Pulmonary T.B.
Medical of anaesthesia department technique
MSc. MUSTAFA QASIM
Tuberculosis
(TB) is an infectious disease usually caused by Mycobacterium tuberculosis
(MTB) bacteria. Tuberculosis generally affects the lungs, but can also affect
other parts of the body.
Mycobacterium Tuberculosis organism First discovered in 1882 by Robert
Koch, M. tuberculosis has an unusual, waxy coating (bilipid layer) on its cell
surface primarily due to the presence of mycolic acid. This coating makes the
cells impervious to Gram staining, and as a result, M. tuberculosis can appear
weakly Gram-positive. Instead another culture media are used like Acid-fast
stains such as Ziehl–Neelsen, or fluorescent stains such as auramine are
used to identify M. tuberculosis with a microscope. The physiology of M.
tuberculosis is highly aerobic and requires high levels of oxygen.
The most frequently used diagnostic methods for tuberculosis are the
tuberculin skin test, acid-fast stain, culture, and polymerase chain reaction.
Sign and symptoms.
Tuberculosis may infect any part of the body, but most commonly occurs in
the lungs (known as pulmonary tuberculosis).Extra-pulmonary TB occurs
when tuberculosis develops outside of the lungs, although extra-pulmonary
TB may coexist with pulmonary TB
Pulmonary T.B.
it most commonly involves the lungs (in about 90% of cases).
1- About 25% of people may not have any symptoms (i.e. they remain
asymptomatic).
2- General signs and symptoms include fever, chills, night sweats, loss of
appetite, weight loss, and fatigue.
3- Symptoms may include chest pain and a prolonged cough producing
sputum.
4- cough up blood in small amounts
Tuberculosis may become a chronic illness and cause extensive scarring in
the upper lobes of the lungs. The upper lung lobes are more frequently
affected by tuberculosis than the lower ones. The reason for this difference is
not clear. It may be due to either better air flow, or poor lymph drainage within
the upper lungs.
Extra Pulmonary T.B.
Notable extrapulmonary infection sites include
1- the pleura (in tuberculous pleurisy),
2- the central nervous system (in tuberculous meningitis),
3- the lymphatic system (in scrofula of the neck),
4- the genitourinary system (in urogenital tuberculosis),
5- the bones and joints (in Pott disease of the spine)
General signs and symptoms include fever, chills, night sweats, loss of
appetite, weight loss, and fatigue.
Transmission
When people with active pulmonary TB cough, sneeze, speak, sing, or spit,
they expel infectious aerosol droplets 0.5 to 5.0 µm in diameter. A single
sneeze can release up to 40,000 droplets. Each one of these droplets may
transmit the disease, since the infectious dose of tuberculosis is very small
(the inhalation of fewer than 10 bacteria may cause an infection).
Risk of transmission
People with prolonged, frequent, or close contact with people with TB are at
particularly high risk of becoming infected, with an estimated 22% infection
rate, A person with active but untreated tuberculosis may infect 10–15 (or
more) other people per year.
The probability of transmission from one person to another depends upon
several factors, including the number of infectious droplets ( dose of
bacteria)expelled by the carrier, the effectiveness of ventilation, the duration
of exposure, the virulence of the M. tuberculosis strain, the level of
immunity in the uninfected person,
Pathophysiology
Tuberculosis is classified as one of the granulomatous inflammatory
diseases. Macrophages, epithelioid cells, T lymphocytes, B lymphocytes,
and fibroblasts aggregate to form granulomas, Another feature of the granulomas is
the development of abnormal cell death (necrosis) in the center of tubercles. To the
naked eye, this has the texture of soft, white cheese and is termed caseous necrosis.
Tuberculosis prevention and control efforts rely primarily on the vaccination of infants
and the detection and appropriate treatment of active cases
Treatment
Active TB is best treated with combinations of several antibiotics to reduce the
risk of the bacteria developing antibiotic resistance, The recommended
treatment of new-onset pulmonary tuberculosis, as of 2010, is six months of a
combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and
ethambutol for the first two months, and only rifampicin and isoniazid for the
last four months.
Complication
1- Respiratory failure
2- Haemoptysis
3- Pathological bone fracture.
4- Local tissue damage and loss of function
