Tuberculosis

Tuberculosis (TB) is a disease caused by bacteria called 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.

Causes—-

  • Transmission of bacteria Mycobacterium tuberculosis via air on coughing, sneezing

  • HIV, Diabetes or other compromised immune conditions.
  • Having lived in, travelled to or had visitors from parts of the world where TB is common
  • Long use of corticosteroids, chemotherapy, TNF(tumor necrosis factor)
  • Too young or too old
  • Poor health
  • Poor diet
  • Alcoholism
  • Poor housing with associated overcrowding
  • Gastric surgery
  • Silicosis

Types–

Table of Contents hide

A.

Latent TB infection

The bacteria is present in inactive form in the body, and does not produce any symptoms or illness. People with latent TB infection have a positive skin test reaction, but they cannot spread the disease.

Latent TB can develop to  active TB

  •  if treatment is not received for latent TB infection
  • if immunity is weak

Active TB infection

The bacteria is present in the body in an active form. The active bacteria begin to multiply in the body and cause active TB disease.

B. 

Pulmonary tuberculosis

  • Primary TB

Primary focus in lungs, tonsil or bowel is almost invariably accompanied by caseous lesions in the regional lymph nodes

  • Progressive pulmonary TB

Develops directly from a primary lesion or following reactivation of an incompletely healed primary focus

  • Post-primary pulmonary TB

Formation of tuberculous cavity

Extra-pulmonary tuberculosis

  • Central nervous system TB

  • Gastrointestinal TB
  • Genitourinary TB
  • Lymph node TB
  • Skeletal TB

  • Pericardium TB

Symptoms And Signs–

Symptoms might not begin until many years after initially exposed to the bacteria.

Pulmonary tuberculosis

  • Breathlessness
  • Clubbing of the fingers or toes(in advanced stage)
  • Fatigue
  • Crackles(unusual breath sounds)
  • Evening pyrexia
  • Anorexia
  • Malaise
  • Persistent cough with thick phlegm( may be bloody)
  • Pleural effusion
  • Weight loss
  • Sleep sweats

Lymph node TB

  • Persistent, painless swelling of the lymph nodes(usually cervical node)
  • Caseation
  • Liquefaction
  • Sinus formation

Skeletal TB

  • Vertebral collapse
  • Pyarthrosis
  • Osteomyelitis
  • weakened bone that may fracture easily
  • Cold abscess formation

Gastrointestinal TB

  • Tuberculous ulceration of tongue
  • Malabsorption
  • Intestinal obstruction
  • Ascites
  • Diarrhoea

Genitourinary TB

  • Burning micturition
  • Hematuria
  • Nocturia
  • Increased frequency of micturition
  • Salpingitis
  • Tubal abscess
  • Painless craggy swelling resulting in sinus formation (epididymis)

Central nervous system

  • Headaches
  • Stiff neck
  • Vomiting
  • Disordered consciousness
  • Changes in mental state(confusion)
  • Blurred vision
  • Fits

Pericardium TB

  • Pericardial effusion
  • Tamponade
  • Fibrosis
  • Calcification

Investigations—-

  • Mantoux skin test (tuberculin skin test; TST or PPD test)

  • Bronchoscopy
  • Sputum examination and cultures
  • Thoracentesis
  • QuantiFERON-TB Gold test
  • Chest X-ray
  • CT-scan
  • MRI-scan
  • USG
  • Blood and urine test
  • Biopsy
  • Lumbar puncture

Treatment–

Tuberculosis of any type is completely curable with medicines. Only need is early diagnosis and time bound follow -up.

Complications —

  • Antibiotic-resistant tuberculosis (TB)
  • Multi-drug resistance tuberculosis (MDR-TB)
  • Extensive multi-drug resistance tuberculosis (XDR-TB)
  • Aspergilloma
  • Blood –borne dissemination
  • Empyema
  • Ischiorectal abscess
  • Pleurisy
  • Pneumothorax
  • Respiratory failure
  • Right ventricle failure
  • Tuberculous enteritis
  • Tuberculous laryngitis

Prevention —

  • Always cover mouth when coughing, sneezing or laughing.
  • Carefully dispose of any used tissues in a sealed plastic bag.
  • Open windows when possible to ensure a good supply of fresh air.
  • Stay away from work, school or college until TB treatment team advises that it is safe to return.
  • Bacillus Calmette-Guérin (BCG) vaccination provides protection against TB

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