PULMONARY TUBERCULOSIS (FINALS)

A. OVERVIEW

Pulmonary tuberculosis (TB) is a bacterial infection caused by the bacterium Mycobacterium

tuberculosis that mostly affects the lungs. It is a dangerous and potentially fatal condition that, if
left untreated, can spread to other parts of the body. When an infected individual coughs,
sneezes, or talks, the bacteria are normally transferred through the air, and another person
inhales the bacterium-containing droplets. Transmission is more likely in crowded and poorly
ventilated areas.

B. ETIOLOGY
● The cause/causative agent of pulmonary tuberculosis is mycobacterium tuberculosis. Its
other names are MTB for short or Koch's bacillus. It is a pathogen included in the
Mycobacteriaceae family, and was discovered in the year of 1882 by Robert Koch.

● Most mycobacteria are environmental organisms that are found in water and soil.
Habitats such as peat bogs are particularly rich sources of mycobacteria. Although most
are not important human pathogens, many can infect other hosts as diverse as frogs and
birds.

So, now you guys are probably thinking how does Mycobacterium tuberculosis cause
tuberculosis?

● The process of becoming infected with TB begins when the Tubercle bacilli are inhaled
in aerosol droplets, enter into the lungs and, when the host innate immune defenses fail
to eliminate the bacteria, Mtb start multiplying inside alveolar macrophages and then
spreads to other tissues and organs through the bloodstream and lymphatics.

● Pulmonary tuberculosis infects the lungs, as well as the other organs. Although the
disease is preventable, it still has the capability to be dormant and is considered
contagious, therefore it can affect people that are exposed to a patient with TB
immediately.

● There are two types of TB infection; primary and secondary. In primary MTB, the
bacteria can infect people through cough, sneeze, or spit coming from the infected
patient, and if an individual is exposed from these droplets, there is a chance that the
bacteria will enter their lungs, and cause infection.

● Meanwhile, the secondary MTB, is where the dormant bacteria reactivates or wakes up
from its slumber, and this is because the individual’s immune system weakens, and it will
show symptoms like chronic cough, weight loss, fatigue, fever, and night sweats.
 ● Though, there are also some factors that increase the risk of a person developing TB, for
instance; old age, smoking, and having autoimmune disorder, diabetes, as well as
kidney diseases.

● However, people with latent TB infection are not infectious, and most people who have
this never develop the disease, and it remains inactive for a lifetime without causing
infection, therefore the pathogen won’t spread and infect other uninfected individuals.
Usually, people with latent TB are asymptomatic, but if left untreated and the person’s
immune system is weak, it will develop into active TB in the future, and that’s when the
disease will be contagious, though they can be cured if they seek medical help.

C. SYMPTOMS AND SIGNS

Pulmonary tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis that
primarily affects the lungs. The signs and symptoms of pulmonary tuberculosis can vary
depending on the stage of the infection. Here are some common signs and symptoms:

1. Persistent cough: A cough that lasts for more than two to three weeks is a common symptom
of pulmonary tuberculosis. The cough may be dry or productive, with sputum that may be green,
yellow, or blood-tinged.

2. Fatigue: Generalized fatigue, weakness, and lack of energy are common symptoms of
tuberculosis. The infection can cause a significant impact on overall well-being and energy
levels.

3. Weight loss: Unexplained weight loss, often accompanied by loss of appetite, is a typical
symptom of pulmonary tuberculosis. It may be gradual and progressive over time.

4. Night sweats: Profuse sweating, especially at night, is a characteristic symptom of

tuberculosis. Night sweats are often drenching and can disrupt sleep.

5. Fever: Low-grade fever, typically in the afternoon or evening, is a common symptom.

However, not everyone with tuberculosis will have a fever.

6. Chest pain: Chest pain may be present, especially during deep breathing, coughing, or
laughing. It can range from mild discomfort to severe pain.

7. Shortness of breath: As the infection progresses, it can cause inflammation and damage to
the lung tissue, leading to shortness of breath, especially with physical activity or exertion.

8. Hemoptysis: In some cases, tuberculosis can cause coughing up of blood or bloody sputum.
This symptom is more common in advanced stages of the disease.
It's important to note that these signs and symptoms can also be indicative of other respiratory
conditions. If you suspect you have tuberculosis or are experiencing any of these symptoms, it's
crucial to consult a healthcare professional for an accurate diagnosis and appropriate treatment.

D. PATHOPHYSIOLOGY
-(Gwen)
-When Mycobacterium tuberculosis enters the lungs, it is taken up by immune cells called
macrophages. These cells are not able to kill the bacteria, and they are instead used by the
bacteria as a place to hide from the immune system. Over time, the bacteria multiply within the
macrophages and form small clumpps called granumolomas. These granulomas can become
calcified and form scars in the lungs.
-(Bea)
-When a susceptible person breathes in aerosolized Mycobacterium tuberculosis and droplets
small enough to reach the alveolar sacs, macrophages, dendritic cells, and monocytes are
activated. The macrophages will phagocytose the bacteria and try to eliminate it. Dendritic cells
will move to lymph nodes, where they will activate T-helper cells. M. Tuberculosis inhibits
phagolysosome fusion, avoids destruction, initiates replication, and releases DNA, RNA,
proteases, and lipids.

E. DIAGNOSIS- LABORATORY DIAGNOSIS.

Gram Staining
Acid-fast bacilli (AFB):presumptive diagnosis of tuberculosis.

Culture Media
-Löwenstein-Jensen or Middlebrook:

Rapid techniques are available for M. tuberculosis, including automated and semiautomated
-Blood test
-PCR amplification of mycobacterial DNA

Molecular diagnostic and gas–liquid chromatography

LABORATORY DIAGNOSIS.
Gram Staining
Acid-fast bacilli (AFB):presumptive diagnosis of tuberculosis.

Culture Media
-Löwenstein-Jensen or Middlebrook:

Rapid techniques are available for M. tuberculosis, including automated and semiautomated
-Blood test
-PCR amplification of mycobacterial DNA
Molecular diagnostic and gas–liquid chromatography

-In multi-bacillary diseases with a high mycobacterial load, a positive AFB smear with a positive
NAAT would indicate active tuberculosis whereas a positive AFB smear with a negative NAAT in
the absence of inhibitors would indicate nontuberculous mycobacterial (NTM) disease.

F. MANAGEMENT / TREATMENT
A patient with TB will most likely be treated for six to twelve months with a combination
of antibiotics if you have active TB disease. The drugs rifampin, pyrazinamide, and ethambutol
are routinely used with isoniazid INH to treat active TB. Taking medicines for at least six months
is the major treatment for tuberculosis (TB). You might also need to take steroid medication for a
few weeks if TB has gone to your brain, spinal cord, or the region around your heart. Patients
should start on a 4-drug regimen that includes isoniazid, rifampin, pyrazinamide, and either
ethambutol or streptomycin for the initial empiric treatment of TB. Ethambutol (or streptomycin, if
it is being used as a fourth medication) can be stopped if it is established that the TB isolate is
fully sensitive. If the course of therapy is not continued for a sufficient amount of time, the
surviving bacteria may cause the patient to become unwell and contagious once more, possibly
developing an illness that is drug-resistant. By eliminating these bacterial populations as they
periodically emerge from the nonreplicating condition, long-term antibiotic therapy may be able
to eradicate the illness. Although TB is typically treatable and curable, if it is not properly
treated, a person may pass away. When bacteria develop a resistance to the medications used
to treat TB, drug-resistant TB can occasionally result. As a result, the medicine is no longer able
to eliminate the TB germs.

G. PREVENTION

As with all illnesses, TB prevention is always better than cure. Although there isn't currently a
guaranteed technique to totally stop the transmission of TB, there are a number of steps that
can be taken to reduce the spread of the illness.

1. VACCINATION - The BCG (Bacille Calmette-Guérin) vaccine is a live tuberculosis

vaccination. The vaccine is made from a weakened strain of the tuberculosis bacillus,
Mycobacterium bovis.

The BCG vaccine remains as the sole licensed TB vaccine and has been in use since
1921. Despite being one of the most commonly used vaccinations in the world, we still
see approximately 9 million new cases of tuberculosis each year, demonstrating the
BCG's low effectiveness.
2. EDUCATION - Educate the general public on TB symptoms, diagnostic methods, and
the importance of receiving good and complete treatment.
3. MANAGING YOUR ENVIRONMENT - To prevent exposure in households where
someone has contagious tuberculosis, the following steps should be taken:
 ●Houses should be properly ventilated.
●Anyone who coughs should be educated on cough etiquette and respiratory
hygiene and be committed to it at all times.
● When coughing or sneezing, cover your nose and mouth: This can be done using
a tissue, or if the person does not have one, they can cough or sneeze into their
upper sleeve or elbow, but not into their hands. The tissue should subsequently
be disposed of properly.
4. A HEALTHY IMMUNE SYSTEM -
● Consume a diet high in protein and green leafy vegetables.
● Maintain good hygiene. Hands should be washed often and after returning home.
● Avoid all types of tobacco, as well as tobacco smoking.

References:
https://www.healthline.com/health/pulmonary-tuberculosis

https://www.ncbi.nlm.nih.gov/books/NBK344409/