclei of](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-4.jpg)
Contd… Mode of Infection: *direct inhalation of aerosolised bacilli contained in droplet nuclei of expectorated sputum. *Infection also occurs infreequently by ingestion for eg; through infected milk.
![Contd… Contd…](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-5.jpg)
Contd…
![Contd… Contd…](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-6.jpg)
Contd…
![PRIMARY TUBERCULOSIS PRIMARY TUBERCULOSIS](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-7.jpg)
PRIMARY TUBERCULOSIS
![CONTD… M. tuberculosis enters macrophages by endocytosis mediated my macrophage mannose receptors which bind CONTD… M. tuberculosis enters macrophages by endocytosis mediated my macrophage mannose receptors which bind](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-8.jpg)
CONTD… M. tuberculosis enters macrophages by endocytosis mediated my macrophage mannose receptors which bind to “LIPOARABINOMANNAN”, a glycolipid in bacterial cell wall. M. tuberculosis replicate inside by blocking fusion of “PHAGOSOMELYSOSOME”
![Contd… Contd…](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-9.jpg)
Contd…
![CONTD… “LYMPHO – HEMATEGENOUS” spread of bacilli is seen because in early stages of CONTD… “LYMPHO – HEMATEGENOUS” spread of bacilli is seen because in early stages of](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-10.jpg)
CONTD… “LYMPHO – HEMATEGENOUS” spread of bacilli is seen because in early stages of primary infection Th -1 response is not seen. Because of this lympho hemategenous dissemination , bacilli reaches lymphnodes leading to development of Th-1 response , which activates macrophages to become bactericidal.
![Contd… TH-1 cells are stimulated by mycobacterial antigens drained to lymphnodes, which are presented Contd… TH-1 cells are stimulated by mycobacterial antigens drained to lymphnodes, which are presented](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-11.jpg)
Contd… TH-1 cells are stimulated by mycobacterial antigens drained to lymphnodes, which are presented with class II MHC by APC. Differentiation of TH-1 cells depends on presence of IL-12, which is produced by APC.
![Contd… Mature TH-1 cells Interferon-gamma • Critical mediator which drives macrophages to become competent Contd… Mature TH-1 cells Interferon-gamma • Critical mediator which drives macrophages to become competent](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-12.jpg)
Contd… Mature TH-1 cells Interferon-gamma • Critical mediator which drives macrophages to become competent to contain tuberculous infection
![Contd… Interferon gamma stimulates phagolysosome formation in infected macrophages, exposing the bacteria to an Contd… Interferon gamma stimulates phagolysosome formation in infected macrophages, exposing the bacteria to an](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-13.jpg)
Contd… Interferon gamma stimulates phagolysosome formation in infected macrophages, exposing the bacteria to an acidic environment. It also stimulate expression of inducible nitric oxide synthase, which produces nitric oxide.
![Contd… Nitric oxide generates reactive nitrogen intermediates and free radicals capable of oxidative destruction Contd… Nitric oxide generates reactive nitrogen intermediates and free radicals capable of oxidative destruction](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-14.jpg)
Contd… Nitric oxide generates reactive nitrogen intermediates and free radicals capable of oxidative destruction of several mycobacterial constituents. Activated marophages stimulated by ifngamma, produce TNF, which recruits monocytes.
![Contd… These monocytes differentiate into “epitheloid histiocytes” that characterise formation of granulomas and c. Contd… These monocytes differentiate into “epitheloid histiocytes” that characterise formation of granulomas and c.](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-15.jpg)
Contd… These monocytes differentiate into “epitheloid histiocytes” that characterise formation of granulomas and c. asseous formation.
![Contd… Contd…](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-16.jpg)
Contd…
![Contd… In this primary tuberculosis infection , exudative lesion is seen. Exudative type of Contd… In this primary tuberculosis infection , exudative lesion is seen. Exudative type of](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-17.jpg)
Contd… In this primary tuberculosis infection , exudative lesion is seen. Exudative type of lesion consists of acute inflamatory reaction, edema fluid, pmn , later monocytes around bacilli. This parenchymal lung lesion is called “GHON FOCUS”
![CONTD… This ghon focus is seen mainly in lower part of upper lobe(or)in lower CONTD… This ghon focus is seen mainly in lower part of upper lobe(or)in lower](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-18.jpg)
CONTD… This ghon focus is seen mainly in lower part of upper lobe(or)in lower lobe. This ghon focus along with enlarged hilum lymph nodes constitutes “GHON COMPLEX” It is also called primary complex
![Contd… Contd…](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-19.jpg)
Contd…
![Contd… Ghon complex undergoes progressive fibrosis leading to radiological detectable calcification called RANKE COMPLEX Contd… Ghon complex undergoes progressive fibrosis leading to radiological detectable calcification called RANKE COMPLEX](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-20.jpg)
Contd… Ghon complex undergoes progressive fibrosis leading to radiological detectable calcification called RANKE COMPLEX
![Contd… About 5% of newly infected people develops clinical significant disease. The elderly and Contd… About 5% of newly infected people develops clinical significant disease. The elderly and](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-21.jpg)
Contd… About 5% of newly infected people develops clinical significant disease. The elderly and profound immunosuppressed persons may lose their immunity to the tubercle bacillus and develops this “PROGRESSIVE PRIMARY TB”
![CONTD… In primary progressive TB, lymphnode involvement may lead endobronchial consequences such as bronchial CONTD… In primary progressive TB, lymphnode involvement may lead endobronchial consequences such as bronchial](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-22.jpg)
CONTD… In primary progressive TB, lymphnode involvement may lead endobronchial consequences such as bronchial stenosis. Progressive primary TB may also lead to massive hematogenous dissemination , causing “MILIARY TB”
![CONTD… Thus primary infection takes one of the following paths: A)healed lesions B)latent lesions(organism CONTD… Thus primary infection takes one of the following paths: A)healed lesions B)latent lesions(organism](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-23.jpg)
CONTD… Thus primary infection takes one of the following paths: A)healed lesions B)latent lesions(organism is dormant) - they may be pulmonary (or)extrapulmonary -persons with latent infection cannot spread infection to others.
![Contd… C)it may end as progressive primary TB, which is disseminated hamatogenously leading to Contd… C)it may end as progressive primary TB, which is disseminated hamatogenously leading to](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-24.jpg)
Contd… C)it may end as progressive primary TB, which is disseminated hamatogenously leading to miliary TB.
![SECONDARY TUBERCULOSIS It arises because of: a)reactivation of dormant primary lesions, when host resistance SECONDARY TUBERCULOSIS It arises because of: a)reactivation of dormant primary lesions, when host resistance](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-25.jpg)
SECONDARY TUBERCULOSIS It arises because of: a)reactivation of dormant primary lesions, when host resistance is weekened. b)exogenous re-infection. Reactivation of tuberculosis is more common in low prevalence areas, while re-infection plays an important role in high contagious areas.
![Contd… It is clasically localised to apex or upper lobes of lungs. Bacause of Contd… It is clasically localised to apex or upper lobes of lungs. Bacause of](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-26.jpg)
Contd… It is clasically localised to apex or upper lobes of lungs. Bacause of pre existance of hypersensitivity the bacilli elicit a prompt and marked tissue response that tends to wall off the focus of infection. As a result of this localisation regional lymphnodes are less involved.
![Contd… Cavitation occurs readily in secondary form leading to dissemination of mycobacteria along the Contd… Cavitation occurs readily in secondary form leading to dissemination of mycobacteria along the](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-27.jpg)
Contd… Cavitation occurs readily in secondary form leading to dissemination of mycobacteria along the air ways. Now the patient sputum contains active bacilli. Seconday tuberculous infection is characterised by productive type of lesion.
![Contd… Exudative lesion : - it is a chronic avascular granuloma. -3 zones -central Contd… Exudative lesion : - it is a chronic avascular granuloma. -3 zones -central](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-28.jpg)
Contd… Exudative lesion : - it is a chronic avascular granuloma. -3 zones -central zone: multinucleated giant cells. -mid zone: radially arranged epitheloid cells. -peripheral zone of fibroblasts, lymphocytes, monocytes.
![Contd… Such a lesion is called tubercle. It is the characteristic fauture of tuberculosis. Contd… Such a lesion is called tubercle. It is the characteristic fauture of tuberculosis.](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-29.jpg)
Contd… Such a lesion is called tubercle. It is the characteristic fauture of tuberculosis. This secondary TB , also disseminate hematogenously, leading to MILIARY TB.
![Contd… Contd…](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-30.jpg)
Contd…
![EXTRA PULMONARY TB SYSTEMIC MILIARY TUBERCULOSIS -seen in liver, lngs, kidney, adrenals… ISOLATED ORGAN EXTRA PULMONARY TB SYSTEMIC MILIARY TUBERCULOSIS -seen in liver, lngs, kidney, adrenals… ISOLATED ORGAN](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-31.jpg)
EXTRA PULMONARY TB SYSTEMIC MILIARY TUBERCULOSIS -seen in liver, lngs, kidney, adrenals… ISOLATED ORGAN TUBERCULOSIS -In kidney: renal TB -in meninges: tuberculous meningitis -in bones: osteomyelitis -in fallopian tubules: salpingitis - in intestine: intestine tuberculosis
![Picture of miliary tb in lung Picture of miliary tb in lung](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-32.jpg)
Picture of miliary tb in lung
![Clinical manifestations In primary tuberculosis: -usually asymptomatic -may have mild flu like symptoms Clinical manifestations In primary tuberculosis: -usually asymptomatic -may have mild flu like symptoms](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-33.jpg)
Clinical manifestations In primary tuberculosis: -usually asymptomatic -may have mild flu like symptoms
![Contd… In progressive pulmonary tb: -hilar adenopathy -plueral effusion Contd… In progressive pulmonary tb: -hilar adenopathy -plueral effusion](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-34.jpg)
Contd… In progressive pulmonary tb: -hilar adenopathy -plueral effusion
![Contd… In secondary pulmanary tb: -FEVER: low grade and remittent(appearing each afternoon and subsiding) Contd… In secondary pulmanary tb: -FEVER: low grade and remittent(appearing each afternoon and subsiding)](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-35.jpg)
Contd… In secondary pulmanary tb: -FEVER: low grade and remittent(appearing each afternoon and subsiding) &night sweats occur. -SPUTUM: initially: mucoid later: purulent half of cases: hemoptysis is seen
![Contd… In secondary pulmonary tb -PLUERITIC PAIN -WEIGHT LOSS -APPETITE LOSS -EASY FATIGUABILITY -ANOREXIA Contd… In secondary pulmonary tb -PLUERITIC PAIN -WEIGHT LOSS -APPETITE LOSS -EASY FATIGUABILITY -ANOREXIA](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-36.jpg)
Contd… In secondary pulmonary tb -PLUERITIC PAIN -WEIGHT LOSS -APPETITE LOSS -EASY FATIGUABILITY -ANOREXIA
![CONTD… IN ACUTE MILIARY TB -HIGH FEVER, DRAMATIC INFECTIOUS ILLNESS. LOCALISING SYMPTOMS MAY POINT CONTD… IN ACUTE MILIARY TB -HIGH FEVER, DRAMATIC INFECTIOUS ILLNESS. LOCALISING SYMPTOMS MAY POINT](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-37.jpg)
CONTD… IN ACUTE MILIARY TB -HIGH FEVER, DRAMATIC INFECTIOUS ILLNESS. LOCALISING SYMPTOMS MAY POINT OUT ORGAN INVOLVEMENT EG: HEADACHE(MENINGITIS), CHEST PAIN(PLUERITIS), ABDOMINAL PAIN(PERITONITIS)
![CONTD… . IN CHRONIC MILIARY TB: *fever of unknown origin hematological dsorders: -thrombocytopenia, -leukaemoid CONTD… . IN CHRONIC MILIARY TB: *fever of unknown origin hematological dsorders: -thrombocytopenia, -leukaemoid](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-38.jpg)
CONTD… . IN CHRONIC MILIARY TB: *fever of unknown origin hematological dsorders: -thrombocytopenia, -leukaemoid reaction, -POLYCYTHEMIA
![“The greatest killer of all time… The captain of all these men of “The greatest killer of all time… The captain of all these men of](http://slidetodoc.com/presentation_image/172c421ff4bb6bf0405cbbe7dd0a9b9a/image-39.jpg)
“The greatest killer of all time… The captain of all these men of death… …During this centuary and last, One billion people died of tuberculosis “THE WHITE PLAGUE”
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