TUBERCULOSIS

Tuberculosis (Koch's disease/phthisis/consumption disease)

▪ Is a chronic, sub-acute or acute respiratory

disease commonly affecting the lungs
characterized by the formation of tubercles in the
tissues which tend to undergo caseation, necrosis
and calcification.

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Etiologic Agent
The causative organism is a rod-organism
MYCOBACTERIUM TUBERCULOSIS,M.
africanum from human and M. bovis from
cattle
▪ “ Pathophysiology
Infection with M tuberculosis results most
commonly through exposure of the lungs or
mucous membranes to infected aerosols.
Droplets in these aerosols are 15um in
diameter: in a person with active pulmonary
TB, a single cough can generate 3,000
infective droplets with as few as 10
bacilli needed to initiate infection. When
inhaled, droplet nuclei are deposited
within the terminal airspaces of the lung.
The organisms grow for 2-12 weeks, until
they reach 1,000-10,000 in number which is
sufficient to elicit a cellular immune
response that can be detected by a reaction
to the tuberculin test.
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Period of
Communicability
▪ The patient is capable of
discharging the organism all
throughout life if he remains
untreated
▪ The disease is highly
communicable during the active
phase 5
“ Mode of Transmission
▪
▪
The disease is transmitted by deliberate
inoculation of microorganism or by droplet.
Inhalation of organism directly into the
lungs from contaminate air.
▪ Direct or indirect contact with infected
persons, usually by discharges from the
respiratory tract by means of coughing,
sneezing or kissing.
▪ It is transmitted through contact with
contaminated eating or drinking utensils.
▪ Rarely can the disease be transmitted
through skin lesion.
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Sources of infection:

▪ Sputum
▪ Blood form hemoptysis
▪ Nasal discharge
▪ Saliva

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Quantitative Classification of Tuberculosis:
▪ Minimal - characterized by slight lesion without
demonstrable excavation, confined to a small part of one or
both lungs.
▪ Moderately Advanced
a. One or both lungs may be involved.
b. The volume affected should not extend to one lobe.
c. Total diameter of the cavity should not exceed four
centimeters.
 Far Advanced Classifications - lesions are more
extensive than moderate.
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Clinical Classification:
▪ Inactive TB ▪ Active TB
a. Tuberculin test is positive
a. Symptoms of tuberculosis
b. X-ray of the chest is generally progressive.
are absent.
c. Symptoms due to lesions are usually
b. Sputum is absent for present.
tubercle bacilli after d. Sputum and gastric content are positive for
tubercle bacilli.
repeated examination.
 Activity not determined
c. There is no evidence of > when activity has not been determined
cavity on chest x-ray. from a suitable period of observation or
adequate laboratory and
x-ray studies.
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Clinical Manifestations:
▪ Afternoon rise of temperature
▪ Night sweating
▪ Body malaise and weight loss
▪ Cough, dry to productive
▪ Dyspnea, hoarseness of voice
▪ Hemoptysis
▪ Occasional Chest Pain
▪ Sputum positive for AFB
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Pathogenesis/Pathology:
 After gaining access into the body, the organism penetrates the lining
of the respiratory tract or the intestinal mucosa, is picked up by the lymph
or blood channels and reaches the lungs or other organs where it lodges
and produces original lesion, the tubercle, from where the disease got its
game.
 This initial tubercle is due to structural changes in the tissue brought
about by the tubercle bacillus at the site of the first recognizable location.
 Usually, the site is in the parenchyma of the lungs and is termed
GHON’S TUBERCLE.
 Then the bacilli will establish themselves in the alveoli of the lungs, the
walls of the blood vessels, in the lymph channels or gland or in the walls
of the bronchi.
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Diagnostic Procedures:

 Sputum analysis for

AFB
 Chest x-ray
 Tuberculin testing
a. Mantaux test (PPD)
b. Tine test (OT)
c. Heaf test (LT)

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Modalities of Treatment:
▪ Short course chemotherapy may be given through
a six-month treatment with Isoniazid
(INH),Rifampicin,Pyrazinamide (PZA) and
Ethambutol.
 Patients with drug resistance may be given with
second line drugs such as capreomycin,
streptomycin, cycloserine, amikacin and quinolone
drugs.

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▪ WHO recommends “Direct Observed Therapy” (DOT)
to prevent noncompliance. The health worker insures
that the patient takes his/her drugs.
▪ If the medicine is taken incorrectly, the patient becomes
resistant to anti-TB drugs and this is very dangerous
because if the disease recurs it becomes hard to treat
the second time around.
▪ Relapsing patients usually become resistant to
individual drugs. They are the c0mbination of the above
mentioned drugs.

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“
TUBERCULOSIS TREATMENT REGIMEN FOR
CHILDREN

Treatment Regimen
Types of TB Maintenance
Intensive Phase Phase

Pulmonary
Tuberculosis HRZ (2months) HR (4months)

Extrapulmonary
Tuberculosis HRZS (2months) HR (10months)

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Others Diseases/Problems Associated with PTB:

 The aging population

 Diabetes mellitus
 Chronic alcoholism
 Psychiatric patient
 Hematologic disorder
 HIV infection

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Nursing Management:
▪ Maintain respiratory isolation until patient responds to treatment or until
the patient is no longer contagious.
▪ Administer medicines as ordered.
▪ Always check sputum for blood or purulent expectoration.
▪ Encourage questions and conversation so that the patient can air his
or feelings.
▪ Teach or educate the patient all about PTB.
▪ Encourage to reduce tobacco exposure of the patient.
▪ Teach the patient to cough or sneeze into tissue paper and dispose
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secretions properly.
Nursing Management:
▪ Advised patient to have plenty of rest and eat balanced meals.
▪ Be alert for signs of drug reaction.
▪ If the patient is receiving ethambutol, watch for optic neuritis.
▪ If the patient receives rifampicin, watch for hepatitis and purpura.
▪ Emphasize the importance of regular follow-up examinations and
instruct the patient and his family about the signs and symptoms of
recurring TB.

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Prevention and
Control:
▪ Submit all newborns for BCG
immunization.
▪ Avoid overcrowding.
▪ Improve nutritional and health
status.
▪ Advise persons who have been
exposed to infected persons to
receive tuberculin test and if
necessary, chest x-ray and
prophylactic isoniazid. 19