PULMONARY TUBERCULOSIS

Submitted by- Sabyasachi JenaGuided by- Dr. Sayantan Chowdhury

DEFINITION

• It is a contagious bacterial(mycobacterium tuberculosis) infection that involves the lungs. It may spread to other organs.

TYPES

1. Primary PTB2. Cavitary PTB(post primary)3. Miliary PTB(post primary)

1.PRIMARY PTB

• Primary PTB occurs in an individual who has never been exposed to the tuberculosis bacteria before. This type of tuberculosis is very uncommon and usually occurs in the very young, the very old or those with immune compromised symptoms, such as AIDS.

Etio-pathogenesis

• From the primary site of infection, bacilli are carried to the lymph nodes via lymphatics, and the hilar nodes enlarge. This parenchymal lesion(Ghon’s lesion) with its enlarged rigional(hilar) lymph nodes and inter connecting lymphangitis is known as primary complex of Ranke(Ghon’s complex).

• The parenchymal lesion is subpleural and usually located in lower part of the upper lobe, upper part of lower lobe or the middle lobe.

• Bacilli in alveoli also invade and replicate within alveolar macrophases that interact with T-lymphocytes, resulting in differentiation of macrophases into epithelioid histiocytes. Epthelioid histiscytes and lymhocytes aggregate into small clusters resulting in granulomas.

• In the granuloma, CD4+ T-lymphocytes secrete cytokines, such as interferon, which activate macrophages to destroy the bacteria with which they are infected.

SYMPTOMS

Majority are asymptomaticA brief ‘flu-like’ febrile illness, which lasts 7-14

daysReduced apetite, weight loss, fretfulnessDry cough(occasionally)

PHYSICAL SIGNS

Majority, no abnormal signsGeneral debility, thin, pale and fretful childGlossy hair and less elastic skinMay be few crepitations over a large lung

componentErythema nodosum

Bluish red, raised tender, cutaneous lesions on the shins and less on thigh.

Fever and polyarthralgia

DIAGNOSIS

a) History of contact with a case of active tuberculosis.

b) Tuberculin testc) Chest radiographd) Sputum examination

2.CAVITARY PTB

• It occurs in final stage of the disease. When macrophases fail to sorround and digest bacteria, a cheesy form of necrosis occurs in the center , known as caseation. The caseous tissue may later become calcified. But if the lesion progresses, the caseous tissues become liquefied to form purulent material. This material may be discharged into bronchi resulting in cavitation.

• Samples taken from an infected person may test –ve because the bacteria are hidden in the cavities.

MILIARY TB

• Miliary TB is when the PTB becomes chronic and spreads though either the blood stream or the lymph system to infect other organs of the body.

Pathogenesis

Direct progression of a primary lesionRe-activation of a dormant primary lesiono Malnutritiono Diabeteso Taking steroids(immuno suppresive)o HIV infectiono Malignancies

o Renal failureo Haemophiliao SilicosisHaematogenous spread to the lungsCommon sites are apical and posterior

segment of upper lobe or apical of lower lobe.

CLINICAL FEATURES

GENERAL SYMPTOMS Loss of apetite and weight Fever Night sweats Tiredness Mental symptoms Amenorrhoea

Cough Hemoptysis Chest pain Breathlessness Pneumonia

PHYSICAL SIGNS

Pallor and cachexia Fever Tachycardia and tachypnoea Finger clubbing(may be)

COMPLICATIONS OF PTB

Hemoptysis Pneumothrax Pleural effusion Empyema Pulmonary fibrosis Bronchiectasis Persistent of cavities even after treatment

Scar carcinoma Spread of tuberculus to other organs Respiratory failure and R-heart failure Amyloidosis Anemia

ANTITUBERCULAR DRUGS

1. Isoniazid-10mg/kg2. Rifampicin-10mg/kg(max 900mg)3. Streptomycin-15mg/kg(max 800mg)4. Pyrazinamide-35mg/kg5. Ethambutol-30mg/kg

VACCINE

• BCG(Bacillus Calmette Guerin), prtective against PTB

DOTS(directly observed treatment short course)

FIVE ELEMENT OF DOTS Political commitment with increased and

sustained financing. Case detection through quality assured

bacteriology. Standardised treatment, with supervision and

patient support.

An effective drug supply and management system.

Monitoring and evaluation system and impact measurement.

THANK YOU

JAY JAGANNATH