Pulmonary Tuberculosis - Evolution and Clinical picture doc

Pulmonary Tuberculosis Pulmonary Tuberculosis Evolution and Clinical picture Global burden of TB Global burden of TB z In 1993 WHO declared TB a global emergency . z It is estimated that 9 million new cases of TB occurred /year and 3 million TB deaths/year . z Tuberculosis poses a major problem for developing countries . z 75% of TB cases in developing countries are in the economically productive age group ( 15-50 ys) [...]... manifestations of Tuberculosis - Post tuberculin reaction - Epituberculosis • This term is not used now • It describes dense homogenous shadow in lung of children with tuberculosis •This radiological appearance is due to - hypersensitivity reaction to tubercle protein - tuberculous pneumonitis (rarely caseating) - collapse by pressing lymph node pouring of caseous material caseous bronchitis and stenosis - Erythema... the caseous reaction Clinical features Acute or classical miliary tuberculosis • The disease is most common in infants and young children • In children, the onset may be associated with an acute or sub acute febrile illness • In adults, the onset is insidious with gradual development of vague ill-health, malaise, anorexia, weight loss and fever • Cough, breathlessness, haemoptysis and night sweats are... lymphadenopathy and splenomegaly may be found in a proportion of cases • Choroidal tubercles are found in over 90% of children with miliary tuberculosis but less commonly in adults • Miliary lesions of the skin are very occasionally seen and may take the form of macules, papules, vesicles or purpuric lesions Cryptic miliary or disseminated tuberculosis A variant pathological type known as ‘non-reactive’... weight loss, malaise and a fever of unknown origin Anemia is usual and the ESR is often elevated A variety of blood dyscrasias, including leucopenia, pancytopenia, aplastic anaemia, leukemoid reactions leucoerythroblastic anaemia and polycythemia, have been seen The liver function tests are commonly disturbed, with elevation of transaminases and alkaline phosphatase Hyponatremia and hypokalemia are... childhood Most children are symptom-free and are discovered only when they are investigated as contacts of an adult case, • may occur in elderly people who have lost their tuberculin sensitivity • In most cases there are no detectable physical signs • the child may be unwell with loss of appetite, fretfulness and failure to gain weight • Cough is not usual but may occur, and may mimic the paroxysms of... may be imprisoned alive and become active again when resistance decreases (2)Bad fate (progressive primary – one type of postprim tuberculosis) • Occurs when high virulence or dose of bacilli low host resistance •Local extension pneumonia, cavitation pleural effusion •Hematogenous dissemination bronchial vein Rt side of Ht lungs pulmonary vein Lt side of Ht allover the body pulmonary artery one lung... tuberculous histology, and are teeming with tubercle bacilli The spleen and liver may be enlarged and studded with irregular necrotic foci, usually less than 1 cm in diameter or only visible microscopically Any organ may be affected Increasingly being seen in the elderly, where it may be difficult to diagnose since the chest film may be normal, choroidal tubercles are absent and the tuberculin test... via blood to involve more than one organ not related to each other except by blood stream Source of bacillemia - Progressive primary - During advanced bronchogenic TB - Surgery on tuberculous origin (curettae of endometritis, massage of arthritis) so surgery should be under anti TB cover -Tuberculous endangitis : Seeding of bacilli into vessel walls may cause a caseous vasculitis of the intima , with... between prim and postprim in adults unless recent tuberculin conversion has been documented) Allergic reaction: • Appears against the protein part of the bacillus • reflected pathologically as caseous necrosis by the 2nd wk Immunologically manifested by : Hypersensitivity (tuberculin reaction & other hyperergic manifestations) +ve tuberculin is the earliest indicator of infection by TB (6th wk) -ve reaction... Erythema nodosa - Phlyctenular conjunctivitis - Allergic pleural effusion Other sequela of prim TB • Broncholith Calcified primary or lymph node extruded to bronchus hemoptysis • Bronchiectasis mostly in upper lobe • Obstructive emphysema external pressure or endobronchitis valve like mechanism Radiological features • Radiological changes are found at the time of tuberculin conversion in 7-3 0% of young . Pulmonary Tuberculosis Pulmonary Tuberculosis Evolution and Clinical picture Global burden of TB Global burden of TB z In 1993 WHO. Rt side of Ht lungs pulmonary vein Lt side of Ht allover the body pulmonary artery one lung dissemination II.Fate II.Fate of primary focus (glandular of primary focus (glandular component) component) (1)Good. increase? z Improper management z Impact of HIV pandemic z Poverty, drug addiction and an increasing number of homeless people . Etiology: Mycobacterium tuberculosis Three types can infect man: 1.