Infection with TB requires inhalation of droplet nuclei.

In the course of primary infection, a period of bacillaemia usually occurs and M tuberculosis may be scattered in various areas of the body. Exposure may be followed by clearance, persistent latent infection, or progression to primary disease. Successful containment of TB is dependent on the cellular immune system, mediated primarily through T-helper cells (TH1 response). T cells and macrophages form a granuloma with a centre that contains necrotic material (caseous centre) and M tuberculosis, and peripheral granulation tissue consisting primarily of macrophages and lymphocytes. The granuloma serves to prevent further growth and spread of M tuberculosis. These individuals are not infectious and have latent TB infection (LTBI); the majority of these patients will have a normal chest xray and positive tuberculin skin test (TST).

Pleural TB (particularly primary disease) may occur from a few mycobacteria gaining access to the pleural space with a resultant T cell response and delayed hypersensitivity reaction. The effusion is due to increased capillary permeability and decreased lymphatic drainage.

Skeletal TB is an osteomyelitis that starts in the growth plates of bones where the blood supply is the richest, and from there spreads into joint spaces. Vertebral disease usually starts in the subchondral cancellous bone, from where it spreads to the cortex and on to the disc. Bone destruction is more extensive on the ventral aspect leading to anterior wedging. Paraspinous collections may also develop. [20]

TB meningitis results from haematogenous spread of M tuberculosis with the development of submeningeal or intrameningeal foci called Rich foci. With rupture of a Rich focus into the subarachnoid space, meningitis develops. This may result from reactivation (more common in adults) or primary infection (more common in children). BCG vaccination is about 64% effective against TB meningitis in young children. [21]

In peritoneal TB, the peritoneum becomes studded with tubercles. As protein-rich fluid is exuded, ascites accumulate. More than 90% of patients with peritoneal TB will have ascites; the remainder generally have more advanced disease and present with fibroadhesions. TB enteritis may occur secondary to ingestion of infected sputum that causes caseation necrosis in the intestine. If this source spreads to the mesenteric lymph nodes, they may rupture into the peritoneum. GI TB occurs most frequently in the ileocecal region. Its appearance may be ulcerative or hypertrophic. [19]

Pericardial TB results from contiguous spread from adjacent mediastinal lymph nodes, or progression of a primary or latent focus within the pericardium. Some patients present with signs of cardiac constriction without an acute phase of pericarditis being noticed.

Disseminated TB refers to simultaneous involvement of multiple organ sites that may occur with primary infection (particularly in immunocompromised individuals) or with reactivation. Disseminated TB is sometimes called miliary

TB; its lesions are yellowish granulomas 1 to 2 mm in diameter that resemble millet seeds on chest x-ray. It is due to haematogenous spread of M tuberculosis.

Many forms of extrapulmonary TB (EPTB) are paucibacillary, and the diagnosis of EPTB is therefore challenging. Acid-fast bacilli (AFB) smear of biological specimens is often negative. Tuberculin skin testing (TST) and interferon-gamma release assays (IGRA) are adjunctive diagnostic tools, at best. Constitutional symptoms associated with EPTB, (such as fever, weakness, and weight loss) may be infrequent and non-specific. In addition, EPTB is less common than pulmonary tuberculosis (PTB) and may be less familiar to clinicians. A high level of suspicion is important in evaluating a patient with presence of risk factors (for full details please refer to risk factor section). The firm diagnosis of TB requires culturing ofMycobacterium tuberculosis and is important for drug-susceptibility testing. Appropriate specimens are obtained and tested microbiologically and histologically. Although culture remains the diagnostic standard, it can take up to 8 to 10 weeks using a solid media, and in 10% to 15% of patients the diagnosis of TB is based on clinical grounds. Delays in diagnosis and initiation of therapy are associated with increased mortality.

Extrapulmonary Tuberculosis is a condition in which the infection of the patient's lungs spreads to other parts of her body. The lymph nodes are affected and the bacteria spreads to bones, soft tissue and organs. This disease process can lie dormant for years. The organs and tissue affected include the bones and joints, bronchus, cervical lymph nodes, eye, larynx (voice box), lining of the abdominal cavity, lining of the brain and spinal cord, lining of the heart, reproductive systems of a male or female, skin, small bowel and stomach. Symptoms may include a cough, fatigue, fever, generalized discomfort, shortness of breath, sweating, weight loss, abdominal swelling, chills, joint pain, pale skin and swollen glands. There are several antibiotics that may be used to treat it. Amikacin Sulfate Amikin (prescribed as the generic amikacin sulfate) is an antibiotic used to treat infections such as extrapulmonary tuberculosis. It will not work for colds, flu or viral infections. This medication is infused into a vein or injected into a muscle by a health care professional in a hospital or clinic setting.
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Wearwww.FarInfraredHealth.com Ethambutol Myambutol and Servambutol (prescribed as the generic ethambutol) may be used to treat tuberculosis. This medication is taken with a glass of water in the form of a pill with or without food. The medication may be taken at home, but should not be taken alone. Someone else should always be present. Side effects include color blindness or blindness. These side effects may be permanent.

Ethionamide Trecator (prescribed as the generic ethionamide) is another antibiotic used to treat Tuberculosis. This medicine is used with other medicines and should not be used alone. It can cause clumsiness, depression, numbness and concentration difficulties, among other side effects. Isoniazid Niazid (prescribed as the generic isoniazid) can be used to treat or prevent TB. This medication is taken orally with a glass of water and should be taken on an empty stomach at least 30 minutes prior to eating or two hours after. Side effects include possibly fatal liver conditions. It also can cause heartburn, numbness, dizziness and nausea. Moxifloxacin Avelox (prescribed as the generic moxifloxacin) is an antibiotic used to treat certain types of bacterial infections. This medication is taken orally with a glass of water. Side effects include insomnia, vomiting, nausea and headaches.

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tuberculosis/#ixzz2HppnMSod Article reviewed by Carolyn Williams Last updated on: Sep 23, 2009

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5 Pulmonary Tuberculosis Nursing Care Plan (NCP) Risk for Infection Pulmonary Tuberculosis Nursing Care Plan (NCP) Ineffective Airway Clearance Pulmonary Tuberculosis Nursing Care Plan (NCP) Impaired Gas Exchange Pulmonary Tuberculosis Nursing Care Plan (NCP) Imbalanced Nutrition Pulmonary Tuberculosis Nursing Care Plan (NCP) Knowledge Deficit Pulmonary Tuberculosis Nursing Care Plan (NCP) Nursing Priorities Achieve/maintain adequate ventilation/oxygenation. Prevent spread of infection. Support behaviors/tasks to maintain health. Promote effective coping strategies. Provide information about disease process/prognosis and treatment needs. Discharge Goals Respiratory function adequate to meet individual need. Complications prevented. Lifestyle/behavior changes adopted to prevent spread of infection. Disease process/prognosis and therapeutic regimen understood. Plan in place to meet needs after discharge. Diagnostic Studies Sputum culture: Positive for Mycobacterium tuberculosis in the active stage of the disease. Ziehl-Neelsen (acid-fast stain applied to a smear of body fluid): Positive for acid-fast bacilli (AFB). Skin tests (purified protein derivative [PPD] or Old tuberculin [OT] administered by intradermal injection [Mantoux]): A positive reaction (area of induration 10 mm or greater, occurring 4872 hr after interdermal injection of the antigen) indicates past infection and the presence of antibodies but is not necessarily indicative of active disease. Factors associated with a decreased response to tuberculin include underlying viral or bacterial infection, malnutrition, lymphadenopathy, overwhelming TB infection, insufficient antigen injection, and conscious or unconscious bias. A significant reaction in a patient who is clinically ill means that active TB cannot be dismissed as a diagnostic possibility. A significant reaction in healthy persons usually signifies dormant TB or an infection caused by a different mycobacterium. Enzyme-linked immunosorbent assay (ELISA)/Western blot: May reveal presence of HIV. Chest x-ray: May show small, patchy infiltrations of

early lesions in the upper-lung field, calcium deposits of healed primary lesions, or fluid of an effusion. Changes indicating more advanced TB may include cavitation, scar tissue/fibrotic areas. CT or MRI scan: Determines degree of lung damage and may confirm a difficult diagnosis. Bronchoscopy: Shows inflammation and altered lung tissue. May also be performed to obtain sputum if patient is unable to produce an adequate specimen. Histologic or tissue cultures (including gastric washings; urine and cerebrospinal fluid [CSF]; skin biopsy): Positive for Mycobacterium tuberculosis and may indicate extrapulmonary involvement. Needle biopsy of lung tissue: Positive for granulomas of TB; presence of giant cells indicating necrosis. Electrolytes: May be abnormal depending on the location and severity of infection; e.g., hyponatremia caused by abnormal water retention may be found in extensive chronic pulmonary TB. ABGs: May be abnormal depending on location, severity, and residual damage to the lungs. Pulmonary function studies: Decreased vital capacity, increased dead space, increased ratio of residual air to total lung capacity, and decreased oxygen saturation are secondary to parenchymal infiltration/fibrosis, loss of lung tissue, and pleural disease (extensive chronic pulmonary TB). Read more at Nurseslabs.com Nursing Care Plan 5 Pulmonary Tuberculosis Nursing Care Plan (NCP) http://nurseslabs.com/5-pulmonary-tuberculosis-nursing-care-plans/