2Tuberculosis Primary –selflimiting Infection in patients previously not exposed to M tuberculosis (under age 5 in the past, now common in adults also)Postprimary-progressiveReactivation and reinfection
4Manifestations of Primary TB are: Parenchymal diseaseLymphadenopathyMiliary diseasePleural Effusion
5Manifestations of Postprimary TB are: Upper lobe distributionCavityAbsence of adenopathyAirway involvement
6Human disease causing mycobacteria are more likely: Slow growingFast growing
7Mycobacteria – aerobic rods Categories by disease cause: 1.tuberculosis complex: causes human disease 2.nontuberculous or atypicalCategories by rate of growth: 1.rapid growing: < 7 days 2.slow growing:> 7 daysRapid: M.abscessus, M.fortiutum, M.chelonaeSlow: MTB, MAC, M.Kansasii
8Transmission Respiratory Desiccated bacilli remain airborne for long time – indoor close many months contact is necessary for transmissionLaryngeal, transbronchial, cavitary disease produce most bacilliVentillation reduces infectiousness
14TB mediastinal adenopathy is seen as part of Reactivation TBHIVPrimary TB usually in children
15TB mediastinal adenopathy is seen as part of Reactivation TBHIVPrimary TB usually in children
16TB Lymphadenopathy Central low attenuation Active disease Necrosis R hilar is most common
17PathogenesisTB bacilli in the body elicit acute inflammatory response – no symptomsMacrophages ingest bacilli and transport them to regional lymph nodesIf not contained in local LNs, hematogenous dissemination of bacilli occurs and usually is contained, if not, then: miliary, meningeal, GU, MSK
37Cavity vs cyst vs bullaCavity: Gas-filled space in an area of lung consolidation or mass or nodule produced by the expulsion of a necrotic part of the lesion via the bronchial tree; wall thickness variesCyst: wall thickness is 4 mm or lessBulla: wall thickness < 4 mmOften difficult to distinguish the 3Clin Microbiol Rev April; 21(2): 305–333
41CavityT bacilli grow in cavities which communicate with bronchi and spread infectionMDR bacilli grow in cavities exclusivelyHydrolytic enzymes break down lungTuberculosis Volume 89, Issue 4 , Pages , July 2009
65TB & HIV Clinical features depend on the severity immunosuppression Relatively intact cellular immunity = non– HIV-infected individuals- TB remains localized to the lung.HIV (CD4 T-lymphocyte count: <200/mm3), pulmonary TB with extra-pulmonary involvement: lymphadenitis, miliary
76The History of Tuberculosis The Hebrew word for phthisis or consumption (schachepheth) means to waste away occurs twice in the Bible:Leviticus 26:16I, in turn, will do this to you: I will appoint over you a sudden terror, consumption and fever that will waste away the eyes and cause the soul to pine away; also you will sow your seed uselessly, for your enemies will eat it up.Deuteronomy 28:22The Lord will smite you with consumption and with fever and with inflammation and with fiery heat and with the sword and with blight and with mildew and they will pursue you until you perish.
77The History of Tuberculosis By 1650 consumption was the leading cause of mortality and became a reference in some of Shakespeare's plays- one of the consumptive lovers, in "Much A Do About Nothing" , as well as scrofula in "Macbeth"
78The History of Tuberculosis Early attempts at treatment can be found throughout historyGreeks believed cutting off cool air eventuated in a burning up of the tissuesRomans put importance of dietHebrews control disease from diet to the destruction of clothingEarly "cures" from physiciansWarm sea airMilk from pregnant womenSeaweed placed under the pillowCold bathsDeep breathing
79The History of Tuberculosis The first breakthrough came when German bacteriologist named Robert Koch isolated the infectious agent known as tuberculosis bacteria or tubercle bacilli in He was later awarded the Nobel Prize for physiology or medicine in 1905
80The History of Tuberculosis The first sanatorium opened in 1854 in Gorbersdorf, Germany. Sick patients were given wholesome food and plenty of fresh air. This became the modern way to fight the disease. The sanatoriums provided medical care for almost 100 years and became one of the most remarkable and unique periods of medical care in history.By 1889 in the USA the National Tuberculosis Association fully realized that TB was distinctly preventable and not directly inheritedNo real progress was made until new antibiotics were used betweenIt has taken almost three thousand years to understand the full nature of Tuberculosis
82ReferencesJoshua Burrill, Christopher J. Williams, Gillian Bain, Gabriel Conder, Andrew L. Hine, Rakesh R. Misra RadioGraphics, 2007, Vol.27: , /rgSantiago Enrique Rossi, Tomas Franquet, Mariano Volpacchio, Ana Giménez, Gabriel Aguilar RadioGraphics, 2005, Vol.25:JR Cohen, JK Amorosa, PR Smith –The air-fluid level in cavitary pulmonary TB, Radiology, radiologyJK Amorosa, PR Smith, JR Cohen, C Ramsey… - …, Tuberculous mediastinal lymphadenitis in the adult1978 – radiologyMedscape Tuberculosis (TB), a multisystemic disease ….JK Amorosa….
83Famous people who had TB Gaius Valerius Catullus (ca. 84 BC – ca. 54 BC), Roman poetBronte sistersElizabeth Barrett BrowningAlbert CamusAnton ChekhovMaxim GorkyFranz KafkaEugene O'NeillEugene O'NeillMolièreRobert Louis StevensonDylan ThomasVoltairePaul GauguinAmedeo ModiglianiFrédéric ChopinNiccolò PaganiniIgor StravinskyCardinal RichelieuSimón Bolívar
84Opera, Theatre, Novels - TB Puccini: La bohemeVerdi: La TraviataThomas Mann: The Magic MountainVictor Hugo: Les MiserablesUpton Sinclair: The JungleJohnny Nolan: A Tree Grows in BrooklynW.Somerset Maugham: SanatoriumFrank McCourt: Angela’s Ashes