TUBERCULOSIS

Is a contagious chronic bacterial infection that primarily affects the lungs, although it may involve almost
any party of the body.

Classification

1. PRIMARY TUBERCULOSIS
(Primary infection stage)
- Follows the patient’s first exposure to the TB pathogen, Mycobacterium tuberculosis- a rod
shaped bacterium with a waxy capsule.
- Begin when inhaled bacilli implant in the alveoli.
- This phase of tuberculosis coincides with a positive tuberculin reaction.
- The lung tissue surrounds the infected are slowly produces a protective cell wall called a
tubercle a granuloma that surrounds and encases the bacilli.

Although the initial lung lesions may be difficult to identify o a chest radiograph, the lesions may be seen
as small, sharply defined opacities. When detected on a chest radiograph, these initial lung lesions are
called Ghon nodules.

Ghon complex - the combination of tubercles and the involvement of the lymph nodes in the hilar
region.

Caseous lesion- a tubercle consist of a central core containing caseous necrosis and TB bacilli.

A tubercle takes about 2 to 10 weeks to form. The function is to contain the TB bacilli, thus preventing
the further spread of infectious TB organisms.

Dormant TB also called latent TB do not feel sick or have any TB-related symptoms. They are still
infected with TB but do not have clinically active TB.

- The only indication of TB infection is a positive reaction to the tuberculin skin test (mantoux
test).
- Individuals with dormant (latent) TB are not infectious and cannot spread the TB bacilli to
other.
2. POSTPRIMARY TUBERCULOSIS
(secondary or reinfection tuberculosis)
- Reactivation of the tuberculosis months or years after the initial infection has been
controlled.
- At any time the bacilli encased in a tubercle may become reactivated.
 RISK FACTORS:
 Malnourished individuals
 People in institutional housing (e.g., nursing homes, prisons, homeless shelters)
 People living in overcrowded conditions
 Immunosuppressed patients (e.g., organ transplant patients, cancer patients)
 Human immunodeficiency virus (HIV) – infected patients (TB is a leading cause of
death in HIV patients)
 Alcohol abuse

If the TB infection is uncontrolled, further growth of the caseous granuloma tubercle

develops. The patient progressively experiences more severe symptoms, including
violent coughing episodes, greenish or bloody sputum (possibly mixed with TB
bacilli), low-grade fever, anorexia, weight loss, extreme fatigue, night sweats, and
chest pain.

In severe cases, a tubercle cavity may rupture and allow air and infected material to
flow into the pleural space or the tracheobronchial tree. Pleural complications are
common in TB.

3. DISSEMINATED TUBERCULOSIS
(also called Extrapulmonary tuberculosis)
-Refers to bacilli that escape from tubercle and rapidly disseminated to sites other than the
lungs by means of the pulmonary lymphatric system or blood stream.
MILIARY TUBERCULOSIS_ presence of numerous small tubercles into the blood stream scattered
thoughout the body.
TB complications include hemoptysis, pneumothorax, bronchiectasis, extensive pulmonary
destruction, malignancy, and chronic pulmonary aspergillosis.

Tuberculosis primarily results in a chronic restrictive pulmonary disorder. The major pathologic
or structural changes of the lungs associated with TB (mainly postprimary TB) are as follows:
• Alveolar consolidation
• Alveolar-capillary membrane destruction
• Caseous tubercles or granulomas
• Cavity formation
• Fibrosis and secondary calcification of the lung parenchyma
• Distortion and dilation of the bronchi
• Increased bronchial secretions
 Etiology and Epidemiology
Tuberclosis is one of the oldest diseases known to man and remains one of the most
widespread diseases in the world.
-primarily caused by mycobacterium tuberculosis transmitted via aerosol droplet.

Diagnosis
Mantoux tuberculin skin test, acid-fast bacilli (AFB) sputum cultures, and chest radiographs.
Recently a new blood test for TB, called the QuantiFERON-TB Gold (QFT-G) test, has been
approved.
1. Mantoux Tuberculin Skin Test
The most widely used tuberculin test is the Mantoux test, which consists of an intradermal
injection of a small amount of a purified protein derivative (PPD) of the tuberculin bacillus.

5mm Negative
5mm-9mm suspicious
10mm or greater positive

2. Chest radiograph
3. Acid fast stain
- Used to confirm the diagnosis of M.tuberculosis.
a. Ziehl – Neelsen stain
-Reveals bright red acid- fast bacilli (AFB) against a blue background.

b. Fluorescent Acid – fast stain

- Reveals luminescent yellow-green bacilli against a dark brown background.

4. Sputum Culture

- Differentiate M. tuberculosis from other acid-fast organisms. Also identifies drug resistant
bacilli and their sensitivity to antibiotic.

5. QuantiFERON-TB Gold Test

The QFT-G test is a whole-blood test used for diagnosing M. tuberculosis infection, including latent TB
infection.
Assessment

1. cor pulmonale

2.Chest Assessment Findings

• Increased tactile and vocal fremitus

• Dull percussion note

• Bronchial breath sounds

• Crackles, wheezing

• Pleural friction rub (if process extends to pleural surface)

• Whispered pectoriloquy

4. Chest Radiograph

• Increased opacity

• Ghon nodule

• Ghon complex

• Cavity formation

• Cavitary lesion containing an air-fluid level

• Pleural effusion