Anatomy & Physiology of the Disease

Tuberculosis
By Dr. Robert Petros, eHow Contributor
updated: April 8, 2010

Tuberculosis is an infectious disease that causes infection in many of the human body's
organ systems. It is caused mainly by the Mycobacterium tuberculosis bacteria.
Tuberculosis is an airborne infection.

Pulmonary Tuberculosis
1. Approximately 75 percent of tuberculosis cases are pulmonary. Tuberculosis
infection occurs primarily in the upper part of the lower lobe or the lower part of
the upper lobe of a lung.

Urogenital tuberculosis
2. Urogenital tuberculosis is usually a secondary form of tuberculosis. The infection
usually spreads from the lungs to the urogenital tract.

Meningitis
3. Meningitis is one of the most serious complications of tuberculosis. It is most
common in immunodeficient patients. This type of tuberculosis also is usually
secondary.

Tuberculous Spondylitis
4. Tuberculosis can infect the vertebral discs of the human spine. Thoracic vertebrae
are most often affected. Tuberculous spondylitis can cause spinal damage by
collapsing spinal discs.

Cutaneous Tuberculosis
5. Cutaneous tuberculosis most often infects the skin of the hands and feet. It causes
warty papules that grow slowly and may later exude pus and keratinous material.
This type of tuberculosis can be primary or secondary.
What is tuberculosis?

History of Tuberculosis
During the 19th century, TB claimed more lives in the United States than any other
disease. But, with improvements in nutrition, housing, sanitation, and medical care during
the first half of the 20th century, the number of cases and deaths dropped dramatically. In
the 1940s and 1950s, with the introduction of antibiotic therapies for TB, the decline
continued. By 1985, the number of cases had fallen to the lowest figure recorded in
modern US history.

However, TB re-emerged as a serious public health problem in the US, with more than
25,000 active TB cases reported in 1993, an increase of 14 percent since 1985. Between
1992 and 1998, the number of reported TB cases declined 31 percent. However, in
addition to those with active TB, an estimated 15 million people in the US have latent TB
infections that may develop into active TB at some time in their lives.

Reasons for Increased Cases of

Tuberculosis
A number of differing factors are cited as the reasons for the increase in cases of
tuberculosis:

• the HIV/AIDS epidemic

• increased numbers of immigrants from countries with many cases of TB
• increased poverty, injection-drug use, and homelessness
• poor compliance with treatment regimens
• increased numbers of residents in long-term care facilities

The TB crisis has been intensified by the emergence of disease caused by multiple drug-
resistant organisms (MDR), which may cause an essentially incurable form of the
disease.

Tuberculosis (TB) is a chronic bacterial infection that usually infects the lungs, although
other organs are sometimes involved. TB is primarily an airborne disease.

There is a difference between being infected with the TB bacterium and having active
tuberculosis disease.

There are 3 important ways to describe the stages of TB. They are as follows:

1. Exposure: This occurs when a person has been in contact, or exposed to, another
person who is thought to have or does have TB. The exposed person will have a
negative skin test, and normal chest x-ray, and no signs or symptoms of the
disease.

2. TB infection: This occurs when a person has the TB bacteria in his/her body, but
does not have symptoms of the disease. This person would have a positive skin
test, but a normal chest x-ray.

3. TB disease: This describes the person that has signs and symptoms of an active
infection. The person would have a positive skin test and a positive chest x-ray.

The predominant TB bacterium is Mycobacterium tuberculosis (M. tuberculosis). Most

people infected with M. tuberculosis never develop active TB. However, in people with
weakened immune systems, especially those with HIV (human immunodeficiency virus),
TB organisms can overcome the body's defenses, multiply, and cause an active disease.
Who is at risk for developing TB?

TB affects all ages, races, income levels, and both genders. Those at higher risk include
the following:

• people who live or work with others who have TB

• medically underserved populations

• homeless people

• people from other countries where TB is prevalent

• people in group settings, such as nursing homes

• people who abuse alcohol

• people who use intravenous drugs

• people with impaired immune systems

• the elderly

• healthcare workers who come in contact with high-risk populations

What are the symptoms of TB?

The following are the most common symptoms for TB. However, each individual may
experience symptoms differently.

• cough that will not go away

• fatigue
• loss of appetite
• loss of weight
• fever
• coughing blood
• night perspiring

The symptoms of TB may resemble other lung conditions or medical problems. Consult a
physician for a diagnosis.
What causes TB?

The TB bacterium is spread through the air; however, repeated exposure to the germs is
usually necessary before a person will become infected. It is not likely to be transmitted
through personal items, such as clothing, bedding, or other items that a person with TB
has touched. Adequate ventilation is the most important measure to prevent the
transmission of TB.

How is TB diagnosed?

TB is diagnosed with a TB skin test. In this test, a small amount of testing material is
injected into the top layer of the skin. If a certain size bump develops within two or three
days, the test may be positive for tuberculosis infection. Additional tests to determine if a
person has TB disease include x-rays and sputum tests.

TB skin tests are suggested for those:

• in high-risk categories.
• who live or work in close contact with people who are at high-risk.
• who have never had a TB skin test.

Recommendations for skin testing in children, from the American Academy of Pediatrics
are as follows:

Immediate testing:

• If the child is thought to have been exposed in the last 5 years.

• If the child has an x-ray that looks like TB.
• If the child has any symptoms of TB.
• A child that is coming from countries where TB is prevalent.

Yearly skin testing:

• Children with HIV.

• Children that are in jail.

Testing every 2 to 3 years:

• Children that are exposed to high-risk people.

Consider testing in children from ages 4 to 6 and 11 to 16 if:

• A child's parent has come from a high-risk country.

• A child has traveled to high-risk areas.

 • Children who live in densely populated areas.

Treatment for tuberculosis:

Specific treatment will be determined by your physician based on:

• your age, overall health, and medical history

• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• short-term hospitalization
• medications

Treatment may last for many months. However, once the treatment begins, the patient
begins to feel well very soon. The patient is not usually contagious once treatment begins,
provided that treatment is carried through to the end, as prescribed by a physician.