INTERNATIONAL MEDICAL SCHOOL

BACHELOR’S IN MEDICAL SCIENCE

SUBJECT/CODE: PATHOPHYSIOLOGY OF RESPIRATORY
SYSTEM/QPT20302T
Assignment 1 : TUBERCULOSIS
LECTURER NAME: DR.MOHANAD RAHMAN

NAME: ILHAASHINI KRISHNAN

IC NUMBER: 010301-05-0546
ID NUMBER: 012021090323
DATE OF SUBMISSION: 4TH OCTOBER 2022
Introduction

Tuberculosis is an airborne disease that caused by a bacteria called Mycobacterium

tuberculosis. The lungs are usually affected by this illness. When infected individuals cough,

sneeze, or spit, the droplets enter the air and are inhaled by healthy individuals. About 10

million people worldwide develop TB each year. Even though TB is a disease that may be

prevented and treated, 1.5 million people die from it every year. It has thus become the most

common infectious death cause worldwide. TB is the primary cause of death for HIV-positive

individuals and a major cause of antibiotic resistance. All age groups are generally at risk, but

children under the age of five are more vulnerable. Additionally, persons with recent exposure

to the TB bacteria as well as those with diseases like HIV and diabetes that weaken the

immune system are at a higher risk of acquiring TB. Additionally, men have a much higher

frequency of TB than women.This is due to men have smoking habits than women.

WHO claims that TB is a problem everywhere in the world. The WHO South-East Asian

Region dominated all other regions with 43% of all new TB cases in 2020, with the WHO

African Region coming in second with 25% and the WHO Western Pacific Region coming in

third with 18%.

86% of new TB cases in 2020 were centered in the 30 countries with the highest TB burden.

Two thirds of the new TB cases were from eight countries: India, China, Indonesia, the

Philippines, Pakistan, Nigeria, Bangladesh, and South Africa.

CLASSIFICATION OF TB

Extrapulmonary tuberculosis is the term used when tuberculosis has spread to other

organs.Pulmonary tuberculosis categorised into Primary and secondary diseases.While

secondary TB lasts greater than two years, primary TB lasts less than 2 years.When the

pathogen is encountered for the first time, primary TB occurs.Secondary TB occurs when

reactivation of previous lesions and the slow transformation of primary tuberculosis into a

chronic condition can both contribute to secondary tuberculosis.

Lymph node TB, pleural TB, upper airway TB, skeletal TB, genitourinary TB, miliary TB,

pericardial TB, gastrointestinal TB, and tuberculous meningitis are examples of extra

pulmonary TB.

A TB infection doesn’t always mean you’ll get sick. There are two forms of the disease:

Latent TB: Although the bacteria are present in the body, our immune system prevents them

from being active. As a result, it has no symptoms and is not contagious. However, the virus

is still present and might become active at some point. Your doctor will prescribe you drugs to

prevent active TB if your body is at a high risk for reactivation, such as if you have HIV, had

an infection within the previous two years, your chest X-ray is odd, or your immune system is

compromised.

Active TB: You become ill as the bacteria develop. The sickness can spread to other people.

Adults with current TB infections account for 90% of all cases.

Causes

TB caused by the bacterium called Mycobacterium tuberculosis.It is a rod-shaped bacillus.It

appear in pink due to acid-fast stain.It produces mycolic acid which protects the pathogen from

antibiotic therapy and host defenses.The bacteria spread usually through air and usually infect

the lungs.Although TB is infectious,it doesn’t spread easily.You usually have to spend a lot of
time in contact with someone who is contagious in order to catch it. TB also caused by drinking

unsterilized milk which contains Mycobacterium bovis.TB also can caused by viruses

Pathogenesis

Infection happens when tubercle bacilli-containing droplet nuclei are inhaled by a person,The

tubercle bacilli travel and enter the lungs where they get deposited in the alveolar sacs.In

alveoli,bacteria attaches to the mucosa of alveoli.The bacteria start attacking the tissue.The

bacteria will secrete a strong acid called mycolic acid that prevent itself from engulf of the

macrophage.The bacteria covers itself by mycolic acid.Therefore,the pathogens cannot killed

by the WBC.After that the bacteria will escape and increase in number.The mycolic acid

damage the wall of alveoli and also the wall of blood capillary.The blood enter the alveoli.There

will be formation of pus which is semisolid.The cheezy pus also called caseation.The cheezy

pus stuck into the lungs and hard to remove.The fibroblast covers the pus with fibrous tissue

form granuloma.The WBC become huge because contains a lot of bacteria and it becomes

huge called Langhan’s giant multinucleated cell. Latent TB infection is detected in the patient.

When the bacteria escape the granulomas and multiply in the lungs, latent tuberculosis can

develop into full-blown TB disease within 8–10 weeks, making the patient ill with the disease

and at risk of spreading it to others. This could occur right away following the infection, years

later, or not at all. Pulmonary TB refers to the condition that results when the TB bacteria

escape from the granuloma and infect the person's lungs. The upper portion of the lower lobe
or the lower portion of the upper lobe are frequently the locations of the Gohn Focus, which is

the primary site of TB infection in the lungs.

Morphology of tuberculosis

Chest x-ray showing bilateral CT scan of the chest reveals multiple

hilar adenopathy of primary areas of consolidation with large right
pulmonary TB. upper lobe irregular cavity formation.
 Radiology showing Gohn
Focus
Histology of lung tuberculosis.The necrosis
cells present in the center of the tubercles.

Coalescent granulomas are present,

composed of epithelioid cells surrounded by a
zone of fibroblasts and lymphocytes that
usually contains Langhan’s giant cells.

Lungs with pulmonary TB

Signs and symptoms

-Fever

-Prolonged cough

-Chest pain

-Shortness of breath

-Clubbing of fingers

-Blood sputum

-Weight loss

-Tiredness and fatigue

-loss of apetite

Diagnosis

There are two kinds of screening tests for TB:

The Mantoux tuberculin skin test (TST) and the blood test, called the interferon gamma release

assay (IGRA).

Mantoux tuberculin Interferon gamma

skin test(TST) release assay(IGRA)
A small amount of a substance known as pure protein derivative (PPD) will be injected under

the skin of your forearm by a medical professional for the TST. You must visit to the doctor or

other healthcare professional after two to three days so they may examine the injection site.

After two days, a red spot will appear at the injection site if the person has TB.Delayed

hypersensitivity to the antigen by the T cells,which means the person not necessarily has the

disease but has been exposed to the bacterium. For IGRA, A medical professional will take

blood and submit the sample to the lab. Additional examinations to identify whether an

infection is present or whether your lungs are infected include:

• Lab tests on sputum and lung fluid.

• Chest X-ray.

• Computed tomography (CT) scans.

Treatment

Drug-resistant TB presents an increasing threat. Noncompliance is a major reason in

resistance. Many people immediately quit using medications. Patients who may have

tuberculosis should be housed separate in a room with negative pressure. To ensure

adherence and completion, directly observed therapy is recommended.

First-line medications are bactericidal medicines that are important in the early stages of

infection because they destroy active bacteria.

Bacteriostatic medicines, which prevent bacterial growth, are second-line medications.

In the event of resistant bacteria, it is a stronger therapy.

TB infection and disease is treated with these drugs:

 • Isoniazid (Hyzyd®).

• Rifampin (Rifadin®).

• Ethambutol (Myambutol®).

• Pyrazinamide (Zinamide®).

• Rifapentine (Priftin®).

Treatment for Drug-Resistant TB

You have a drug-resistant strain of TB if it does not react to the common drugs used to treat

TB. This means that a combination of second-line medications, which might be less effective,

will be used to treat you. These medications must be taken for a longer period of time.

Ethambutol is used as the first line of treatment if the strain is drug-resistant.It will pass through

into the granuloma and kill the bacteria.

Conclusion
We draw the conclusion that populations with poor housing, drug use, and HIV infection

continue to have high rates of tuberculosis infection and illness. It is possible to prevent and

treat tuberculosis. Through the air, tuberculosis can spread from one person to another. It will

remain in the air for a while. TB that is latent can also become active. An efficient way to deliver

highly targeted screening services to the population at serious risk for disease acquisition and

transmission is by connecting a big medical provider with community-based organisations.

References

• Tuberculosis,WHO,Retrieved from

https://www.who.int/healthtopics/tuberculosis#tab=tab_1 on 11th September 2022.

• Minesh Khatri, MD on June 27, 2020,Tuberculosis,WebMD,Retrieved from

https://www.webmd.com/lung/understanding-tuberculosis-basics on 11th September

2022.

• Cleveland Clinic,Tuberculosis, https://my.clevelandclinic.org/health/diseases/11301-

tuberculosis

• Al Ubaidi BA (2018) The Radiological Diagnosis of Pulmonary Tuberculosis (TB) in

Primary Care. J Fam Med Dis Prev 4:073. doi.org/10.23937/2469-5793/1510073

• https://www.cdc.gov/tb/education/corecurr/pdf/chapter2.pdf