BY HEMANT SHARMA

TUBERCULOSIS

INTRODUCTION

Tuberculosis (TB) is a potentially serious infectious disease that mainly affects

your lungs. The bacteria that cause tuberculosis are spread from one person to
another through tiny droplets released into the air via coughs and sneezes.

It is a slowly spreading, chronic, granulomatous bacterial infection, characterized

by gradual weight loss.

DEFINITION

Tuberculosis is the infectious disease primarily affecting lung parenchyma is most

often caused by Mycobacterium Tuberculosis.

TYPES

1. PULMONARY TUBERCULOSIS

2. AVIAN TUBERCULOSIS (Mycobacterium avium; of birds)

3. BOVINE TUBERCULOSIS (Mycobacterium bovis; of cattle)

4. MILIARY TUBERCULOSIS /DISSEMINATED TUBERCULOSIS (Invade

the blood stream and spread to all body organs.

CLINICAL MANIFESTATION

 Latent TB. In this condition, you have a TB infection, but the bacteria remain
in your body in an inactive state and cause no symptoms. Latent TB, also
called inactive TB or TB infection, isn't contagious. It can turn into active TB,
so treatment is important for the person with latent TB and to help control the
spread of TB. An estimated 2 billion people have latent TB.
 Active TB. This condition makes you sick and in most cases can spread to
others. It can occur in the first few weeks after infection with the TB bacteria,
or it might occur years later.
Signs and symptoms of active TB include:

 Coughing that lasts three or more weeks

 Coughing up blood
 Chest pain, or pain with breathing or coughing
 Unintentional weight loss
 Fatigue
 Fever
 Night sweats
 Chills
 Loss of appetite

Tuberculosis can also affect other parts of your body, including your kidneys,
spine or brain. When TB occurs outside your lungs, signs and symptoms vary
according to the organs involved. For example, tuberculosis of the spine may
give you back pain, and tuberculosis in your kidneys might cause blood in
your urine.

CAUSES

HIV and TB

Since the 1980s, the number of cases of tuberculosis has increased dramatically
because of the spread of HIV, the virus that causes AIDS. Infection with HIV
suppresses the immune system, making it difficult for the body to control TB
bacteria. As a result, people with HIV are many times more likely to get TB and to
progress from latent to active disease than are people who aren't HIV positive.

Drug-resistant TB

Another reason tuberculosis remains a major killer is the increase in drug-resistant

strains of the bacterium. Since the first antibiotics were used to fight tuberculosis
more than 60 years ago, some TB germs have developed the ability to survive
despite medications, and that ability gets passed on to their descendants.

RISK FACTORS

Anyone can get tuberculosis, but certain factors can increase your risk of the
disease. These factors include:

Weakened immune system

A healthy immune system often successfully fights TB bacteria, but your body
can't mount an effective defense if your resistance is low. A number of diseases,
conditions and medications can weaken your immune system, including:

 HIV/AIDS
 Diabetes
 Severe kidney disease
 Certain cancers
 Cancer treatment, such as chemotherapy
 Drugs to prevent rejection of transplanted organs
 Some drugs used to treat rheumatoid arthritis, Crohn's disease and psoriasis
 Malnutrition
 Very young or advanced age
Traveling or living in certain areas

The risk of contracting tuberculosis is higher for people who live in or travel to
areas that have high rates of tuberculosis and drug-resistant tuberculosis, including:

 Africa
 Eastern Europe
 Asia
 Russia
  Latin America
 Caribbean Islands
Poverty and substance use

 Lack of medical care. If you receive a low or fixed income, live in a remote
area, have recently immigrated to the United States, or are homeless, you may
lack access to the medical care needed to diagnose and treat TB.
 Substance use. Use of IV drugs or excessive alcohol weakens your immune
system and makes you more vulnerable to tuberculosis.
 Tobacco use. Using tobacco greatly increases the risk of getting TB and
dying of it.

PATHOPHYSIOLOGY

 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 via blood stream and
phagocytosis by neutrophils and macrophages
 Mycobacterium
 Pulmonary alveoli
 Immune system has lodged in (Alveolar Macrophages)
 Detects presence of pathogen and engoulph the bacteria
 Mycobacterium bacteria inhibit the Macrophages (phagosome+ Lissome) to
forms phagolysosome and remains protected inside the macrophages.
 Starts replication inside macrophages.
 Primary infection occurs.
 Cell mediated immunity gets activated, surrounds the cell to forms
granuloma (3weeks)
  Leads to necrosis of tissues at infection site(TERMINUS GONE FOCUS)
 Involve nearby lymph nodes (CONE COMPLEX)
 Calcification of cone complex (LATENT T.B.)

COMPLICATIONS

Without treatment, tuberculosis can be fatal. Untreated active disease typically

affects your lungs, but it can spread to other parts of your body through your
bloodstream. Examples of tuberculosis complications include:

 Spinal pain. Back pain and stiffness are common complications of

tuberculosis.
 Joint damage. Tuberculosis arthritis usually affects the hips and knees.
 Swelling of the membranes that cover your brain (meningitis). This can
cause a lasting or intermittent headache that occurs for weeks. Mental changes
also are possible.
 Liver or kidney problems. Your liver and kidneys help filter waste and
impurities from your bloodstream. These functions become impaired if the
liver or kidneys are affected by tuberculosis.
 Heart disorders. Rarely, tuberculosis can infect the tissues that surround your
heart, causing inflammation and fluid collections that may interfere with your
heart's ability to pump effectively. This condition, called cardiac tamponade,
can be fatal.
DIAGNOSIS

During the physical exam, your doctor will check your lymph nodes for swelling
and use a stethoscope to listen carefully to the sounds your lungs make while you
breathe.

The most commonly used diagnostic tool for tuberculosis is a simple skin test,
though blood tests are becoming more commonplace. A small amount of a
substance called PPD tuberculin is injected just below the skin of your inside
forearm. You should feel only a slight needle prick.
Within 48 to 72 hours, a health care professional will check your arm for swelling
at the injection site. A hard, raised red bump means you're likely to have TB
infection. The size of the bump determines whether the test results are significant.

Blood tests

Blood tests may be used to confirm or rule out latent or active tuberculosis. These
tests use sophisticated technology to measure your immune system's reaction to TB
bacteria.

These tests require only one office visit. A blood test may be useful if you're at
high risk of TB infection but have a negative response to the skin test, or if you've
recently received the BCG vaccine.

Imaging tests

If you've had a positive skin test, your doctor is likely to order a chest X-ray or a
CT scan. This may show white spots in your lungs where your immune system has
walled off TB bacteria, or it may reveal changes in your lungs caused by active
tuberculosis. CT scans provide more-detailed images than do X-rays.

Sputum tests

If your chest X-ray shows signs of tuberculosis, your doctor may take samples of
your sputum — the mucus that comes up when you cough. The samples are tested
for TB bacteria.

Sputum samples can also be used to test for drug-resistant strains of TB. This helps
your doctor choose the medications that are most likely to work. These tests can
take four to eight weeks to be completed.

TREATMENT

Medications are the cornerstone of tuberculosis treatment. But treating TB takes

much longer than treating other types of bacterial infections.
For active tuberculosis, you must take antibiotics for at least six to nine months.
The exact drugs and length of treatment depend on your age, overall health,
possible drug resistance and the infection's location in the body.

Most common TB drugs

If you have latent tuberculosis, you may need to take only one or two types of TB
drug. Active tuberculosis, particularly if it's a drug-resistant strain, will require
several drugs at once. The most common medications used to treat tuberculosis
include:

 Isoniazid
 Rifampin (Rifadin, Rimactane)
 Ethambutol (Myambutol)
 Pyrazinamide
If you have drug-resistant TB, a combination of antibiotics called fluoroquinolones
and injectable medications, such as amikacin or capreomycin (Capastat), are
generally used for 20 to 30 months. Some types of TB are developing resistance to
these medications as well.

Some drugs may be used as add-on therapy to the current drug-resistant

combination treatment, including:

 Bedaquiline (Sirturo)
 Linezolid (Zyvox)
Medication side effects

Serious side effects of TB drugs aren't common but can be dangerous when they do
occur. All tuberculosis medications can be highly toxic to your liver. When taking
these medications, call your doctor immediately if you experience any of the
following:

 Nausea or vomiting
 Loss of appetite
  A yellow color to your skin (jaundice)
 Dark urine
 A fever that lasts three or more days and has no obvious cause
Completing treatment is essential

After a few weeks, you won't be contagious and you may start to feel better. It
might be tempting to stop taking your TB drugs. But it is crucial that you finish the
full course of therapy and take the medications exactly as prescribed by your
doctor. Stopping treatment too soon or skipping doses can allow the bacteria that
are still alive to become resistant to those drugs, leading to TB that is much more
dangerous and difficult to treat.

To help people stick with their treatment, a program called directly observed
therapy (DOT) is recommended. In this approach, a health care worker administers
your medication so that you don't have to remember to take it on your own.