Tuberculosis (TB)
Aetiology
 Mycobacterium tuberculosis (common)
- Aerobic bacterium
- Acid fast bacilli (AFB): high content of myocolic acis,
long chain cross linked fatty acid
 M. bovis – via unpasteurized milk
High Risk Groups
 Close TB contact: infant, children <5 y/o
 Immunocompromised: DM, HIV infection, end staged
renal disease, malnutrition, use of immunosuppresant
drug
 IVDU
 People living in overcrowded condition
 Health care workers
Primary Pulmonary TB (common in children)
 Fever, occasionally pleuritic chest pain
 Transient hilar, paratracheal lymphadenopathy – when
enlarged, compress bronchi – obstruction, airway
wheezing
 Erythema nodosum on leg [reddish, painful, tender
lumps]
 Phylctenular conjunctivitis
 Exudate lesion – cessation – calcification – Ghon lesion
(small calcified nodule)
 Pleural effusion (penetration of bacilli into pleural space
from adjacent subpleural focus)
Secondary/ Reactivation TB (adult type)
 Reactivation of distant latent TB / recent infection
 Localized to apical & posterior segment of upper lobe
(high oxygen tension –favor aerobic bacteria growth) –
formation of cavity – liquefied necrotic content
discharged into airways – bronchogenic spread – satellite
lesion within lungs – undergo cavitation – massive
involvement of lobes cause cesating pneumonia – some
pulmonary lesion b/c fibrotic by healing – permanent
calcification – can be seen in X ray
C/F:
Pathogenesis
 MOT: droplet (coughing, sneezing, speaking) – suspended in
air for few hrs
 Reach alveoli – activate monocytes & macrophages – some
macrophages manage to kill the bacteria, some replicate in
macrophages – rupture & release the bacillary content –
reseed in lung/ spread to regional LN – extrapulmonary
lesion
Extrapulmonary TB : common affect LN, pleura, genitourinary,
bone, joint, meninges, peritoneum, pericardium
Tuberculous Lymphadenitis / LN TB
 Painless swelling LN (scrofula): in posterior cervical &
supraclavicular site  matted mass w fistulous tract
draining caseous material [fine needle biopsy]
Pleural TB
 Collection of fluid in pleural space – hypersensitivity
response to mycobacterial Ag
 Pleural effusion: fever, pleuritic chest pain, dyspnea ,
dullness on percussion, absence of breathing sound
Genitourinary TB – 10-15%
 Destructive lesion in kidney - Urinary frequency, dysuria,
nocturia, hematuria, flank/ abdominal pain
 Pelvic pain, menstrual abnormalities, infertility – common
in female
 Orchitis, prostatitis
Skeletal TB – 10%
 Weight bearing joint: spine 40%, hips 13%, kness 10%
 Pott’s disease/ tuberculos spondyloitis : involve >= 2
adjacent vertebral bodies
 Adult – lower thoracic, upper lumbar vertebrae
 Child – upper thoracic spine
 Advanced: collapse of vertebral bodies – kyphosis/ gibbus
Tuberculous Meningitis/ Tuberculoma
 Common in children, HIV patient
 Headache, slight mental changes, irritability, confusion,
altered sensorium, neck rigidity
 Common at base of brain, paresis of cranial nerve (ocular
nerve), involve cerebral artery produce focal ischemia –
coma, hydrocephalus, intracranial hypertension
Gastrointestinal TB – 3.5%
 Involve terminal ileum, cecum
 Abdominal pain, swelling, obstruction, hematochezia,
palpable mass
 Cough 90% : non productive, limited to morning  Pericardial TB/ Tuberculous Pericarditis
purulent sputum, w blood streaking  hemoptysis  Common in HIV patient
(erosion of b/v in wall of cavity)  Dyspnea, dull retrosternal pain, pericardial friction rub
 Diurnal/ daytime fever 80% - intermittent, low grade
 Night sweat , weight loss Miliary/ Disseminated TB
 Anorexia, general malaise, weakness  Hepatomegaly, splenomegaly, lymphadenopathy
 Pleuritic chest pain: w subpleural parenchyma lesion/  Choroidal tubercle in eye examination
pleural disease
 Dyspnea
 Rhonchi/ crackles during inspiration, esp after coughing –
fluid accumulation in alveoli
Investigations Management
Pulmonary TB  Dosage of TB drug according to body weight of patient
 Chest X ray

 Sputum smear for acid fast bacilli ZH stain – in 30 min

 Mycobacterium culture & sensitivity – 2 months
 Nucleic acid amplification test (NAAT), PCR – 2 hrs
 Tuberculin skin test (TST): for latent TB infection +ve
>10mm
Extrapulmonary TB
 Chest X ray
 u/s, CT scan, MRI – if other systems involved
 Body fluids, tissue samples for C&S

** Active TB should be rule out in all HIV patient

**100% curable disease – but may cause irreversible lung
damage, heal w fibrosis
** all drug cause: nausea, vomiting, rash
** hepatitis: isoniazid, rifampicin, pyrazinamide
 Trace close contact persion : family members, friends
 (DOT) Directly Observed Therapy – monitor daily patient for
taking drugs
 Vaccine: BCG