5 Classifications of Pulmonary Tuberculosis

Tuberculosis is a contagious disease that primarily affects the pulmonary system and
causes a chronic cough, chest pain and sometimes the coughing up of blood. People with
an active infection can infect others by coughing, sneezing, and talking. The American
Journal of Respiratory and Critical Care Medicine reports that approximately ten percent
of infected individuals will develop active tuberculosis The classifications of tuberculosis
are based upon exposure history, infection and whether the disease is latent or active.
Class 0
Individuals are placed in this class if they have had no exposure to tuberculosis and have
a negative tuberculin test. This test determines if a person has already been infected
with tuberculosis mycobacteria by measuring how sensitive a persons immune system is
to proteins, called tuberculins, from the tuberculosis mycobacteria cultures. In a
tuberculin skin test, the tuberculins are injected under the skin. After 48 to 72 hours the
size of induration, or hardening of the skin, is evaluated.
Class 1
Individuals placed in class 1 have been exposed to tuberculosis, but did not have a
positive tuberculin skin test. Treatment for latent tuberculosis infection should be
initiated if the person is immune compromised and especially if they are HIV positive. A
joint statement prepared by the American Thoracic Society and the Centers for Disease
Control and Prevention recommends that persons with latent tuberculosis infection be
treated daily with isoniazid for nine months. Other recommended alternative treatments
include a two month daily regimen of rifampin and pyrazinamide or rifampin alone for
four months.
Class 2
Individuals placed in class 2 have a positive tuberculin skin test, but no evidence of
active tuberculosis. Some persons in class 2 may be treated for latent tuberculosis
infection.
Class 3
Individuals placed in class 3 have active tuberculosis and exhibit symptoms of the
disease. Patients with active tuberculosis may have abnormalities in the upper lung lobes
that can be detected by a chest radiograph. Patients with past active tuberculosis may
have nodules and fibrotic scars in the upper lung lobes. Individuals in class 3 will remain
in class 3 until treatment of tuberculosis is completed. The American Thoracic Society,
the Centers for Disease Control and Prevention and the Infectious Disease Society of
America recommend all adults with active tuberculosis disease begin treatment with a
two month initial phase of isoniazid, rifampin, purasinamide and ethambutol. At the end
of two months patients are then treated either four months or seven months with
isoniazid and rifampin depending on whether lesions were initially observed in the lungs
and if bacterial cultures are positive after the initial treatment period.
Class 4
Individuals who do not have active tuberculosis disease, but have had a previous episode
of tuberculosis and have a positive reaction to the tuberculin skin test are placed in class
4.
Class 5

Individuals placed in class 5 are suspected of having tuberculosis, but have a pending
diagnosis. After a tuberculin skin test, mycobacterial culture and chest x-ray the person
should be classified in one of the other preceding classes.