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    Tuberculosis: Dr. Kaem Shir Ali

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    Mwanja Moses
    1. Tuberculosis is caused by the Mycobacterium tuberculosis complex, notably M. tuberculosis, which is a thin, acid-fast bacterium. 2. TB can be latent without symptoms after initial infection or can reactivate later in life, causing secondary TB. Risk factors for reactivation include HIV/AIDS, immunosuppression, and silicosis. 3. TB spreads through airborne droplets from the lungs of infected individuals and is most infectious from those with cavitary lung lesions. Diagnosis involves tuberculin skin tests, molecular tests on culture samples to detect M. tuberculosis DNA.

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    Tuberculosis: Dr. Kaem Shir Ali

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    Mwanja Moses
    58 views52 pages
    1. Tuberculosis is caused by the Mycobacterium tuberculosis complex, notably M. tuberculosis, which is a thin, acid-fast bacterium. 2. TB can be latent without symptoms after initial infection or can reactivate later in life, causing secondary TB. Risk factors for reactivation include HIV/AIDS, immunosuppression, and silicosis. 3. TB spreads through airborne droplets from the lungs of infected individuals and is most infectious from those with cavitary lung lesions. Diagnosis involves tuberculin skin tests, molecular tests on culture samples to detect M. tuberculosis DNA.

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    1. Tuberculosis is caused by the Mycobacterium tuberculosis complex, notably M. tuberculosis, which is a thin, acid-fast bacterium. 2. TB can be latent without symptoms after initial infection or can reactivate later in life, causing secondary TB. Risk factors for reactivation include HIV/AIDS, immunosuppression, and silicosis. 3. TB spreads through airborne droplets from the lungs of infected individuals and is most infectious from those with cavitary lung lesions. Diagnosis involves tuberculin skin tests, molecular tests on culture samples to detect M. tuberculosis DNA.

    Copyright:

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    Download as pptx, pdf, or txt
    58 views52 pages

    Tuberculosis: Dr. Kaem Shir Ali

    Uploaded by

    Mwanja Moses
    1. Tuberculosis is caused by the Mycobacterium tuberculosis complex, notably M. tuberculosis, which is a thin, acid-fast bacterium. 2. TB can be latent without symptoms after initial infection or can reactivate later in life, causing secondary TB. Risk factors for reactivation include HIV/AIDS, immunosuppression, and silicosis. 3. TB spreads through airborne droplets from the lungs of infected individuals and is most infectious from those with cavitary lung lesions. Diagnosis involves tuberculin skin tests, molecular tests on culture samples to detect M. tuberculosis DNA.

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    TUBERCULOSIS

    DR. KAEM SHIR ALI


    TUBERCULOSIS
    • Tuberculosis (TB) is caused by organisms of the
    Mycobacterium tuberculosis complex.

    • The complex includes M. tuberculosis (MTB), the most


    frequent and important agent of human mycobacterial
    disease, and M. bovis, previously an important cause of
    disease acquired via ingestion of unpasteurized milk.

    • MTB is a thin aerobic bacterium that is neutral on Gram’s


    staining but that, once stained, is acid-fast—i.e., it cannot
    be decolorized by acid alcohol because of the cell wall’s
    high content of mycolic acids and other lipids.
    DEFINITIONS
    • Primary tuberculosis (TB)
    – Acute clinical illness directly following infection
    • Latent TB
    – Evidence of exposure without active disease
    – Dormant bacilli can persist in the host for years without causing any
    clinical symptom-atology.
    – Only evidence may be a positive skin test to purified protein derivative
    (PPD).
    – Noninfectious during this stage
    – Risk of reactivation and resultant secondary TB
    • Secondary TB
    – Also known as adult-type TB or reactivation TB
    – Reactivation of previously acquired infection
    – Caused by previously dormant bacilli
    – Often infectious
    Reactivation TB
    • Secondary (reactivation) TB
    • 10% of persons infected in youth eventually
    develop secondary TB.
    – Reactivation risk is highest (5%) in the first 2
    years after primary infection.
    – 5% over remaining lifetime after 2 years
    • 10% risk of reactivation per year in HIV-
    infected patients
    Definitions cont’d
    • Multidrug-resistant TB (MDR TB)
    -Resistant to at least isoniazid and rifampin
    • Extensively drug-resistant TB (XDR TB)
    – Resistant to at least isoniazid, rifampin, any
    fluoroquinolone, and at least 1 second-line injectable
    drug (kanamycin, amikacin, or capreomycin)
    • Miliary TB
    – Widespread hematogenous dissemination of bacilli
    – Can occur with both primary and secondary TB
    Natural history

    – One-third of untreated patients die of severe


    pulmonary TB within a few weeks or months after
    reactivation.
    – May remit spontaneously
    – Potential for progressively debilitating course
    ("consumption")
    Risk Factors
    • Acquisition: exogenous factors

    – Close contact with infected person


    • Poverty
    • Homelessness
    • Drug and alcohol abuse
    • Incarceration/Imprisonment
    • Residence in nursing home or other long term–care facility
    – Exposure to endemic area for those from non endemic areas
    • Primary TB
    -Age
    • Common among children ≤ 4 years of age
    Risk factors cont’d
    • Secondary (reactivation) TB: Endogenous factors
    • Recent infection (< 2 years)
    • HIV infection
    – No CD4+ count protects fully against associated risk.
    – Risk is highest at low CD4+ counts.
    • Immunosuppressive treatment
    – Glucocorticoids
    – Immunomodulating drugs
    • Tumor necrosis factor α blockers (e.g., infliximab)
    • Chemotherapy
    • Jejunoileal bypass
    • Post-transplantation period (renal, cardiac)
    • Chronic renal failure/hemodialysis
    • Silicosis
    Risk factors cont’d
    • Fibrotic lesions on chest radiography (spontaneously healed)
    • Diabetes
    • Intravenous drug use
    • Gastrectomy
    • Malnutrition/severe underweight
    • Celiac disease
    • Head/neck carcinoma
    – No increased risk in patients with other types of solid tumors
    • Lymphomas/leukemias
    • Recent immigration (< 5 years) from high-prevalence area
    • Age
    – Incidence highest in late adolescence and early adulthood
    – Risk increased in elderly persons
    • Smoking
    – Risk increases with number of cigarettes smoked per day, years of smoking, and pack-years of
    smoking.
    Spread
    • Disease from a patient with infectious pulmonary TB is
    most commonly spread by droplet nuclei that are
    aerosolized by coughing, sneezing, or speaking.
    • Droplets may be suspended in air for several hours.
    • Transmission is determined by the intimacy and
    duration of contact with a patient with TB, the degree of
    infectiousness of that pt, and the shared environment.
    • Patients with cavitary disease are usually most
    infectious, with as many as 100,000 acid-fast bacilli
    (AFB) per milliliter of sputum.
    PATHOGENESIS
    • AFB that reach alveoli are ingested by activated macrophages.

    • If the bacilli are not contained, they multiply, lyse the macrophages,
    and spread to non activated monocytes.
    • Macrophages may transport bacilli to regional lymph nodes, from
    which dissemination throughout the body may occur.

    • About 2–4 weeks after infection, delayed-type hypersensitivity


    (DTH) destroys non activated macrophages that contain multiplying
    bacilli, and a macrophage activating response activates cells capable
    of killing AFB.
    • DTH is the basis for the PPD skin test.
    Pathogenesis cont’d
    • A granuloma forms at the site of the primary lesion and
    at sites of dissemination.
    • The lesions can then either heal by fibrosis or undergo
    further evolution.
    • Despite “healing,” viable bacilli can remain dormant
    within macrophages or in the necrotic material for
    years.
    • Cytokines secreted by alveolar macrophages contribute
    to disease manifestations, granuloma formation, and
    mycobacterial killing.
    Samples required for Diagnosis of TB
    Diagnosis of TB
    Tuberculin skin test (Mantoux)
    Diagnosis of TB
    Molecular tests
    Are used on culture to detect the presence of M.
    Tuberculosis DNA or the DNA from other mycobacterial
    species
    They have three stages:
    Extraction
    Amplification(Polymerase chain reaction)
    Detection(Electrophoresis, line probe assays or real time
    detection)
    Detect presence, resistance and the species
    Diagnosis summary

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