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TB

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22 views5 pages

TB

B. Pharm notes

Uploaded by

ibaminaa548
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PATHOPHYSIOLOGY OF TUBERCULOSIS

INTRODUCTION 

 TB is caused by tubercle bacilli, which belong to the genus


Mycobacterium. 
 The burden of TB in many countries is compounded in those who
have co- infection with the human immunodeficiency virus (HIV). 
 In 2006, the emergence of extensively drug-resistant tuberculosis
(MDR-TB) was first reported.

INCIDENCE

 In spite of great advances in chemotherapy and immunology,


tuberculosis still continues to be worldwide in distribution.
 More common in developing countries of Africa, Latin America and
Asia.
 Other factors malnutrition, inadequate medical care, poverty,
crowding, chronic debilitating conditions like uncontrolled diabetes,
alcoholism and immune compromised states like AIDS.

ETIOLOGY

These form a large group but only three relatives (Mycobacterium


tuberculosis complex) are obligate parasites that can cause TB disease. 
M. tuberculosis complex: M. tuberculosis, M. bovis, M. africanum 

RISK FACTORS

 Length of exposure time to contaminated air


 Immune status of the exposed individual
 Infected persons living in crowded or closed environments pose a
particular risk to non infected persons.
 Microepidemics have occurred in closed environments such as
submarines and on transcontinental flights, hospital employees, inner-
city residents, nursing home residents, and prisoners.
 Examples of factors that increase risk of developing TB
 HIV positive
 Injecting drug users
 Solid organ transplantation
 Haematological malignancy, for example leukaemia and lymphomas
 Silicosis
RISK GROUPS 

 Close contacts of patients with TB (sputum smear-positive


pulmonary) 
 Casual contacts (e.g. work colleagues) if they are immunosuppressed

 People from countries with a high incidence of TB (40/100,000
population or greater).
 People with certain medical conditions are at increased risk of
developing active TB

MODE OF TRANSMISSION.

Human beings acquire infection with tubercle bacilli by one of the


following routes:

1. Inhalation of organisms present in fresh cough droplets or in dried


sputum from an open case of pulmonary tuberculosis.
2. Ingestion sputum of an open case of pulmonary tuberculosis, or
ingestion of bovine tubercle bacilli from milk of diseased cows.
3. Inoculation of the organisms into the skin may rarely occur from
infected postmortem tissue.
4. Transplacental route results in development of congenital tuberculosis
in foetus from infected mother and is a rare mode of transmission.

TYPES OF TUBERCULOSIS

Lung is the main organ affected in tuberculosis.

Depending upon the type of tissue response and age, the infection with
tubercle bacilli is of 2 main types:
1. Primary tuberculosis
2. Secondary tuberculosis

PRIMARY TUBERCULOSIS

 The infection of an individual who has not been previously infected


or immunised is called primary tuberculosis or Ghon’s complex or
childhood tuberculosis.
 The most commonly involved tissues for primary complex are lungs
and lymph nodes. Other tissues are tonsils and cervical lymph nodes,
lesions may be found in small intestine and mesenteric lymph nodes.
 Progressive primary tuberculosis is particularly high in
immunocompromised host e.g. in patients of AIDS.

SECONDARY TUBERCULOSIS

 The infection of an individual who has been previously infected or


sensitised is called secondary, or post-primary or reinfection, or
chronic tuberculosis.
 The infection may be endogenous source such as reactivation of
dormant primary complex. exogenous source such as fresh dose of
reinfection by the tubercle bacilli.
 Secondary tuberculosis occurs most commonly in lungs in the region
of apex. Other sites and tissues which can be involved are tonsils,
pharynx, larynx, small intestine

HIV-ASSOCIATED TUBERCULOSIS.

 Moreover, HIV-infected individual on acquiring infection with


tubercle bacilli develops active disease rapidly (within few weeks)
 Extra-pulmonary tuberculosis is more common in HIV disease and
manifests commonly by involving lymph nodes, pleura, pericardium,
and tuberculous meningitis.
 Infection with M. avium- intracellulare (avia or bird strain) is
common in patients with HIV/AIDS.

SIGNS & SYMPTOMS

Classic clinical features associated with active pulmonary TB are as


follows

 Cough
 Weight loss/anorexia
 Fever
 Night sweats
 Hemoptysis
 Chest pain
 Fatigue

Pulmonary TB:

 Abnormal breath sounds


 Rales or bronchial breath signs (rattling sound)
Extrapulmonary TB:

 Confusion
 Coma
 Neurologic deficit
 Chorioretinitis
 Lymphadenopathy
 Cutaneous lesions
 Cough for 3 weeks or more/productive cough
 Sputum usually mucopurulent or purulent
 Haemoptysis not always a feature
 Fever may be associated with night sweats
 Tiredness
 Weight loss variable
 Anorexia variable
 Malaise.

SPREAD OF TUBERCULOSIS.

The disease spreads in the body by various routes:

1. Local spread.

This takes place by macrophages carrying the bacilli into the surrounding
tissues.
2. Lymphatic spread.

Tuberculosis is primarily an infection of lymphoid tissues.


The bacilli may pass into lymphoid follicles of pharynx, bronchi,
intestines or regional lymph nodes resulting in regional tuberculous
lymphadenitis

3. Haematogenous spread.

This occurs either as a result of tuberculous bacillaemia because of the


drainage of lymphatics into the venous system
This produces millet seed-sized lesions in different organs of the body
like lungs, liver, kidneys, bones and other tissues and is known as miliary
tuberculosis.
4. By the natural passages:

 lung lesions into pleura (tuberculosis pleurisy)


 trans bronchial spread into the adjacent lung segments
 Tuberculous salpingitis into peritoneal cavity (tuberculous peritonitis)
 Infected sputum into larynx (tuberculous laryngitis)
 Swallowing of infected sputum (ileocaecal tuberculosis)
 Renal lesions into ureter and down to trigone of bladder.

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