TB - Tuberculosis

Edit this Article | Original article by Tom

Leach and Lily Stanley | Last updated on
15/4/214 | !ie" #e$isions
Organism
%ycobacteriu& tuberculosis

Transmission
!ia droplet spread - only the pulmonary form is
infectious
'sually needs sustained close contact "ith an
in(ectious case)

Epidemiology
#oughly one third o( the "orld*s population has
been in(ected "ith M. tuberculosis (2 billion people)
+early nine &illion ne" cases o( TB, and 1)4
&illion deaths (ro& TB per year -&a.ority in
de$eloping countries/
Leading cause o( death due to a
curable in(ectious disease
0igni(icant nu&ber cases occur in those co-
in(ected "ith 12!)
Appro3i&ately 9000 cases reported each
year in the United Kingdom -&ostly in large cities,
especially in London/, causing 45 deaths each
year
Around 15 o( cases are drug resistant
2ncidence is increasing in de$eloping countries,
due to increased drug resistance, 12! and an
ageing population

Risk factors
12! -145 cases also ha$e 12!/
O$ercro"ding/close contact "ith acti$e case
-1/4 chance o( contracting (ro& household &e&ber/
Ethnic &inority groups
%alnutrition
2! drug use
6hronic lung disease
2&&unosuppression
Pathogenesis
%ycobacteria reach the pul&onary al$eoli
These are engul(ed by
al$eolar &acrophages and replicated "ithin the&)
These carry the bacteria to hilar ly&ph nodes
to try and control the in(ection)
7ri&ary site o( in(ection -in the lungs/ 8 9:hon
(ocus9 -generally in upper lobe/
Ly&phocytes surround the in(ected
&acrophages along "ith (ibrolasts and this causes
granulo&a (or&ation
This pre$ents disse&ination
o( bacteria -pre$ents extra-pulmonary TB/
2nside these lesions, the bacteria &ay de$elop
abnor&al cell death in the centre -caseous
necrosis/ and can eli&inate the bacteria
In some instances infection can be cleared,
or can become dormant - latent infection
2t can then later beco&e reacti$ated
-secondary TB/, precipitated by ac;uired i&paired
i&&une (unction)
Alternatively, if there is a failure of the above
mechanism...
The bacteria &ay gain entry to the bloodstrea& can
spread throughout the body and set up &any (oci o(
in(ection -tubercles/ -e)g) &iliary TB/)This is etra!
p"lmonary TB
Those "ith less e((ecti$e i&&une syste&s
progress to pri&ary progressi$e tuberculosis
<or less i&&unoco&petent
people, granulo&as are (or&ed but then the
necrotic tissue undergoes li;ue(action and the
(ibrous "all brea=s do"n) +ecrotic &aterial then
o >rains into bronchi and is coughed up and
can in(ect others
o >rains into nearby blood $essels and
seeds to other areas leading to e3trapul&onary TB

#linical feat"res
90% of cases exhibit pulmonary features only
10% exhibit extrapulmonary features
#omplications
%ulti-drug resistant TB -%>#-TB/- can de$elop o(
TB is not properly treated)
$iagnosis
Active TB
6?#
0a&ples e)g) sputu&, pus, or a tissue biopsy@
o 4 separate sputu& sa&ples in pul&onary
TB -including one early &orning sa&ple/
o 6an do broncoscopy and la$age or gastric
"ashings
o Aiehl-+eelsen -A+/ stain - rapid direct
&icroscopy (or acid-(ast bacilli
o LB"enstein-Censen culture -ta=es 4-D
"ee=s due to slo" bacterial gro"th and sensiti$ities
ta=e a 4-4 "ee=s &ore/
*treatment should be started before culture
results are back, and continued even if cultures
are negative*

Latent tuberculosis
%antou3 tuberculin s=in test-used to screen people
at high ris= (or TB
-(alse positives in those previously immunize)
(false ne!atives in certain conitions such
as sarcoidosis, 1odg=in*s ly&pho&a/
Treatment
Antibiotics
"or more infor see #extra info# section belo$
%ultidrug regi&en (or prolonged period in
acti$e disease
-isoniaEid and ri(a&picin, pyraEina&ide and etha&b
utol/
o All 4 (or 2 &onths, then,
0ingle antibiotic (or latent TB
%>#-TB should be treated "ith at least (our
e((ecti$e antibiotics (or 1D to 24 &onths is
reco&&ended)

Pre%ention
!accination -B6:/
7ublic health &easures@ treat&ent/prophyla3is
o( contacts etc
+oti(iable disease in 'F

Extra nfo
$r"gs "sed in TB
Rifamycins
Inhibits DNA
transcription
Rifamycin,
rifabutin
Cidal Nausea, anorexia,
pseudomembranous colitis,
hepatotoxicity, orange colouration
of excreted bodily fluids, toxicity
syndromes, drug interactions
Isoniazid
Inhibits
synthesis of
cell wall
Isoniazid Cidal /
static
Nausea,
omiting, constipation, peripheral
neuropathy, hepatitis, !"#$li%e$
symptoms
&yrazinamide
"owers
intracellular
p',
disrupting
synthesis of
fatty acids
pyrazinamide Cidal 'epatotoxicity, nausea, omiting,
arthralgia, sideroblastic anaemia
#thambutol
Interferes
with cell wall
synthesis
#thambutol !tatic (ptic neuritis ) resulting
in red/green
colourblindness. neuritis

&yo'acteria
This is its o"n genus o( bacteria -li=e :G or :-/)
The group include TB and leprosy( They are acid
fast( They are also aero'ic(

)cid fast
This basically &eans the organis&s are di((icult to
stain using nor&al staining techni;ues) The na&e
re(ers to the (act they canHt be stained by nor&al
acid -ethanol/ staining techni;ues)
These bacteria are o(ten partic"larly diffic"lt to
c"lt"re and identify* e)g) TB ta=es around I-D
"ee=s

- 0ee &ore at@
http@//al&ostadoctor)co)u=/content/syste&s/-
respiratory-syste&/tb-
tuberculosisJsthash)>A1r%K.h)dpu(