Name : Muhammad Hafiz bin Mohamad Radzi

ID : 10-4-165

PULMONARY TUBERCULOSIS
Definition
Pulmonary tuberculosis is an infection (inflammation) caused by mycobacterium
tuberculosis.
Types of pulmonary TB

Primary pulmonary TB (primary exposure) is characterized by the Ghon

complex and consists of 1.) subpleural (fissure) focus of inflammation. 2.)
Infected (inflamed) lymph nodes draining the primary, subpleural lesion.
Secondary pulmonary TB (reactivation) is characterized by a focus of
infection and granuloma formation usually in the apex of the lung. The small
granulomas (tubercles) eventually coalesce to form larger areas of
consolidation with central caseating necrosis. Regional lymph nodes contain
caseating granulomas.
Progressive pulmonary TB: Primary or secondary TB may go on to heal as
caseating granulomas are replaced by fibrosis and calcification. However,
cases do not heal spontaneously or with therapy and progress to form
cavities or spread to other parts of the lung and other organs of the body
through lymphatic channels and the blood stream. This type of spread is
known as miliary tuberculosis.

Case Definition
A. Suspected case
Patient with cough and expectoration more than 3 weeks associated
with fever, loss of weight and night sweating.
B. Confirmed case
Pulmonary TB, smear positive
Positive sputum for acid fast bacilli by direct microscopic
examination of two initial specimens.
Positive sputum for acid bacilli by direct microscopic
examination of single specimen and radiologic abnormalities
consistent with active pulmonary TB as determined by the
treating medical officer.
Positive sputum for acid bacilli by direct microscopic
examination of a single smear specimen and culture postive for
acid bacilli.
Pulmonary TB, smear negative

 With symptoms suggestive of pulmonary TB ; with at least three

sputum smear specimens for acid bacilli by direct microscopic
examination; and with radiographic abnormalities consistent
with active pulmonary TB determined by treating medical officer
followed by a decision to treat the patient with a full course of
anti-tuberculous therapy.
Culture positive for acid bacilli but negative sputum smear by
direct microscopic examination.
Situation in Malaysia
The latest value for Incidence of tuberculosis (per 100,000 people) in Malaysia was 81.00 as of 2011.
Over the past 21 years, the value for this indicator has fluctuated between 127.00 in 1990 and 81.00
in 2011.
Definition: Incidence of tuberculosis is the estimated number of new pulmonary, smear positive, and
extra-pulmonary tuberculosis cases. Incidence includes patients with HIV.

Descriptive Epidemiology
a) Place
TB is a worldwide disease, more prevalent in developing country.
Uniformly distributed in urban and rural areas.
In urban areas, found more in slum dwellers and lower socioeconomic
groups.
b) Time
Secular trend :
Since mid 20th century, morbidity and mortality from TB
markedly declined due to ;
Improvement of living conditions
Advance in antimicrobial chemotherapy
Nowadays TB re-emerging as major public health problem due to
;
TB control program is :
o Neglected by governments
o Poor management
increase the emerging
drug resistent strains
increase the disease
burden
o Difficulty and high expenses of treating multi-drug
resistent cases
Rapid population growth and its sequences ( malnutrition,
housing problems, lack of health facilities )
Emerging problem of HIV/AIDS and its link with TB led to
explosion of cases in HIV/AIDS endemic areas. (HIV
destroys immune system and activates TB in individual
infected by TB )
c) Person
Age and sex
Both sexes equally susceptible in early childhood
Increase with increasing age sepecially in males
No congenital TB
Genetic factors
Exposure risk in family
Not by hereditary or genetic predisposition
Nutritional status
Malnourished more prone to TB (poor immune)
May precipitate malnutrition in patient with border-line nutrition
Infection and underlying diseases

Measles, uncontrolled diabetes, cancer, renal failure, major

surgeries, AIDS and prolonged intake of immunosuppressive
drugs.
Occupation
Silicosis (exposure to silica dust)
Certain occupation increase the risk of contracting the infection
and development of the disease.
Health care workers who are in close contact with TB patients.
Persons living under socioeconomic conditions
Physical and mental stress
Increased physical activity with heavy work leads to increase
respiration and circulation enchances the extension of TB.
Mental worry proves to be responsible predesposing factor for
activation of TB.

Reference
1. http://www.meddean.luc.edu/lumen/MedEd/medicine/pulmonar/pathms/path1
8.htm
2. http://www.indexmundi.com/facts/malaysia/incidence-of-tuberculosis
3. Staff Members of Community Medicine Department (2012-2013). Essential of
Community Medicine.4th year. Page 26-29