TUBERCULOSIS

MARIANA NGUNDJU AWANG

 Definition

Tuberculosis:
is an infectious disease that mainly
affects the lungs but can also involve
other organs. Tuberculosis is often
called TB and was called consumption
in the past. This disease once ranked
among the most common causes of
death in the world.
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Today, improved methods of prevention,
detection, diagnosis, and treatment have
greatly reduced both the number of people
who get the disease and the number of
people who die from it. However,
tuberculosis remains a major concern in
developing countries where these
improved methods are not widely
available.
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Other people at greater risk of

getting tuberculosis include those
with weakened immune systems,
such as AIDS patients, and people
suffering from malnutrition. The
disease can also afflict animals,
especially such livestock as cattle,
hogs, and poultry.
 CAUSED

The disease is caused by rod-shaped

bacteria called tubercle bacilli. The
German physician Robert Koch
discovered tubercle bacilli in 1882
(see KOCH, ROBERT). Tubercle bacilli
belong to a genus (group) of bacteria
called Mycobacterium. They are
aerobes--that is, they must have
oxygen to live.
 How tuberculosis affects
the body:
In most cases, a person becomes
infected with tubercle bacilli by
inhaling tiny droplets of moisture that
contain Mycobacterium tuberculosis
bacteria.
 These droplets form when a person with
tuberculosis coughs or sneezes. Infection
also can result from eating food
contaminated with the bacteria or from
drinking milk from cattle infected with
Mycobacterium bovis bacteria. Such infection
rarely occurs in developed countries,
where milk is pasteurized and animals are
routinely tested for diseases.
 Primary infection
is likely to result from tubercle bacilli that
penetrate beyond airways lined with mucus
into the alveolar sacs deep in the lungs.
Primary infection is a stage in the
development of tuberculosis, but it does
not always lead to the disease.
It often occurs in children.
Tubercle bacilli that enter an alveolar sac
are usually engulfed by large, amebalike
cells called alveolar macrophages.
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These cells are usually able to digest
bacteria.
However, tubercle bacilli resist digestion
and most of them actually thrive and
multiply inside the macrophages.
Some of the macrophages carrying these
bacteria may migrate to the mucus layer
and be carried out of the body.
Others may carry the bacteria to another
part of the lungs or even into the blood.
 The disease known as tuberculosis
develops if the tubercle bacilli again
become active. It may occur immediately
after the primary infection, especially in
infants, children, and the elderly, and in
people who have other illnesses. In most
cases, however, tuberculosis develops
many years after the primary infection has
occurred. What causes this reactivation of
the bacilli is not entirely clear.
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It may occur when the body's

defense mechanisms are impaired by
another illness or by old age, or it
may result from a second infection by
tubercle bacilli.
Reactivation of the bacteria causes
the tubercles to rupture and the
bacilli to reproduce rapidly
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Cells may carry the bacteria to other

parts of the lung or into the lymph
vessels. The bacteria also may enter
blood vessels and be transported to
other organs, including the bones,
brain, joints, kidneys, and skin.
 In tuberculosis of the lungs, called
pulmonary tuberculosis, alveolar
macrophages and white blood cells
accumulate at the sites of the reactivated
bacteria and form caseous material.
The caseous material eventually liquefies
and moves up the respiratory tract with
the mucus layer.
The patient coughs this mucus and
caseous material up as sputum.
 Coughing and sputum production are the
most common early symptoms of
pulmonary tuberculosis. The cough is not
usually severe and the symptoms are often
mistaken for a lingering cold. If blood
vessels in the lungs are damaged, there
may be blood in the sputum. In advanced
stages of the disease, the patient may
cough up large quantities of blood.
 Other symptoms of advanced
tuberculosis include chest pain, fever,
sweating at night, fatigue, weight
loss, and loss of appetite.
Although tuberculosis may lead to a
rapid death, it occurs more
commonly as a long-term,
progressively worsening disease.
 Diagnosis of tuberculosis

Physicians use several methods to

detect tuberculosis. The chief
methods are skin tests, chest X rays,
and laboratory tests.
 Skin tests

can determine if a person has been

infected with tubercle bacilli in the past.
However, such tests do not tell the
physician whether the active disease is
present.
All types of skin tests are based on specific
allergic reactions to the tubercle bacilli.
The body develops the allergy to the bacilli
within a few weeks after the primary
infection.
 Treatment of tuberculosis

The first effective treatment for

tuberculosis was provided by health
resorts called sanitariums
 Today almost all tuberculosis patients can be
treated successfully with drugs.
Isoniazid (INH) is one of the most effective
antituberculosis drugs.
Others include rifampin, rifapentine,
ethambutol, streptomycin, and
pyrazinamide. These drugs stop the
bacteria from multiplying in the body.
 They also allow the body's natural
defenses to work against the disease.
Doctors typically prescribe two or more
drugs at a time because tubercle bacilli
may become resistant to only one
medication.
Drug treatment usually lasts at least six
months.
 Prevention of tuberculosis
The drug isoniazid prevents most detected
tuberculosis infections from developing into
the disease.
Doctors often prescribe isoniazid for people
who have a positive skin test.
They may also give the drug to children,
elderly people, or others at special risk
who live with someone who has
tuberculosis.
 In hospitals and other places where
patients come into contact with
people who do not have the disease,
the use of ultraviolet overhead light
helps prevent the disease from
spreading.
A vaccine called BCG (Bacillus
Calmette-Guerin) has been used in
many parts of the world in an effort
to prevent tuberculosis. However, the
vaccine is not always effective,
especially among certain populations.