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Ri 91-7-29
Tuberculosis
An ancient infection Tubercle bacillus discovered in 1882 WHO: 8,000,000 active cases in 1990 Developing countries (95%) Developed countries: HIV infection
Tuberculosis
Pathogenesis
Chronic necrotizing bacterial infection Tubercle bacilli: Mycobacterium tuberculosis (MTB) Optimal growth: PO2140mmHg Hematogenous dissemination and lymphatic spread Modified form of tuberculosis (AIDS)
Tuberculosis
Clinical stages
Stage 1: Onset (macrophage inhalation) Stage 2: Symbiosis Stage 3: Early caseous necrosis Stage 4a & 4b: Interplay of cell-mediated immunity and tissue-damaging delayed-type hypersensitivity Stage 5: Liquefaction and cavity formation
Extrapulmonary Tuberculosis
Proportion in all TB in USA : 7% (1963) to 18% (1987) to 20% (now) Increase maybe due to HIV infection More in minorities and foreign-borns Lymphatic TB (30%) > Pleural TB (24%) > Bone and joint TB (10%) > Genitourinary TB (9%) > Miliary TB (8%) > Meningeal TB (6%)
(New York, 1995)
Hematogenous dissemination
Miliary Tuberculosis
Lympho-hematogenous dissemination Infants and children: primary Elders or HIV infection: reactivation Fever, weakness, anorexia, Wt loss, cough Dx: CXR, HRCT Tx: Chemotherapy for 9-12 months (HIV at least 12 months) or steroids (controversial, prevent reactivation and infection)
Other EPTB
Otologic Tuberculosis Ocular Tuberculosis Cardiovascular Tuberculosis Tuberculous Peritonitis Tuberculous Enteritis Tuberculosis of the liver and biliary tract