Pathophysiology of Tuberculosis: Group 5 Latosa, Selene Lee, Guk Lim, Johanna Magalona, Stephen Mendoza, Coleen

Pathophysiology of Tuberculosis
Group 5
Latosa, Selene
Lee, Guk
Lim, Johanna
Magalona, Stephen
Mendoza, Coleen
Tuberculosis
• Is an infectious bacterial disease caused by
Mycobacterium tuberculosis.
• The bacteria usually attack the lungs, but TB
bacteria can attack any part of the body such as
the kidney, spine, and brain.
• If not treated properly, TB disease can be fatal.
Mycobacterium Tuberculosis
• Also called Koch Bacillus
• Slender
• Aerobic rods, require CO2
• Gram positive
• Slow growing
• Produces niacin
• They have unique waxy cell wall composed of
mycolic acid, which makes them acid fast.
Tuberculosis
• Acquired by inhalation of airborne droplets.
• The lungs are the major site of infection.
• Most exposed individuals successfully contain
the infection and remain asymptomatic,
although they remain at risk for reactivation of
infection in later in life, especially in the
setting of immunosuppression.
• Patients with TB can present pulmonary or
extrapulmonary manifestations.
• Major syndromes of pulmonary TB
includes:
– Primary tuberculosis
– Reactivation tuberculosis
– Endobronchial tuberculosis
– Tuberculoma
Primary Tuberculosis
• Symptomatic primary TB occurs in few individuals
shortly after exposure.
• Primary TB pneumonia is a more common clinical
presentation in children and HIV-infected
individuals compared with non-HIV infected adults.
• Symptoms are:
– Fever
– Chest pain
– Cough
Reactivation Tuberculosis
• Develops months to years after acquisition of infection.
• May occur spontaneously or in the setting of
immunosuppression.
• Most common symptoms are: fever, cough, night
sweats, and weight loss.
• Sputum production increases as the infection
progresses and is occasionally accompanied by
hemoptysis.
• Older patients may present more indolent illness in
which fever and night sweats are absent.
Endobronchial Tuberculosis
• Involves the airways.
• May be seen in both Primary and Reactivation TB.
• In Primary TB, hilar nodal enlargement may impinge
on the bronchi, resulting in compression and
ultimately ulceration.
• In patients with reactivation disease, endobronchial
involvement may occur as a result of direct extension
from the parenchyma or pooling of secretions from
upper lobe cavities in the dependent distal airways.
Endobronchial Tuberculosis
• Symptoms
– Barking cough in two-thirds of patients
– Sputum production
– Wheezing
– Hemoptysis
Tuberculomas
• Rounded solitary mass lesions and
may occur in primary or
reactivation tb.
• Often asymptomatic and may mimic
malignancy.
• Tuberculoma is in the different
diagnosis of solitary pulmonary
nodule and may be difficult to
diagnose w/out biopsy or excision
because expectorated sputum in px
with tuberculoma rarely shows M.
tuberculosis on smear or culture.
Complications of Pulmonary TB
• Tuberculous empyema
• Bronchiectasis
• Extensive pulmonary
parenchymal destruction
• Spontaneous pneumothorax
• Massive hemoptysis from
rupture of a Rasmussen
aneurysm in the wall of cavity.
Extrapulmonary Tuberculosis
• Spread of M. tuberculosis infection beyond
the lung and may involve virtually any organ.
• The most common sites of extrapulmonary TB
are:
– Central nervous system
– Musculoskeletal system
– Genitourinary tract
– Lymph nodes (scrofula)
Extrapulmonary Tuberculosis
• Patients with HIV infection may develop rapidly
progressive primary infection and may present with
both pulmonary and extrapulmonary disease.
• In patients with advanced AIDS, TB may manifest as
disseminated disease with involvement of multiple
organs, including:
– Lymph nodes
– Bone marrow
– Liver
– Spleen
• Symptoms
– high fevers
– Sweats
– progressive weight loss
– inanition (wasting)
Assessment
• History
– A vital in diagnosis and management of patients
with suspected tuberculosis.
• Inquire about ant prior history of TB, presence
of risk factors for acquiring infections,
presence of risk factor for HIV infection, any
history of travel, potential contacts with
individuals with known or suspected TB.
• Patients with a prior history of TB, get their
outside medical record and drug susceptibility
results of prior isolates.
• If the patient was previously treated, these
should be evaluated:
– Drug chosen
– Duration of treatment
– Adherence to therapy
Laboratory Diagnosis
• Culture isolation
– Gold standard for diagnosis of tb from pulmonary
and extrapulmonary sites.
– It can be on solid or liquid media.
– Culture may take 4 - 6 weeks to grow.
• Acid fast staining of sputum, bronchoscopic
specimens and other body fluids or tissues.
– Used in patients with suspected pulmonary and
extrapulmonary disease.
• 10^4 organisms/ml
– Positive smear for patients with TB.
• The presence of acid-fast bacilli on smear is
not synonymous with a diagnosis of M.
tuberculosis because nontubeculous
mycobacteria can produce pulmonary and
extrapulmonary disease in selected
populations.
• Tuberculin skin test
– Gold standard for detecting latent TB infection
– 5 TU PPD
– Must have a wheal of 6 – 10 mm in diameter.
– Read result after 48 – 72 hours, but can also be
delayed up to 1 week.
References
• Schmitt, Steven K. and Longworth, David L., Chapter 22: Pulmonary
Infections, In Egan’s Fundamentals of Respiratory Care (10th ed.), 505.
• Diaz-Guzman, Enrique, Dweik, Raed A., and Stoller, James K., Chapter
23: Obstructive Lung Disease: Chronic Obstructive Lung Disease, Astma,
and Related Diseases, In Egan’s Fundamentals of Respiratory Care (10th
ed.), 525.
• Strange, Charlier, Chapter 25: Pleural Diseases, In Egan’s Fundamentals
of Respiratory Care (10th ed.), 564.
• Dr. Evangelista, Ryan R., Tuberculosis, powerpoint presentation.
• Dr. Weerakkody, Yuranga and Dr. Namdev, Rupesh et al, UDM Medica
network. Tuberculosis Empyema,
http://radiopaedia.org/articles/tuberculous-empyema, (Accessed 2015-
10-15)

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