All about Tuberculosis , pulmonary or extra-pulmonary.

• Details about PULMONARY TUBERCULOSIS Diagnosis Signs and Symptoms with Treatment.

Detail about PULMONARY TUBERCULOSIS Diagnosis Signs and Symptoms with Treatment

PULMONARY TUBERCULOSIS Primary disease:

Primary pulmonary tuberculosis –

• Is due to first infection with the tubercular  bacilli. It is seen in chil­dren. It involves middle and lower lung zones
• Lesion is peripheral with hilar or paratracheal lymphadenopathy .
• Lesions heal and remain as a calcified nodule called Ghon lesion.

Progressive primary tuberculosis –

• In children and persons with low immunity, malnutrition, HIV infec­tion, primary pulmonary tuberculosis progresses to pleural effusion, necrosis of central part, cavity for­mation, hilar and mediastinal lymphadenopathy, com­pression of bronchi, segmental or lobar collapse of lung called Progressive Primary Tuberculosis.
• Spread by blood, called haematogenous dissemina­tion, results in severe primary tuberculosis infection.
• Bacilli enter the blood stream from lungs and lymph nodes and spread to various organs where they pro­duce granulomatous lesions.
• Healing may occur, or miliary tuberculosis and men­ingitis may occur.

Post Primary Disease:

• It occurs in adults due to reactivation.
• This is called secondary tuberculosis or post primary disease due to endogenous reactivation of infection. It found in apical and posterior segments of upper lobe of lungs.
• This is due to the high oxygen content in these re­gions favoring growth of bacteria.
• There is infiltration, and cavity formation containing necrotic contents, which can spread to other parts of the lungs. Tubercular pneumonia may occur.
• The disease may be fatal in a few weeks or become chronic in several months.

The lung lesions may be —

• Pneumonia
• Cavity
• Fibrosis
• Calcification Pleural effusion

PULMONARY TUBERCULOSIS Symptoms are

• Fever,
• night sweats,
• weight loss,
• anorexia,
• malaise,
• weakness,
• cough,
• purulent spu­tum or blood stained sputum,
• massive hemoptysis,
• pleuritic chest pain and dyspnoea.

PULMONARY TUBERCULOSIS Physical findings:

• There may be no findings.
• Crepts or rales may be present especially after cough­ing.
• Ronchi may be present due to bronchial obstruction. Amphoric breathing is heard over a cavity communi­cating with bronchus.
• Fever – low grade, wasting, anaemia, pallor, finger clubbing, leucocytosis;and hyponatraemia are seen.
• Syndrome of inappropriate ADH (SIADH) may occur. Acute respiratory distress syndrome (ARDS) may oc­cur rarely.
• Rasmussen’s aneurysm (dilated vessel in a cavity) is rare.

PULMONARY TUBERCULOSIS TREATMENT Case definitions

• 1. Tuberculosis suspect : Any person with symp­toms or signs suggestive of tuberculosis like cough more than 2 weeks.
• 2. Case of tuberculosis: A patient in whom tuber­culosis is confirmed bacteriologically
• 3. Definite case of tuberculosis : A patient with positive culture for M. tuberculosis complex or patient with 2 sputum smears showing AFB

History of Tuberculosis treatment – Definitions for diagnosis

• 1. New -A patient who has never taken antituber­cular treatment or taken for less than a month.
• 2. Relapse -A patient treated for TB and declared cured, or full treatment taken but smear or cul­ture for tuberculosis is positive.
• 3. Treatment after failure – A patient given An again, after failed previous treatment
• 4. Treatment after default – If a patient, bacterio­logically positive, interrupts treatment for 2 moths or more and starts An again.
• 5. Transfer in – A patient transferred from another TB centre for continuation of treatment.
• 6. Other – Any other case like chronic case, spu­tum positive at the end of repeat treatment.
• Sometimes pulmonary and extra pulmonary relapse cases may be smear-negative.

DRUGS – ATT (ANTITUBERCULAR TREATMENT)

There are 3 main properties of antituberculous drugs:

1. Bactericidal action
2. Sterilizing activity
3. To prevent resistance.

The Tuberculosis first line agents consist of

• Isoniazid,
• Rifampin,
• Pyrazinamide,
• Ethambutol.

Tuberculosis Second line drugs have lower efficacy and more toxicity.

• streptomycin,
• kanamycin,
• amikacin,
• capreomycin,
• ethionamide,
• cycloserine, and PAS(Paraamino salicylic acid).
• Complete TUBERCULAR TREATMENT