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Narrative Pathophysiology:

TB is an airborne disease caused by the bacterium Mycobacterium tuberculosis


(M. tuberculosis). M. tuberculosis and seven very closely related mycobacterial species
(M. bovis, M. africanum, M. microti, M. caprae, M. pinnipedii, M. canetti and M. mungi)
together comprise what is known as the M. tuberculosis complex. Most, but not all, of
these species have been found to cause disease in humans. The majority of TB cases
are caused by M. tuberculosis. M. tuberculosis organisms are also called tubercle
bacilli. Bronchiectasis is a condition in which damage to the airways causes them to
widen and become flabby and scarred. The airways are tubes that carry air in and out of
your lungs. On the other hand, Bronchiectasis often is caused by an infection or other
condition that injures the walls of the airways or prevents the airways from clearing
mucus. Mucus is a slimy substance. It helps remove inhaled dust, bacteria, and other
small particles from the airways. In bronchiectasis, your airways slowly lose their ability
to clear out mucus. The mucus builds up, and bacteria begin to grow. This leads to
repeated, serious lung infections. Each infection causes more damage to the airways.
Over time, the airways can't properly move air in and out of the lungs. As a result, the
body's vital organs might not get enough oxygen. Going back to tuberculosis, Infection
occurs when a person inhales droplet nuclei containing tubercle bacilli that reach the
alveoli of the lungs. These tubercle bacilli are ingested by alveolar macrophages; the
majority of these bacilli are destroyed or inhibited. A small number may multiply
intracellularly and are released when the macrophages die. If alive, these bacilli may
spread by way of lymphatic channels or through the bloodstream to more distant tissues
and organs (including areas of the body in which TB disease is most likely to develop:
regional lymph nodes, apex of the lung, kidneys, brain, and bone). This process of
dissemination primes the immune system for a systemic response. The systemic
response includes the inflammatory response which then results in necrotic
degeneration. The degeneration would then prompt draining of cheese like mass of
tubercle bacilli, dead WBCs and necrotic lung tissue into the tracheobrochial tree that
would result in a primary infection which then interferes with the diffusion of oxygen and
carbon dioxide. It would then result in decreasing the oxygen carrying capacity of the
lungs that would produce tissue hypoxemia. Just as the primary infection occurs, the
ghon complex would then calcify and would form scars that may heal over a period of
time that would reactivate the tubercle bacilli and would result in secondary infection.