TUBERCULOSIS DEFINITION TUBERCLOSIS is a communicable chronic granulomatous

TUBERCULOSIS

DEFINITION • TUBERCLOSIS : is a communicable, chronic, granulomatous disease, caused by mycobacterium tuberculosis. • It usually involves the lungs but may affect any organ or tissue of the body.

ETIOLOGY • The causative organism mycobacterium tuberculosis. • Mycobacteria are aerobic, acid-fast bacilli, and it is a gram negative bacilli.

SPREAD OF INFECTION • Direct droplet spread : it mean from person to person by inhalation of air –borne bacilli that have been coughed or sneezed into the atmosphere. • Indirect spread : via dishes, clothing and other article of daily use laden with bacilli.

PREDISPOSING FACTORS 1. ENVIRONMENTAL FACTORS : which lower the body resistance such as : malnutrition, poverty, overcrowding, alcoholism and heavy smoking. 2. PATHOLOGICAL FACTORS : which lower the body resistance such as : diabetes mellitus, steroids, chronic lung disease.

TYPE OF TUBERCULOSIS 1. PRIMARY TUBERCULOSIS. 2. POST-PRIMARY ( SECONDARY TUBERCLOSIS ).

PRIMARY TUBERCULOSIS • It is a form of disease that develops in a previously unexposed and therefore non sensitized individual, usually in children.

• Occurs in the lung (Ghon focus ) in subpleural

Ghon focus

SYMPTOMS AND SIGNS • The primary stage of the disease may be symptom-free, this called the “inactive phase”. • within the active stage of the disease, there might be a slight fever, night sweating, weight loss, fatigue.

PATHOPHYSIOLOGY

Primary tuberculosis • Definition: Infection of an individual who has not been previously infected or immunised. • The inhaled bacilli implant in the distal airspaces of lower part of upper lobe or upper part of lower lobe close to the pleura • As sensitization develops, a gray-white inflammatory consolidation is formed Ghon focus

Secondary tuberculosis • Definition: the infection of an individual who has been previously infected or sensitized • The infection may be acquired from – Endogenous source: reactivation of dormant primary complex – Exogenous source.

Tuberculous Granulomas

Lung TB - Cavitation

Complications of cavitatory secondary TB • Extension to pleura producing bronchopleural fistula. • Tuberculous empyema. • Thickened pleura. • Pleural effusions.

Diagnosis of TB • • Clinical features are not confirmatory. Zeil Nielson Stain. Culture most sensitive and specific test. Mantoux test.

AFB - Ziehl-Nielson stain

TREATMENT • • • INITIAL PHASE – FIRST 2 MONTHS : Rifampicin. Isoniazid. Pyrazinamide. Ethambutol. CONTINUATION PHASE – NEXT 4 MONTHS : • Rifampicin. • Isoniazid.

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