NUR SAKINAH BINTI ZULKIFLI 082012100043

CONTENT
Introduction Etiology Pathogenesis Modes of transmission Spread of tuberculosis Types of tuberculosis Clinical feature Diagnosis Prognosis

INTRODUCTION
Communicable granulomatous disease cause by Mycobacterium tuberculosis Usually involve the lung (pulmonary) but may affect other organ and tissue of the body (extrapulmonary)

Flourished under the condition of poverty, crowding and chronic debilitating disease.
Remain leading cause of death.

1.7 billion infected, 8-10 million new cases and 3 million death annually.
HIV ,diabetes mellitus, hodgkin lymphoma, chronic lung disease, chronic renal failure,malnutrition,alcoholism, and immunosupression.

ETIOLOGY
M. tuberculosis hominis (human strain) -responsible for most cases. M. tuberculosis bovis (bovine strain) -consumption of unpasteurized milk, tuberculous dairy cow -oropharyngeal and intestinal tuberculosis M. smegmatis - found in smegma - contaminent in urine M. africanum, M. pinnipedii, M. canettii.

PATHOGENESIS
Previously unexposed immunocompetent -development of targeted cell mediated immunity -result in development of tissue hypersensitivity to tubercular antigen. Destructive tissue hypersensitivity resulting caseating granulomas and cavitation.

Also signal the acquisition of immunity to the organism.

MODES OF TRANSMISSION
Inhalation Ingestion
fresh cough droplet, dried sputum

self swallowing of infected sputum Bovine tubercle bacilli from milk of diseased cow Tonsillar or intestinal tuberculosis

Inoculation
into skin

Transplacental route

infected mother Congenital tuberculosis rare

SPREAD OF TUBERCULOSIS
LOCAL Macrophages carrying the bacili. LYMPHATIC Lymphoid follicle of pharynx, bronchi, intestine or regional lymph nodes. Tuberculous lymphadenitis. HAEMATOGENOUS
Tuberculous

Drainage of lymphatics into venous system Caseous material escape through the ulcerated wall of a vein. Produce millet sized lesion ( kidney, lungs, liver, bones and other) Miliary tuberculosis

bracillaemia

 NATURAL PASSAGE lung lesion into pleura (tuberculous pleurisy) Transbronchial spread into adjacent lung segment Tuberculous salpingitis (falopian tube) into peritoneal cavity (tuberculous peritonitis) Infected sputum into larynx (tuberculous laryngitis) Swallowing of the infected sputum ( iliocaecal tuberculosis) Renal lesion into urethra and to trigone of bladder.

TYPES
1. Primary tuberculosis 2. Secondary tuberculosis

PRIMARY TUBERCULOSIS
No previous infection. Primary complex / Ghons complex
lesions consist of a calcified focus of infection and an associated lymph node. Commonly, lung and hilar lymph nodes Tonsil and cervical lymph nodes. Small intestine and mesenteric lymph nodes (ingested bacili)

High in immunocompromised host AIDS

 Primary complex consist of 3 component: 1. pulmonary component - contain tuberculous granulomas with caseation necrosis 2.lymphatic vessel component 3.lymph nodes component -extensive caseation , tuberculous granulomas and fibrosis - potential cause of reinfection

 FATE OF PRIMARY TUBERCULOSIS

1. Do not progress, heal by fibrosis. 2. Progressive primary tuberculosis -caseous material is disseminated through bronchi to the other lung 3. Primary miliary tuberculosis -bacili enter circulation through erosion of blood vessel and spread. 4. progressive secondary tuberculosis - lowered resistance or increased hypersensitivity . -bacili reactivated.

SECONDARY TUBERCULOSIS
Previously infected. May be acquired from 1. endogenous sources: reactivation of dormant complex 2. exogenous sources : fresh dose of reinfection of tubercle bacili. Most commonly in lungs in the region of apex. Tonsils, pharynx, larynx, small intestine and skin.

 FATE OF SECONDARY TUBERCULOSIS

1. Heal with fibrous scarring and calcification 2. Lesion coalesce together forming larger area of tuberculosis pneumonia. - progressive secondary pulmonary tuberculosis. fibrocaseous tuberculosis

Tuberculous caseous pneumonia Miliary tuberculosis.

CLINICAL FEATURE
LUNG
Productive cough Haemoptysis Pleural effusion Dyspnoea Orthopnoea Fever Night sweat Fatigue Loss of weigh and appetite.

SYSTEMIC FEATURE

DIAGNOSTIC
Positive Mantoux skin test. Positive sputum of AFB Complete haemogram Chest x-ray Fine needle aspiration cytology.

PROGNOSIS
UNTREATED CASE - more than 50% people died in five year. - TB bacteria multiply very slowly. POOR PROGNOSIS - extreme age - multi-drug resistance -smoking -alcoholism - malnutrition -debilitating disease - immunosuppressed person. FAVORABLE - Infection localized to the lung.

REFERENCE
Textbook Of Pathology; 6th edition; Harsh Mohan Robbins Basic Pathology; 9th edition; Kumar, Abbas, Aster.