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Tuberculosis
- 2. Overview: ■ INTRODUCTION ■ TYPES ■ TRANSMISSION ■ PATHOGENESIS ■ GHON’S FOCUS ■ COMPLICATIONS ■ EXTRA- PULMONARY SITES
- 3. Tuberculosis ■ Chronic granulomatous inflammation ■ Predominant in developing countries ■ Predisposing factors: malnutrition, poverty, over-crowding, immunocompromised status
- 4. Causative organism ■ Mycobacterium tuberculosis (strict aerobe) ■ Tubercle bacillus ■ Also known as Koch’s bacillus ■ Mycobacterium tuberculosis complex- Eg: M.tuberculosis hominis and M.bovis Less common strains : M. africanum M. microti M. smegmatis
- 5. Atypical mycobacteria ■ Also know as non-tuberculous mycobacteria. ■ Or Environmental mycobacteria 1)Rapid growers (within 7 days) M.abscessus, M.fortitum, M.chelonae. 2) Slow growers (2-3 weeks) ■ Photochromogens-yellow pigment produced in light ■ Scotochromogens-pigment produced in light or in dark ■ M.avium intracellulare,M.kansaii etc ■ No person to person contact
- 6. TYPES OFTB ■ PRIMARY ■ SECONDARY
- 7. SITES FOR PRIMARYTB: ■ LUNGAND HILAR LYMPHNODE ■ EXTRA PULMONARY – CERVICAL LYMPH NODE (commonest) – BONE – TONSIL – INTESTINE – SKIN
- 8. Mode of transmission Inhalation Ingestion Inoculation into skin Transplacental route
- 9. Spread ofTB: local, lymphatic, hematogenous, natural passages.
- 10. Pathogenesis ■ Cell mediated immunity and ■ Delayed type of hypersensitivity Bacterial wall contains the lipids: A. Mycosides - cord factor of organism B. Glycolipids - wax D
- 11. PATHOGENESIS:
- 12. Lymph node:
- 15. Fate of granuloma 1) Cold abscess 2) Sinus tract formation 3) Coalesce together enlarging the lesion 4) Dystrophic calcification
- 16. PrimaryTB ■ Ghon’s tuberculosis or childhood tuberculosis ■ Individuals who are not infected previously ■ Lungs and hilar lymph nodes
- 17. GHON’S FOCUS: ■ A primary lesion usually subpleural ■ Site : junction b/w the upper part of lower lobe and lower part of upper lobe. ■ It is named for Anton Ghon (1866–1936), anAustrian pathologist. ■ GHON’S COMPLEX: GHON’S FOCUS, HILAR LYMPHNODE INVOLVEMENT DRAINING LYMPHATICVESSEL INVOLVEMENT
- 18. Ghon’s focus (sub pleural focus in the upper part of the lower lobe)
- 20. Fate of primaryTB ■ Resolution and calcification ■ Progressive primary tuberculosis ■ Primary miliary tuberculosis
- 21. Secondary tuberculosis ■ Previously infected or sensitized individuals develop secondary TB ■ Post-primary or re-infection or chronicTB ■ Endogenous source - dormant bacillus ■ Exogenous source - reinfection of bacillus ■ Commonly in lungs
- 22. Secondary pulmonaryTB ■ Commonest site - Apex of lung ■ Lympho-hematogenous spread ■ HIV patients are more prone ■ M.avium intracellulare occurs in the HIV patients too
- 23. Fate of secondary lungTB ■ Fibrosis and calcification ■ Tuberculous pneumonia ■ Miliary tuberculosis ■ Empyema
- 24. FibrocaseousTB ■ Fibrosed tubercle enter bronchus from a cavity - cavitary or open fibrocaseousTB ■ Non cavitary lesion without entering bronchus - chronic fibrocaseousTB
- 25. CavitaryTB
- 26. CavitaryTB
- 28. Complications of secondary TB ■ Aneurysms of patent arteries ■ Bronchopleural fistula ■ Empyema ■ Adhesions on pleura
- 29. MiliaryTB ■ Spread to systemic organs ■ Via pulmonary vein or pulmonary artery ■ Millet sized lesions of 1 mm diameter
- 30. Gross-miliaryTB
- 32. Intestinal tuberculosis ■ Primary intestinalTB- Ileocaecal region Ingestion of M.bovis Now a days, M.tuberculosis Mesentric lymph nodes ■ Secondary intestinalTB- Self swallowing of sputum in active disease Terminal ileum
- 33. ■ Hyperplastic ileocaecalTB Secondary to pulmonaryTB Common in India
- 35. Transverse ulcers in intestine:
- 37. ■ In the case of primaryTB, tabes mesentrica seen ■ Tabes mesentrica - enlarged mesentric lymph nodes ■ Mesentric lymphatic nodes rupture to causeTB peritonitis
- 38. POTT’S SPINE:
- 40. Clinical features ofTB ■ Productive cough may be with hemoptysis ■ Dyspnoea, orthopnea ■ Fever ■ Night sweats ■ Fatigue ■ Loss of weight ■ Loss of appetite
- 41. Diagnosis ■ Clinical features are not confirmatory. ■ Zeil Neelson Stain ■ Adenosine deaminase test ■ Culture most sensitive and specific test. – Conventional Lowenstein Jensen media 3-6 wks. – Automated techniques within 9-16 days ■ PCR is available, but should only be performed by experienced laboratories ■ Mantoux test
- 42. Demonstration of organism ■ Ziehl-neelsen staining or acid fast staining ■ Fluorescent dyes - auromine and rhodamine ■ LJ medium for sputum ■ Bactec culture, HPLC(high pressure liquid chromatography) ■ Guinea pig inoculation ■ PCR
- 45. immunisation ■ BCG - Bacillus Calmette Guerin
- 46. Mantoux test ■ Tuberculin skin test ■ 0.1 ml of tuberculoprotein,purified protein derivative is administered intradermally ■ Induration more than 15 mm in 72 hours ■ DisseminatedTB-negative ■ False positive - atypical mycobacteria, previous BCG vaccination ■ False negative - sarcoidosis, recentTB, hodgkins disease.
- 47. After 72 hrs…