Pulmonary Tuberculosis

Pulmonary Tuberculosis

Pathology:                    Caseatinggranulomatous disease

Inhalation of infection and alveolar macrophageengulfs bacterium.

Granuloma formation and enlargement of draining lymphnodes (Ghon complex)


Aetiology:                    Mycobacterium tuberculosis


Symptoms:                   Cough lasting > 3 weeksunresponsive to antibiotics, creamy white sputum, haemoptysis, upper lobe cavitation, fever, nightsweats, weight loss


Signs:                              Mild Disease: May have relatively fewsigns

Severe disease: Weightloss, lymphadenopathy, splenomegaly, erythema nodosum

Chest: Dullupper zones with crackles



Investigations:          Chest X-Ray: Miliary shadowing, hilarlymphadenopathy, pleural effusion, cavitating

patchy consolidation in upper lobes, Ghon complex,signs of old TB

Mantoux (tuberculinskin test): Positive after 4-8 weeks on development of cellmediated immune response

Sputumculture: AcidFast Bacilli on Ziehl-Neelsen staining

Tissue forhistology: Caseating granulomas


Treatment:                  6months anti-tuberculous chemotherapy in uncomplicated TB  and contact tracing


Complications:         Cavitation leadingto massive haemoptysis:

Rasmussen’s aneurysm (bronchial artery runs close tocavity and is eroded)

Drug side effects


Prognosis:                   Usuallygood with treatment

Text Box: 	Anti-Tuberculosis Treatment And Side Effects

Induction phase 2 months RIPE
Rifampicin: hepatitis, orange urine, flu-like symptoms, inactivates OCP
Isoniazid: hepatitis, neuropathy, agranulocytosis (Daily pyridoxine protective)
Pyrazinamide: hepatitis, arthralgia
Ethambutol: optic neuritis
Continuation phase 4 months





























Figure 2.2 Left upperlobe cavitating consolidation on miliary TB background

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