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PULMONARY
TUBERCULOSIS
ACTIVE TUBERCULOSIS
INTRODUCTION
Tuberculosis is a highly prevalent chronic infectious disease caused by
Mycobacterium tuberculosis bacilli. Globally Mycobacterium tuberculosis infection
remains at an epidemic level affecting one third of world population. About 1 million
Filipinos have active TB disease. This is the third highest prevalence rate in the
world, after South Africa and Lesotho. It is a highly curable disease. Yet, it is the
number one killer among all infectious diseases. Every day more than 70 people lose
their lives to TB in the Philippines needlessly. the emergence of human
immunodeficiency virus (HIV) infection has made the situation worse.2 Around 10%
of tuberculosis cases are in the first and second decade of life. It affects three times as
many men as women
Pulmonary TB, also known as consumption, spread widely as an epidemic during the
18th and 19th centuries in North America and Europe. After the discovery of
antibiotics like streptomycin and especially isoniazid, along with improved living
standards, doctors were better able to treat and control the spread of TB
INTRODUCTION
35,000,000
will die of TB Tuberculosis IF NO
early detection and treatment
Etiology
● The organism has a poor reaction to Gram stain and, thus, is not classified as
gram-positive or gram-negative. However, sometimes weakly positive cells
are observed on Gram stain, referred to as “ghost cells.” As M. tuberculosis
retains some stains even after being treated with solutions containing acids,
hence it is considered an acid-fast bacillus. The Ziehl-Neelsen stain and the
Kinyoun stain are most commonly used to identify M. tuberculosis. The test
dyes the acid-fast bacilli bright red, which makes it distinct against a blue
background.
● Humans are the only known host in which M. tuberculosis naturally lives
and reproduces. The organism is spread primarily as an airborne aerosol
from an individual in the infectious stage of the disease, although
transdermal and gastrointestinal (GI) transmission is also possible.
Signs and Symptoms
2. Chest pain
5. Fatigue
6. Fever
7. Night sweats
8. Weakness
9. Weight loss
10. Wheezing
PHYSICAL
EXAMINATION
ANATOMY AND PHYSIOLOGY
The lungs are pyramid-shaped, paired organs that are connected to the
trachea by the right and left bronchi; on the inferior surface, the lungs are
bordered by the diaphragm. The diaphragm is the flat, dome-shaped
muscle located at the base of the lungs and thoracic cavity. The lungs are
enclosed by the pleurae, which are attached to the mediastinum. The
right lung is shorter and wider than the left lung, and the left lung
occupies a smaller volume than the right. The cardiac notch is an
LUNGS indentation on the surface of the left lung, and it allows space for the
heart. The apex of the lung is the superior region, whereas the base is the
opposite region near the diaphragm. The costal surface of the lung
borders the ribs. The mediastinal surface faces the midline.
ANATOMY AND PHYSIOLOGY
Each lung is composed of smaller units called lobes. Fissures separate
these lobes from each other. The right lung consists of three lobes: the
superior, middle, and inferior lobes. The left lung consists of two lobes:
the superior and inferior lobes. A bronchopulmonary segment is a
division of a lobe, and each lobe houses multiple bronchopulmonary
segments. Each segment receives air from its own tertiary bronchus and
is supplied with blood by its own artery. Some diseases of the lungs
typically affect one or more bronchopulmonary segments, and in some
cases, the diseased segments can be surgically removed with little
influence on neighboring segments. A pulmonary lobule is a subdivision
formed as the bronchi branch into bronchioles. Each lobule receives its
own large bronchiole that has multiple branches. An interlobular septum
is a wall, composed of connective tissue, which separates lobules from
one another.
ETIOLOGY
Infection with Mycobacterium tuberculosis (alcohol and acid-fast bacillus) causes active tuberculosis. It is classified
under the M. tuberculosis complex group, which includes four other mycobacteria that can cause active
tuberculosis: M. canettii, M. microti, M. bovis, and M. africanum.
Humans are the only known host in which M. tuberculosis naturally lives and reproduces. The organism is spread
primarily as an airborne aerosol from an individual in the infectious stage of the disease, although transdermal and
gastrointestinal (GI) transmission is also possible.
DISEASE CONDITION: Active Tuberculosis
Infectious droplet nuclei are deposited in the alveolar spaces of the contact person where
Mycobacterium tuberculosis (M. tb) can be phagocytosed by alveolar macrophages,
epithelial cells, dendritic cells (DC) and neutrophils. Primary tuberculosis occurs when the
immune system is unable to defend against the Mycobacterium tuberculosis bacterium
(MTB) infection.
Thus, the bacteria multiply in the body, causing noticeable symptoms and rapid effects.
Though the lung is the most commonly involved organ, other organ systems may be
affected which includes the gastrointestinal system, the musculoskeletal system, the
lymphoreticular system, skin, liver, and the reproductive system.
DISEASE CONDITION: Active Tuberculosis
Infection to other people varies but most likely it is a shared contaminated air with a TB
positive person; talking, coughs, sneezes or speaking.
active TB patient’s breaths bacteria out into the air and anyone can acquire and be
infected/corrupted by them. Presumably spread it to their own household, workplace and
can definitely spread elsewhere.
CLASSIFICATION
Data from the history, physical examination, TB test, chest x-ray, and microbiologic studies are used to
classify TB into one of five classes.
• Class 0. There is no exposure or no infection.
• Class 1. There is an exposure but no evidence of infection.
• Class 2. There is latent infection but no disease.
• Class 3. There is a disease and is clinically active.
• Class 4. There is a disease but not clinically active.
• Class 5. There is a suspected disease but the diagnosis is pending.
CAUSES OF PTB
Causes of acquiring tuberculosis include the following:
Immunocompromised person
y.o. and Adults more than Inhalation of droplet Malnourished Individuals
65 y.o. Economically-disadvantaged
infected with
Living in crowded areas
Native Americans, Mycobacterium
Alcohol abuse
Eskimos, Asians, and Tuberculosis Poor hygiene
people with color Lack of access to health care
Collagenous scar tissue Fibrosis and calcification There is then the proliferation
encapsulates the tubercle to happens as the lesion ages of T-lymphocytes in the
separate the organisms from resulting to granuloma surrounding of the central core
the body. formation called as tubercle. of the caseous necrosis causing
some lesions.
As the process progress the bacteria may or
may not be killed and it continue to grow PULMONARY TUBERCULOSIS
and multiply resulting to a cell mediated
immunity
( which can be detected through PPD)
For poorly
The semiliquid necrotic material is
If drained in the bronchus immunocompromised clients,
drained into the bronchus or in the
as purulent discharge, it the necrotic tissue liquefies and
nearby blood vessel, leaving an air
could infect other people the fibrous walls losses its
filled cavity at the original site.
through droplet structural integrity
transmission.
EXTRAPULMONARY TUBERCULOSIS
Risk factorcs of active tuberculosis:
Isoniazid (INH). INH is a bactericidal agent that is used as prophylaxis for neuritis, and has side effects of peripheral
neuritis, hepatic enzyme elevation, hepatitis, and hypersensitivity.
Rifampin (Rifadin). Rifampin is a bactericidal agent that turns the urine and other body secretions into orange or red,
and has common side effects of hepatitis, febrile reaction, purpura, nausea, and vomiting.
Pyrazinamide. Pyrazinamide is a bactericidal agent which increases the uric acid in the blood and has common side
effects of hyperuricemia, hepatotoxicity, skin rash, arthralgias, and GI distress.
Ethambutol (Myambutol). Ethambutol is a bacteriostatic agent that should be used with caution with renal disease, and
has common side effects of optic neuritis and skin rash.
Second-line drugs: ethionamide (Trecator-SC), para-aminosalicylate (PAS), cycloserine (Seromycin), capreomycin
(Capastat).
If drug-resistant TB, report to physician, might give one or more different medicines. may have to take them for much
longer, up to 30 months, and they can cause more side effects.
Pulmonary tuberculosis is treated primarily with antituberculosis agents for 6 to 12 months.
• First line treatment. First-line agents for the treatment of tuberculosis are isoniazid (INH),
rifampin (RIF), ethambutol (EMB), and pyrazinamide.
• Active TB. For most adults with active TB, the recommended dosing includes the administration
of all four drugs daily for 2 months, followed by 4 months of INH and RIF.
• Initial phase. The initial phase consists of a multiple-medication regimen of INH, rifampin,
pyrazinamide, and ethambutol and lasts for 8 weeks.
• Continuation phase. The continuation phase of treatment include INH and rifampin or INH and
rifapentine, and lasts for an additional 4 or 7 months.
• Prophylactic isoniazid. Prophylactic INH treatment involves taking daily doses for 6 to 12
months.
• DOT. Directly observed therapy may be selected, wherein an assigned caregiver directly observes
the administration of the drug. an additional treatment regimen is undergone by patients called
directly observed therapy short-term (DOTS), which closely monitors treatment adherence and
completion [6], with the goal of efficiency and cost-effectiveness [1]. With the emergence of
MDR-TB, DOTS-plus was initiated as a more rigorous treatment strategy