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TUBERCULOSIS. WHAT IS IT ? Bacterial infection Bacterial infection Caused by Mycobacterium tuberculosis (also Caused by Mycobacterium tuberculosis (also.

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Presentation on theme: "TUBERCULOSIS. WHAT IS IT ? Bacterial infection Bacterial infection Caused by Mycobacterium tuberculosis (also Caused by Mycobacterium tuberculosis (also."— Presentation transcript:

1 TUBERCULOSIS

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3 WHAT IS IT ? Bacterial infection Bacterial infection Caused by Mycobacterium tuberculosis (also Caused by Mycobacterium tuberculosis (also called tubercle bacillus) called tubercle bacillus) Damages a persons lungs or other parts of Damages a persons lungs or other parts of the body the body Fatal if not treated properly Fatal if not treated properly

4 Mycobacterium – Slender, aerobic rods Gram +ve, Acid fast M.tuberculosis – Reservoir- Humans M.bovis –Reservoir – contaminated milk M.Avium intracellulare-opportunistic (AIDS)

5 TB flourishes in Poverty, Over crowding, Malnutrition DM, CRF Alcoholism Immunosuppression

6 TRANSMISSION Spreads through the air when aSpreads through the air when a person with active TB (Inhalation) person with active TB (Inhalation) –Coughs –Speaks –Laughs –Sneezes IngestionIngestion

7 SPREAD OF TB Local Spread Lymphatic spread Haematogenous Spread Natural passages – Pleurisy, Peritonitis (salpingitis), Laryngitis, Ileocaecal

8 PATHOGENESIS Breath in infected air and bacilli go to lungs through bronchioles Bacilli infect alveoli Macrophages attack bacteria, but some survive Infected macrophages separate and form tubercles

9 Hypersensitivity to tubercular antigens Cell Mediated immunity Caseating granulomas, Cavitation

10 Host response to lipids such as Mycosides (cord factor) & glycolipids ( Wax-D) on the bacterial cell wall Type IV Hypersensitivity

11 Primary cells infected are MACROPHAGES

12 ACTIVE INFECTION Unhealthy person Unhealthy person Bacilli overwhelm immune system Bacilli overwhelm immune system Bacilli break out of tubercles in alveoli Bacilli break out of tubercles in alveoli and spread through and spread through bloodstream bloodstream

13 LATENT INFECTION Initial infection controlled Initial infection controlled by immune system by immune system Bacilli remain confined in Bacilli remain confined in tubercles for years tubercles for years

14 DIAGNOSIS Mantoux testMantoux test Medical history,Medical history, x-rays, and smears for x-rays, and smears for AFB, Sputum culture, AFB, Sputum culture, PCR PCR

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16 SYMPTOMS Perpetual CoughPerpetual Cough FeverFever Weight lossWeight loss Night sweatsNight sweats Loss of appetiteLoss of appetite FatigueFatigue Swollen glandsSwollen glands Pain while breathingPain while breathing

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19 EVOLUTION OF TUBERCLE ( Granuloma) PMN Macrophages Poorly degradable bacilli CD4+ T cells ( IFN, TNF) Epithelioid cells Hard Tubercle Soft Tubercle

20 GRANULOMA Central caseous necrosis surrounded by epithelioid cells, Langhans giant cells, Rim of lymphocytes and fibroblasts.

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26 FATE OF GRANULOMA Cold Abscess Sinus Formation Fibrosis Dystrophic calcification

27 CLINICAL SPECTRUM Primary – previously unexposed, unsensitized person Secondary – Previously sensitized person - Follows primary, - Reactivation of dormant lesion, - Exogenous reinfection ( Large inoculum of virulent bacilli)

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29 Primary tuberculosis GHONS COMPLEX( Primary complex) Ghons Focus- Subpleural focus in the upper part of lower lobe/ lower part of upper lobe Lymphatic component Lymph node component – Hilar & Tracheo-bronchial

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32 Fate of Primary TB Fibrosis, calcification Progressive Pulmonary TB Primary Miliary TB Secondary TB

33 Secondary Tuberculosis Initially -- small focus (2 cm) of consolidation in the apical pleura Develop a small area of caseation, fibrosis

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35 Fate of secondary TB Heal with fibrosis Fibrocavitary TB Pneumonia Miliary TB

36 Progressive Pulmonary TB Child, Elderly, Immunocompromised Erosion of blood vessels hemoptysis Erosion into bronchus Empyema, effusion, pleuritis

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38 MILIARY TUBERCULOSIS Miliary = millet seeds Spread thro lymphatics Lesions- small / microscopic Liver, Spleen, Kidney, Brain, Bonemarrow adrenals, fallopian tubes, epididymis, etc.

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42 Isolated organ TB: Meningitis Renal Osteomyelitis Adrenals Salpingitis Potts spine Lymphadenitis- Scrofula Intestinal

43 IMMUNIZATION Bacilli Calmette Guerin ( BCG) [ Attenuated Strains of Bovine type of Bacilli]

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