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General Considerations:
Tuberculosis is a chronic infection ,potantially of lifelong duration,caused by two
species of mycobacteria M.tuberculosis and, rarely, M.bovis. Which causes nodular,
caseating granuloms called tubercles that fibrose,ulcerate or calcify.
The disease is confined to the lungs in most patients but may spread to almost any
part of the body.
Etiology:
The tubercle bacillus (M.Tuberculosis) is aerobic, non-motile,non-spore-forming,
high in lipid content, and acid and alcohol-fast. It grows slowly and differs form other
mycobacteria by its ability to produce niacin.
Pathogenesis:
Tuberculosis is transmitted by airborne droplet nuclei (containing tubercle bacilli)
Many droplet nuclei are capable of floating in the immediate environment for several
hours. Large particles may be inhaled by a person breathing the same air and impact on
the trachea or wall of the upper airway As the bacilli multiply, they spread through
lymphatic channels to regional lymph nodes, and through the blood stream to the rest
of the body
Immunity and Tuberculin Hypersensitivity:
The bacilli within 4 to 8 weeks after infection cellular immunity develop, so that the
macrophages are "activated" and are capable of not only phagocytizing but also killing
tbe organisms. Coincident with tfae development of cellular immunity, the delayed
type of skin hypersensitivity to tuberculoprotein can be demonstrated.
The Tuberculin Test
The tuberculin test is best performed by intracutaneous injection of 0.1 ml 1:2000
of old tuberculin. Old tuberculin (OT) is now the standard substance used in
intradermal testing. The classic test is carried out by the intradermal injection of 0.1ml
of (OT) containing 5 tuberculin units (OT) and then measuring the diameter of
induration produced 48 to 72 horns later. A reaction of less than 5 mm is considered
negative, 5-9 mm is considered positive (+); 10-19 mm is considered positive (++);
and more than 20 mm is considered positive (+++). A positive tuberculin skin test
indicates tuberculous infection, with or without disease.
Common Clinical Patterns
1.Primary tuberculosis (Primary Complex and Bronchial Lymphnod_Tbuerculosis).
2.Milliary Tuberculosis (acute, subacute and chronic hematogenous pulmonary
tuberculosis)
3.Secondary pulmonary tuberculosis:including infiltrative pulmonary tuberculosis.
and chronic fibrocavenous pulmonary tuberculosis..
4.Tubercolous pleuritis.
5.Extrapulmonary tuberculosis
Clinical Manifestations
Most patients present as cases of pulmonary tuberculosis with fever, asthma. cough,
weight loss, anorexia, fatigue, night sweats wasting, and pulmonary hemorrhage.
Weight loss and fatigue are more likely to lead to medical attention than is fever
usually in the afternoon, which is often unrecognized.
Cough may vary from mild to severe, and sputum may be scant and mucoid or copious
and purulent.
Hemoptysis may be due to cough of a caseous lesion or bronchial ulceration.
Particularly in late chronic disease, bleeding may be copious and sudden owing to
rupture of an artery within the fibrous walls of a cavity.
Radiology
The following characteristics of a chest radiograph favour the diagnosis of
tuberculosis:
(1). shadows mainly in the upper zone; (2).patchy or nodular shadows; (3).the
presence of a cavity or cavities, although these, of course, can also occur in lung
abscess, carcinoma, etc; (4).the presence of calcification, although a carcinoma or
pneumonia may occur in an areas of the lung where there is calcification due to
tuberculosis; (5).bilateral shadows, especially if these are in the upper zones; (6).the
persistence of the abnormal shadows without alteration in an x-ray repeated after
several weeks; this helps to exclude a diagnosis of pneumonia or other acute infection.
Surgical Intervention
Surgery was thought to be a valuable adjunct to treatment.
Prevention of Tuberculsis Vaccination
BCG(bacille. Calmette Guerin) is a strain ofM.bovis with aaemuated virulence for
man. BCG Vaccination can obtain immunity acquired for tubercle bacillus,
therefore.is one of the most important tuberculosis prevention.
Vaccination target: infants children and youngster of tuberculin negative (vaccination
is of course, of no use in tuberculin-positive persons).