TUBERCOLOSIS

TB REACTIVATION
M. tuberculosis (via airborne droplets) into the Lungs
Activated macrophages create an inflammatory
microenvironment by releasing pro-inflammatory
cytokines, chemokines and reactive oxygen species
Deposition of bacteria in the mid lung zone

Activated fibroblasts produce and deposit collagen in

Release Virulence Factors (Mycosides, Sulfatides, Wax D) the extracellular space between alveoli -> Pulmonary Non-Productive Cough
Fibrosis
Phagocytose Bacteria Are Not Destroyed Decreased Total lung
capacity (TLC) and
CXR: Nodular and Reticulonodular opacities are seen in
Thickening of tissue between alveoli and capillaries 1 Decreased residual
varying lung regions.
Multiply in Macrophages the diffusion distance of atmospheric and blood gasses volume (RV) on
Decreased pulmonary function
Inhalation volume test
Cruise in Lymphatics & Blood Excessive collagen deposition, decreased lung
compliance and lung expansion Decreased Forced vital
capacity (FVC) and &
Present T-cells helper in localized Lymph Node Dec Expiratory volume forced expiratory
volume in 1 second
Decreased Diffusion of CO, from (FEV1) on pulmonary
Sensitized T-Helper Cells Multiply and Enter Circulation function test
blood to alveoli and decreased
diffusion of O2 from alveoli to blood
Release Lymphokines Alveolar capillaries vasoconstrict in Decreased Arterial oxygen content -> Vital Capacity:
response to hypoxia -> increase increased deoxyhemoglobin and Hypoxia
Increase RR to maintain minute 30% of
Pulmonary vascular resistance decreased oxyhemoglobin
ventilation due to decrease lung predicted,
Activated Macrophages Destroy Bacteria
volume and diffusion and limitation FEV1/Vital
Pulmonary Hypertension Increased Deoxyhemoglobin within Capacity 0.80
Caseous Necrosis (Lay Dormant w/c can lead to the vasculature causes the skin and
secondary/Reactivation TB) Dyspnea and Exertional Hypoxemia mucous membranes to appear blue
Right heart must pump blood into
lungs against higher pressure ->
cardiomyocyte growth (via Cyanosis
sarcomeres formed in parallel di  Fatigue
within myofibrils) -> concentric  Loud S2
hypertrophy of right heart

Cor Pulmonale

 JVD
 Hepatomegaly
 Pitting Edema on the Level
of the Knee
 Cyanosis
 Tall P-Waves
 37 y.o, Male

Treatment:
HPI
6 months 2 HRZE 4 HR
CC:
Generalized  DOB
Recommended Treatment for
Weakness and  On-Off Cough EPTB; Skeletal TB
Confusion
PMH 12 months
2 HRZE, 10 HR
 Childhood: TB

Physical Examination
Diagnostics:
General Appearance
 Cyanosis CBC
 Asterixis
 Hgb: 220 g/L HIGH
Vital Signs:  WBC: 7.2 NORMAL
 Platelets: 300,000 NORMAL
 100/90  Sodium: 140 NORMAL
 RR- 36 bpm  Chloride: 88 LOW
 Temp- 36.5C  CO2: 40 HIGH
 02 Sat- 50% (Severe Hypoxia)
 Creatinine: 1.5 HIGH
HEENT:
 Jugular Vein Distention to the base of the ABG
skull when sitting upright
Heart:  PCO2: 80 HIGH
 Cardiac Dullness  PO2: 30 LOW
 pH: 7.32 LOW
Lung:  HCO3-: 40 HIGH
 Asymmetric Rib Cage
 Crackles over the lung field Partially Compensated, Respiratory Acidosis
Indicative of Restrictive Lung
Abdomen:
Vital Capacity: 30% of predicted, FEV1/Vital Capacity Disease
 Hepatomegaly CLINICAL IMPRESSION:
0.80.
Extremities: JVD and Tall P-waves- Indicative Cor Pulmonale secondary to Pulmonary Fibrosis
 Pitting edema (to the level of knee) EKG
of Right Atrial Abnormalities Secondary to Tuberculosis Reinfection
 Tall P waves (Leads II & III, AVF, RSR pattern
Loud S2- Indicative for
Neurological: in lead VI)
Pulmonary Hypertension
 Confusion  S2 loud
CXR
 Extensive Scarring
 Loss of lung volume
 No pleural effusion
Patient’s Details:
Name:
Age: 37 years old

Taken in PA view with good exposure, clavicular ends

equidistant to spinous process with good inspiration

Deviated trachea to right, cardiomegaly hard to measure,

diaphragm normal with costophrenic sulci intact, other
structures are unremarkable. However, diffuse bilateral
opacities with cavitary lesions were noted.