Tuberculosis
Ri
91-7-29
Tuberculosis
An ancient infection
Tubercle bacillus discovered in 1882
WHO: 8,000,000 active cases in 1990
Developing countries (95%)
Developed countries: HIV infection
Tuberculosis
Pathogenesis
Chronic necrotizing bacterial infection
Tubercle bacilli:
Mycobacterium tuberculosis (MTB)
Optimal growth: PO2140mmHg
Hematogenous dissemination and
lymphatic spread
Modified form of tuberculosis (AIDS)
Tuberculosis
Clinical
stages
Stage
1: Onset
(macrophage inhalation)
Stage 2: Symbiosis
Stage 3: Early caseous necrosis
Stage 4a & 4b: Interplay of cell-mediated
immunity and tissue-damaging delayed-type
hypersensitivity
Stage 5: Liquefaction and cavity formation
Extrapulmonary Tuberculosis
Proportion in all TB in USA :
7% (1963) to 18% (1987) to 20% (now)
Increase maybe due to HIV infection
More in minorities and foreign-borns
Lymphatic TB (30%) > Pleural TB (24%) > Bone
and joint TB (10%) > Genitourinary TB (9%) >
Miliary TB (8%) > Meningeal TB (6%)
(New York, 1995)
Hematogenous dissemination
Miliary Tuberculosis
Lympho-hematogenous dissemination
Infants and children: primary
Elders or HIV infection: reactivation
Fever, weakness, anorexia, Wt loss, cough
Dx: CXR, HRCT
Tx: Chemotherapy for 9-12 months (HIV at
least 12 months) or steroids (controversial,
prevent reactivation and infection)
Other EPTB
Otologic Tuberculosis
Ocular Tuberculosis
Cardiovascular Tuberculosis
Tuberculous Peritonitis
Tuberculous Enteritis
Tuberculosis of the liver and biliary tract