Mycobacterium Tuberculosis
1. exposed by inhalation ; 2.In
most people the immune
system clears the bacteria; 3.
Recent resurgence due to HIV
Characteristics
1. Tubercle --> The typical
response takes 3 weeks (time for
Type 4 Hypersensitivity reaction.
Central caseation surrounded by
epetheliod cells. Langerhans cells.
Macrophages. Lymphocytes.
Surrounded by fibrosis.
2. Epetheliod cells -->activated
macrophages. response to
tubercle baccilli mycolic acid. No
phagocytic fxn but secretory
3.Caseation Necrosis --> chalky
cheesy. Tissue destroyed with
no outline seen. Due to Type 4
hypersensitivity
Clinical Features
Fever; cough with bloody
sputum;chest pain;
weight loss
Primary Tuberculosis
AKA Ghon's lesion --> Ghon's
complex consists of 1. Ghons focus.
2. Lymphatics 3. Hilar lymph node
Also PROGRESSIVE PRIMARY
TUBERCULOSIS--> rare, involvement
of surrounding lung, invades blood
vessels and spread -->Miliary TB
Secondary Tuberculosis
Due to 1.reinfection 2.
reactivation. Most lesions
located at apex. CAVITY
FORMATION due to rapid
caseation. Also PROGRESSIVE
SECONDARY TB --> no healing;
direct spread to lungs, pleura,
lymph nodes ; bronchiestasis
and pleural effusion ; blood
spread --> Miliary TB
Miliary Tuberculosis
Millet sized granulomas
all over the lungs, liver,
spleen, brain and gut.
Occurs in primary or
secondary TB.
Mycobacterium enters
the blood and there is
hematogenous spread.
Laboratory Tests
Tuberculin (PPD) Test -->inject
the tubecle protein into skin.
Criteria to treat--> >5mm in
HIV+,those with recent contact,
chest Xray with old TB scar;
>10mm in IV drug users,
homeless, those born in
countries with high incidence,
healthcare workers; >15mm
everyone else
Lab diagnosis of TB
-> mimics lung
cancer. Do a sputum
sample and
demonstrate
tubercle bacilli by
acid fast stain, pcr,
culture; fine needle
aspiration from
lymph node,; lymph
node biopsy;
bronchoscpoic
biopsy; pleural tap
Tuberculosis in Immunocompromised patients
EG. In pts with HIV,
steroid therapy,
lymphoma. -->poor cell
reaction so no
granulomas; extensive
necrosis not caseation; no
cavitation or fibrosis;
abundant acid fast bacilli;
other organisms such as
mycobacterium avium
intracellulare