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Tuberculosis (TB) is a chronic bacterial infection that primarily affects the lungs caused
by tubercle bacillus (Mycobacterium tuberculosis). When affecting the lungs the
disease is referred to as pulmonary TB, disseminated TB (or extrapulmonary TB) refers
to other areas of the body if the bacilli infection has spread (Jardins & Burton, 2006).
The
disease
can
infect
humans
via
three
transmission
routes:
respiratory,
gastrointestinal and through open wounds. The most common route of contraction is
through inhalation of tubercle bacillus contained in aerosol droplets from an infected
individual (Jardins et al., 2006). The primary infection stage follows when the patient is
first exposed to the pathogen, this inflammatory response causes an influx of fluid
leukocytes and macrophages causing consolidation. This is followed by the encasing of
the bacillus pathogen and macrophages by a tubercle formed from fibroblasts,
lymphocytes and neutrophils (Jardins et al., 2006). This housing acts to prevent further
infection but also has negative associations as the center may become necrotic
leading to caseous lesions which occurs within 2 to 4 weeks (Frownfelter & Dean,
2012).
TB is a chronic restrictive pulmonary disorder that causes major pathological and
structural damage to the lungs. Symptoms include: alveolar consolidation, caseous
tubercles or granulomas, fibrosis when the tubercle heals (Frownfelter et al., 2012).
The effects of tuberculosis on pulmonary function vary, if there is lung tissue
involvement it can reduce lung volumes, hypoventilation and compromise arterial
blood gas levels. Fibrosis will reduce long compliance and may restrict airflow if
bronchioles become narrow or distorted, this leads to increased respiratory muscle
activation in order to expand the lungs for gas exchange. Pleural infection is also a
possibility causing restriction which can be the source of effusions, empyema or
pneumothorax. Generally the patient adopts a rapid, shallow breathing pattern leading
to dead space from the infection becoming hyperinflated and alveoli being
hypoinflated (Frownfelter et al., 2012; Wilches, Rivera, Mosquera, Loaiza, & Obando,
2009). This coupled with the lung damage impairs the ventilation-perfusion ratio and
consequently the capability of gas exchange.
The objective of a physiotherapist in the treatment of TB is to aid in improving this
impairment to maximise respiratory efficiency by both increasing ventilation and
moving secretions. The clinical presentation of TB includes: coughing, fever, weight
loss, fatigue and haemoptysis, this must being taken into consideration when
implementing physiotherapy treatments (Frownfelter et al., 2012). There are some
chest physiotherapy techniques that are contraindicated during the active stage of
tuberculosis due to possibility of infection being spread further within the lung, these
include: percussion, shaking and vibrations (Frownfelter et al., 2012; Mitra, 2007). For
this reason techniques such as postural drainage, autogenic drainage and breathing
exercises are more effective as they ensure patient condition does not deteriorate. In
William Morrissey
PS2002
Presentation
terms of fibrosis after the active stage of TB has gone into remission, deep breathing
and breath hold exercises are used in order to stretch the tissue to retain lung
compliance (Mitra, 2007).
References
Frownfelter, D., & Dean, E. (2012). Cardiovascular and Pulmonary Physical Therapy
Evidence to Practice (5 ed.). St. Louis, Missouri: Elsevier.
Jardins, T. D., & Burton, G. G. (2006). Clinical manifestations and assessment of
respiratory disease (5 ed.). St. Louis, Missouri: Elsevier.
Mitra, P. K. (2007). Handbook of Practical Chest Physiotherapy (Vol. 1). New Delhi,
India: Jaypee Brothers Medial Publishers.
Wilches, E. C., Rivera, J. A., Mosquera, R., Loaiza, L., & Obando, L. (2009). Pulmonary
rehabilitation in multi-drug resistant tuberculosis (TB MDR): a case report.
Colombia Medica, 40(4).
William Morrissey
PS2002
Presentation
TREATMENT TUBERCULOSIS
William Morrissey
PS2002
Presentation
William Morrissey
PS2002
Presentation