Mycobacterium Tuberculosis

Source
Children usually infected by an adult or
adolescent with tuberculosis in the immediate
household
 Risk factors
Household contact with anewly diagnosed
smear (+) case
60-80% children become infected
If case is smear negative
30-40% of children become infected
Morbidity of children with history of family
exposure is 2.5 times than without
 Risk factors
Age less than 5 years old
Infants are at greatest risk and remains significant
until the second year of life
Lowest risk among 5-10 years old
 Risk factors
Immunocomprimised state
Such as those with severe malnutrition, HIV, or
other forms of immunosuppression
 Transmission and Portal of Entry
Tubercle bacilli Inhalation of
(5 micra) droplet nuclei

Deposited in the
alveoli

5 to 200 inhaled
bacilli are
necessary for a
successful infection
Incubation period
 Pathogenesis and Pathophysiology
Scavenging non Unrestricted
activated alveolar replication
macrophages ingest
tubercle bacilli Bacilli gets
destroyed or
inhibited
intracellularly
Carry to hillar and or
mediastinal
lyumphnodes
A. Kidneys
B. Meninges
C. Epipheseal plates of
long bones
D. Vertebrae Dissemination via
E. Apical segments of lymphatics or
the lungs bloodstream
 Pathogenesis and Pathophysiology

Delayed type hypersensitivity (DHT)

T-lymph gets sensitized to produce a
progeny of similar reactive cells that
secreate lymphokines( IFN gam and
TNF) and

Cell mediated immunity (CMI)

Activated Macrophages which thereby
increase lytic enzymes which increases the
capacity to kill bacilli.
 Classic lesion
Caseous granuloma(Ghon Focus)

Ghon complex heals by fibrosis, calcification may occur

Most bacilli die but few may remain viable and reactive later if
immune mechanisms fail
 Progressive Primary Tuberculosis
Occurs when immune system is weekend
Failure to control logarithmic growth of bacilli
Observed more commonly in children under 2 years old
Primary focus
Enlarges, liquefies to form a primary cavity
Growth rate increases
Enlarging focus may lead to erosion of infected debris
into a
bronchus(intrapulmonary spread)
Blood or lymphatic vessel( lymphohematogenous spread)
Enarglin focus may cause compression of the bronchi
collapse
Partial obstruction
Cause air trapping or distention of lobe segment
 Secondary TB
Reinfection or reactivation of dormant bacilli
in the Ghon focus or complex.
 Timetable of Tuberculosis
Renal

skeletal
Bronchial
Perforation

Primary
complex
Pleural
effusion
Millary and
meningeal
Initial fever

Hypersensitivity
 Pulmonary TB
Primary
Ghon focus, lymphadenitis and lymphangitis
Heals with fibrosis and or calcification
Clinical signs
Milg cough, low grade fever 14-21 days
Progressive
Infection that fails to heal and continues to
progress cause further pulmonary involvement
and even distant organ involvement
 Pulmonary TB
Secondary
Reactivation of an old, possibly subclinical
infection
Clinical signs
Chronic cough, prolonged fever, chest pain, hemoptysis,
supraclavicular adenitis
 Millary Tuberculosis
Can be acute
Multiorgan failure, septic shock, ARDS
Can be subacute
Failure to thrive
Fever of unknown origin
Dysfunction of one or more organ systems including the
brain
Presentation
chills, night sweats, hemoptysis, productive cough,
peripheral lymphadenopathy and hepatomegaly
 Extrapulmonary TB
Endobronchial TB
Presentation
Moderately to high fever, anorexia, night sweats, loss of
weight, paroxysmal cough ending in cyanosis, crepitant
rales, expiratory wheezes
 Cervical Lymph Nodes TB
Most common form of extrapulmonary TB
Scrofula
Fistula formation can be seen in 10% of scrofula
Lymph node abscess may burst infrequently leading to
a chronic non healing sinus and ulcers formation
Direct extension of the TB into the skin can occur
 TB meningitis
First stage
Personality changes, irritability, anorexia, fever
Second stage
Increased intracranial pressure and cerebral
damage
Drowsiness, stiff neck, cranial nerve palsies, inequalty
of pupils, vomiting, absence of abdominal reflexes,
convulsions
Third stage
Coma, irreular pulse and respirations, rising fever
 TB of the spine(POTTS)
Destruction of the intervertebral disk space,a
and adjacent vertebral bodies, collapse of the
spinal elements and anterior wedging leading
to the characteristic Gibbus formation.
Back pain is the most frequent symptom, night
cries, restless sleep. Daily low grade fever,
sensory disturbance and bowel and bladder
dysfunction are common