TUBERCULOSIS
Tuberculosis is a chronic granulomatous inflammatory process caused by anerobic acid fast bacilli mycobacteria. Ninety five percent of tuberculosis is caused by mycobacterium tuberculosis and rest of the five percent are due to atypical mycobacteria mainly mycobacterium kansasii and mycobacterium avium intracellulare complex.
Tuberculosis can involve any organ of human body but most common site is pulmonary parenchyma. This article focuses on pulmonary tuberculosis.
MODE OF TRANSMISSION OF TUBERCULOSIS:
Tuberculosis spreads by direct contact with the affected person by inhaling droplets emitted by coughing of diseased person. Children are more prone to catch infection due to relatively poor immunity. Overcrowding, homelessness and immigration are the main predisposing factors in the spread of disease. Isolation is the best measure to prevent the spread of tuberculosis.
SITE OF INFECTION:
There are two well known types of pulmonary tuberculosis, primary and post primary.
PRIMARY TUBERCULOSIS:
Primary tuberculosis occurs in those who are not sensitized to the organism previously. It mainly occurs in childhood and most cases are subclinical. Disease occurs in lower lobes of lungs with subpleural predisposition. This is the reason why pleural effusions are common in primary tuberculosis.
FEATURES OF PRIMARY TUBERCULOSIS:
There is initial patch of consolidation at the site of infection which appears as radiopaque density on plain chest x-ray. Then there is spread through lymphatics which cause regional lymph node enlargement mainly hilar lympnadenopathy. The primary lesion is called Ghon’s focus and the combined to Ghon’s focus plus lymph node is ‘primary complex’.
PRIMARY TUBERCULOSIS WITH RIGHT HILAR LYMPHADENOPATHY
SEVERE MEDIASTINAL AND RIGHT HILAR LYMPHADENOPATHY IN PRIMARY T.B
OUT COME OF PRIMARY COMPLEX:
Ninety percent primary infections are destined to heal with remaining ten percent leading either to latency or progression to post primary tuberculosis. Calcification may or may not occur in the process of healing.
Complications are rare in primary form but can occur at times.
POST PRIMARY TUBERCULOSIS:
It is also called reactivation tuberculosis, re-infection tuberculosis or secondary tuberculosis. It is thought now that it is mainly due to reactivation of primary lesion.
SITE OF INFECTION OF REACTIVATION TUBERCULOSIS:
Mainly effects apical or posterior segments or upper lobes or apical segments of lower lobes. These anatomical sites are well aerated leading to enhanced growth of bacteria. Lesions may cavitate due to central caseous necrosis. Unless the patient is immunocompromised, lymph node enlargement is not seen in post primary tuberculosis. There may be bronchgenic spread of disease leading to widespread bronchopneumonis.
POST PRIMARY TUBERCULOSIS WITH CAVITY FORMATION
Empyema formation is more common in post primary tuberculosis.
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