Tuberculosis, causes, symptoms, pathology, tests, treatment.


 Tuberculosis is a chronic infections disease caused by a bacteria Mycobacterium Tuberculosis. 
  • It is also called as Koch's disease. 
  • The disease is confined to the lungs in most patient s but may spread to almost any part of the body. 
  • Upper lobe of the lung is usually affected. 

Causes:-

It is caused by the 2 species of bacteria Mycobacterium tuberculosis & rarely Mycobacterium bovis. 

Mode of entry:-

Tubercle bacilli may gain entry into the body usually by Inhalation/ Ingestion. 
Rarely, they gain entry through the skin, tonsils, Conjunction & external genitalia. 

Mode of Transmission:-

TB germs are passed through the air when a person who is sick with TB disease coughs, sings, sneeze or laughs. 
  • TB infection:- TB germs stay in your lungs, but they do not multiply or make you sick. 
  • TB disease:- TB germs stay in your lungs or move to other parts of the body, multiply or make you sick. 

Clinical features:-
  • Cough (2-3 weeks or more) & wheeze
  • Haemoptysis
  • Chest pains
  • Fever
  • Night sweats
  • Feeling weak & tired
  • Losing weight
  • Anorexia
  • Loss of elasticity of the skin
Pathology:-
  • The bacteria causes irritation of the mucous lining in the alveoli & inflammatory changes takes place
  • The center of this area undergoes Necrosis because soft & cheesy in consistency the process is called Caseation
  • This material may move into bronchus & coughs up leaving a cavity behind
  • This cavity gets healed & calcified & become major source of infection. 

Risk factors:-
  • Poor environment
  • Poor hygiene
  • Over crowding
  • Malnutrition
  • Smoking
  • Disease like Diabetes mellitus, HIV
  • Long term use of corticosteroid. 
Investigation:-
  • Chest X-ray
  • Sputum examination (AFB sensitivity) 
  • Tuberculin testing ( Mantoux test) 
  • TB antibody testing
  • Bronchoscopy
Mantoux test:-
  • Anti- tuberculin is injected on the Flexor compartment of forearm
  • The patient is adviced to come after 48 hours & the reading are measured
  • A reaction of <5mm is considered Negative
  • 5-20 or >20 is considered positive
  • A positive tuberculin test indicates tuberculous infection, with or without disease

Complications:-
  • Pneumothorax
  • Bronchiectasis
  • Empyema
  • Extra- pulmonary expansion
  • Haemoptysis
Treatment:- 

The TB control is adopting the DOTS (1995) 
Directly Observed Treatment, Short course therapy
DOTS strategy is recommended by WHO  
It's a 6months course 
Anti- tubercular drugs are
  • Rifampicin       600mg/daily
  • Isoniazid          300 mg daily
  • Ethambutol      25mg/kg
  • Pyrazinamide   15-30 mg/kg
  • Streptomycin     10-15 mg/kg

Surgical treatment:-
  • Lobectomy
  • Segmentectomy
  • Pneumonectomy
Physiotherapy treatment:-
  • Not much is needed at the rest stage but later it is required
  • Relax positioning
  • Localised breathing exercises
  • Chest mobility exercises to prevent chest deformity
  • Postural drainage ( contraindicated if haemoptysis present) 
  • Chest manipulation contraindicated in active TB
  • Incentive Spirometry

Prevention:-
  • BCG vaccine

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