PULMONARY TUBERCULOSIS

Communicable , chronic, granulomatous . It is a specific ↑ infectious diseases

caused by mycobacterium tuberculosis Primarily affecting Pulmonary region .
Also affecting glands , bones , skin, intestine & other tissue of body
Diseases can affects animals like cattle this is known as “ bovine
tuberculosis”
Microbiology -
Mycobacterium means “ fungus like bacteria”
- these are slender, rod shaped . Sometimes showing branching filamentous
forms resembling fungal mycelium
- These are aerobic, non motile , non capsulated , non sporing
- Acid fast bacilli
Causation –
Tuberculosis is a social disease with medical aspects . It has also been
described as a barometer of social wellfare
Social factors includes –
- Poor quality of life
- Poor housing & overcrowding
- Population explosion
- Under nutrition
- Lack of education
- Large Families
- Lack of awareness
 Types –
According to site & type of infection

Pulmonary T.B. Extra pulmonary T.B.

Primary T.B. Post Primary T.B.

Pathogenesis –
Source of infection – Open case of pulmonary T.B.
Mode of infection - Direct inhalation of aerosolized bacilli contained in droplet
nuclei of expectorated sputum
Majority of inhaled bacilli are arrested by the natural defenses of the
upper respiratory tract. Bacilli teaching the lungs are ingested by the alveolar
macrophages
Several factors
a) The number & the virulence of the infecting bacilli
b) Host factors including genetic susceptibility , age , immunocompetence ,
stress, nutrition & co- existing illness – influence the outcome of the
infection
Tubercular bacilli do not contain or secrete toxin . The basis of their
virulence depend on their ability to survive & multiple in macrophages
Various components of bacilli have shown to possess different
biological activities which may influence he pathogenesis, allergy & immunity
in the infection
Specific immune Mechanism involved in development of active tuberculosis is
cell mediated type humeral immunity appears to be irrelevant . the key cell is the
‘ activated CD4 + helper T cell’ which can develop along two different paths
 1) Th – 1
2) Th – 2 cells
Releasing the cytokines such as → interferon r, interleukins 1 & 2, TNF α &
other exerting different biological factors
Th -1 dependant cytokines activate macrophages resulting in protective
immunity & containment of infection
Th-2 cytokines induce delayed type hypersensitivity tissue destruction &
progressive diseases
Essential Pathology in tuberculosis is production of characteristic lesion called
the tubercle in the infected tissue
Tubercle is an avascular granuloma composed of central zone containing
giant cell , with or without caseation & a peripheral zone of lymphocytes &
fibroblasts
Tuberculous lesions are primarily of 2 types
- Exudative
- Productive
1) Exudative type is an acute inflammatory reaction with accumulation of
oedema fluid , polymorphonuclear leukocytes & later of lymphocytes &
mononuclear cells
This is typically seen when the bacilli are many & virulent & host
response is more in the nature of DTH than of protective immunity
2) The productive type of lesion is predominant cellular associated more with
protective immunity than DTH
Depending on time of infection & type of response , tuberculosis classified
as –
- Primary T.B
- Past Primary T.B./ Secondary
A) Lymphadenitis -
- Most common site for extrapulmonary site
- cervical & mediastinal gland affect frequently
- Nodes are usually painless & initially mobile but becomes matted together
with time
- when caseation & liquefaction occurs , the swelling becomes fluctuant &
may discharge through the skin with the formation of collar –stud abscess &
sinus formation
-
B) Gastro- intestinal tuberculosis –
- T.B. can affect any part of bowel with wide range of signs &symptoms
- Tuberculous peritonitis is characterized by abdominal distention , pain &
constitutional symptoms
- Ascitic fluid is exudative & cellular with a predominance of lymphcytes
- Laparoscopy reveals multiple while tubercles over the peritoneal &
omental surface
-
C) Pericardial Tuberculosis-
- Diseases occurs in main two forms
a) Pericardial effusion
b) Constructive pericarditis
- Fever & night sweat appears insidiously with breathlessness
- Pulsus paradoxus , a very raised JVP, ascitis, hepatosplenomegaly ,
absence of peripheral oedema
- Pericardial effusion associated with increased pericardial dullness &
globular enlarged heart on chest radiographs
 - Constriction is associated with atrial fibrillation , an early 3 rd heart sound &
pericardial calcification
- Pericardial effusion is blood stained
-
D) Bones & Joints Tuberculosis –
- Tuberculosis of spine usually present with chronic back pain & typically
involves , the lower thoracic & lumbar spine
- Infection starts as ascitis & spreads along the spinal ligaments to involve
adjacent anterior vertebral bodies , causing angulations of vertebra & with
subsequent kyphosis
- Paravertebral & psoas abscess formation is common

Review of Pulmonary Tuberculosis

PRIMARY INFECTION

↑ susceptibility in Host + infection with tubercular Bacilli

Engulfed by alveolar macrophages & multiply

Subpleural focus of tuberculars pneumonia

GHONS FOCUS
Along with enlarged hilar lymphnode

PRIMARY COMPLEX ( 3-8 weeks)

Calcified nodules ( 2-6 months)

With Impaired Immunity latent infection

 Enlarged primary lesion Endogenous reactivation

Disseminated Tuberculosis Exogenous Reinfection

Milliary Tuberculosis Post Primary tuberculosis

Diagnosis –
1) Tuberculin Test
- Tuberculin test discovered by von pirquet in 1907
- There main tests –
- The mantoux intradermal test
- The heaf &
- The tine multiple punctux test

Montoux Test –
Carried out by injecting intradermaly on the flexor surface of the
forearm 1TU or PPD in 0.1 ml. the result of test is read after 72 hours ( 3rd
day) PPD → Purified protein derivative
Tuberculin reaction consist of erythema & indurations
Reaction Size Result
Of > 10 mm Positive
indurations > 6 mm Negative
6-9 mm Doubtful

2) Sputum Examination -
Sputum Culture - For those pt. showing chest symptom. Whose sputum smell
is negative by direct microscopy
3) Chest Radiography -
- Helpful pulmonary tuberculosis chest showing calcified tubercles

HOMOEOPATHIC REMEDIES
Tuberculim
 Hard dry cough during sleep
 Expectoration are thick , yellow or yellowish greenish
 Hard, short and dry cough, annoying cough, annoys, people living with them
 Easy & profuse bronchorrhoea
 chronic illness, having a tubercular constitution
 Restlessness physical as well as mental cannot tolerate still or any fixed
position > walking fast
 Easily distracted - can concentrate better when on the move or when
outdoors
 Alteration of mood – frequent emotional upheavals following mood are
seen
 Heightened inspiration
 Sensitivity to music
 Increased spirituality
 Creativity
 < evening < raising arms

2) Spongia Toasta
  There is great dryness of mucus membrane of air passages such as throat,
larynx , trachea, Bronchi etc
 Cough is dry , barking , gasping, ringing , wheezing , whistling
 < dry cold
 < wind
 < sweets
 < smoking
 > Eating or drinking warm things

3) Rumex Crispus
 Dry, Incessant, fatiquing cough, hoarse, barking cough with ticking
sensation
 Dry teasing cough preventing sleep
 Touching the throat pit causes dry teasing cough
 Cough with pain behind the sternum
 In the first stage there is thin, watery, frothy expectoration, later it becomes
yellowish, thick , tenacious
 < Open air
 > Warmth

4) Chelidonium Majus
 There is spasmodic cough, small lumps of mucous fly from mouth when
coughing.
 Dyspnonea, very quick and sharp inspiration
 Pain in the right side of chest and shoulder
 Constriction of chest
 < from motion and touch
 > Pressure