By Arunraj

Group-10 Tbilisi state medical

university

HISTORY The bacillus causing tuberculosis, M.

tuberculosis, was identified and described on 24 March 1882 by Robert Koch. He

received the Nobel Prize in physiology or medicine in 1905 for this discovery.

Albert Calmette and Camille Guérin achieved the first genuine success

in immunization against tuberculosis in 1906, using attenuated bovine-strain

tuberculosis. It was called bacille Calmette–Guérin (BCG). The BCG vaccine

was first used on humans in 1921 in France, but received widespread

acceptance in the US, Great Britain, and Germany only after World War II.

INTRODUCTION Pulmonary Tuberculosis (TB) is an infectious disease

that mainly affect the lungs parenchyma. TB is a contagious bacterial (M. tuberculosis) infection

that mainly affects the lungs parenchyma, but may spread to other organs.

TB is an ancient disease. Signs of skeletal TB (pott disease) were evident in Europe from Neolithic times, ancient egypt, and in the pre-Columbian New World.

Physicians in ancient Greece called this illness as “phthisis” reflecting its wasting character.

Epidemiology Most common infectious cause of death

worldwide Latent phase of TB enabled it to spread

to one third of the world population 8,000,000 new cases each year 3,000,000 infected patients die

Epidemiology

World TB incidence. Cases per 100,000; Red => 300, orange = 200–300, yellow = 100–200, green = 50–100, blue =< 50 and grey = n/a. Data from WHO, 2006

ETIOLOGY TB is caused by the bacteria M. tuberculosis

(most common cause). Other than tuberculosis – includes;

M. avium intracellulare M. kansasi M. scrofulaceuru M. ulcerans M. marinum and etc.

TB spread from person to person by airborne transmission. Infected person release droplet nuclei (1-5 micro meter in diameter) through, Talking Coughing Sneezing Laughing Singing

If not treated properly, TB can be fatal.

Transmission

Risk factors of tuberculosis is; Elderly Infants Low socioeconomic

status Crowded living

conditions Disease that weakens

immune system like HIV Alcoholism Recent Tubercular

infection (within last 2 years) and ect.

PATHOGENESISSusceptible

OrMycobacterium

Tuberculosis

LatentInfection

Recovery

Reactivation

Activetuberculosis

Miliarytuberculosis

ExtrapulmonaryTuberculosis

PULMONARYTUBERCULOSIS

Latent Infection- TB bacteria can live in the body without making you sick and cannot spread the disease to others.

Active Infection-  you do have symptoms and can spread the disease to others.Specific symptoms you will have,depend on TB where infection is occur.

Signs and symptoms A persistent cough Constant fatigue Weight loss Loss of appetite Fever Coughing up blood Night sweats

SIGNIFICANT LAB TEST Tuberculin skin test (PPD test);

Injecting a small amount of protein from tuberculosis bacteria between the derived layer of the skin (usually forearm).

Sputum examination and Cultures;Is examined under a microscope to

look for tuberculosis bacteria and used to grow the bacteria in a culture.

Interferon-gamma Blood test; A simple blood is mixed with synthetic

proteins similar to those produced by the tuberculosis bacteria.

If people are infected with tuberculosis bacteria, their white blood cells produce certain substances (interferons) in response to the synthetic proteins.

IMAGING CONSIDERATION

Chest CT Scan Chest X-ray

RADIOLOGICAL APPERNCE Young male patient

with fever and cough has focal opacity in the left lower lobe that looks like a pneumonia. This is a case of primary tuberculosis in an adult.

TREATMENTThe two antibiotics most commonly used are isoniazid

and rifampicin, and treatments can be prolonged, taking several months.  Latent TB treatment usually employs a

single antibioticNew onset

 In 2010, is six months of a combination of antibiotics containing rifampicin, isoniazid, pyrazinamide, and

ethambutol for the first two months, and only rifampicin and isoniazid for the last four months.[11] Where resistance to

isoniazid is high, ethambutol may be added for the last four months as an alternative.

Recurrent diseaseIf multiple drug-resistant TB is detected, treatment with at

least four effective antibiotics for 18 to 24 months is recommended.

References www.medicinet.com www.nlm.nih.gov http://www.e-radiography.net www.learningradiology.com