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PULMONARY TUBERCULOSIS
Submitted by- Sabyasachi Jena
Guided by- Dr. Sayantan Chowdhury

DEFINITION
• It is a contagious bacterial(mycobacterium
tuberculosis) infection that involves the lungs.
It may spread to other organs.

TYPES
1. Primary PTB
2. Cavitary PTB(post primary)
3. Miliary PTB(post primary)

1.PRIMARY PTB
• Primary PTB occurs in an individual who has
never been exposed to the tuberculosis
bacteria before. This type of tuberculosis is
very uncommon and usually occurs in the very
young, the very old or those with immune
compromised symptoms, such as AIDS.

Etio-pathogenesis
• From the primary site of infection, bacilli
are carried to the lymph nodes via lymphatics,
and the hilar nodes enlarge. This parenchymal
lesion(Ghon’s lesion) with its enlarged
rigional(hilar) lymph nodes and inter
connecting lymphangitis is known as primary
complex of Ranke(Ghon’s complex).

• The parenchymal lesion is subpleural and
usually located in lower part of the upper
lobe, upper part of lower lobe or the middle
lobe.

• Bacilli in alveoli also invade and replicate
within alveolar macrophases that interact with
T-lymphocytes, resulting in differentiation of
macrophases into epithelioid histiocytes.
Epthelioid histiscytes and lymhocytes
aggregate into small clusters resulting in
granulomas.

• In the granuloma, CD4+ T-lymphocytes
secrete cytokines, such as interferon, which
activate macrophages to destroy the bacteria
with which they are infected.

SYMPTOMS
Majority are asymptomatic
A brief ‘flu-like’ febrile illness, which lasts 7-14
days
Reduced apetite, weight loss, fretfulness
Dry cough(occasionally)

PHYSICAL SIGNS
Majority, no abnormal signs
General debility, thin, pale and fretful child
Glossy hair and less elastic skin
May be few crepitations over a large lung
component
Erythema nodosum

Bluish red, raised tender, cutaneous lesions on
the shins and less on thigh.
Fever and polyarthralgia

DIAGNOSIS
a) History of contact with a case of active
tuberculosis.
b) Tuberculin test
c) Chest radiograph
d) Sputum examination

2.CAVITARY PTB
• It occurs in final stage of the disease. When
macrophases fail to sorround and digest
bacteria, a cheesy form of necrosis occurs in
the center , known as caseation. The caseous
tissue may later become calcified. But if the
lesion progresses, the caseous tissues become
liquefied to form purulent material. This
material may be discharged into bronchi
resulting in cavitation.

• Samples taken from an infected person may
test –ve because the bacteria are hidden in
the cavities.

MILIARY TB
• Miliary TB is when the PTB becomes chronic
and spreads though either the blood stream
or the lymph system to infect other organs of
the body.

Pathogenesis
Direct progression of a primary lesion
Re-activation of a dormant primary lesion
o Malnutrition
o Diabetes
o Taking steroids(immuno suppresive)
o HIV infection
o Malignancies

o Renal failure
o Haemophilia
o Silicosis
Haematogenous spread to the lungs
Common sites are apical and posterior
segment of upper lobe or apical of lower lobe.

CLINICAL FEATURES
GENERAL SYMPTOMS
 Loss of apetite and weight
 Fever
 Night sweats
 Tiredness
 Mental symptoms
 Amenorrhoea

 Cough
 Hemoptysis
 Chest pain
 Breathlessness
 Pneumonia

PHYSICAL SIGNS
 Pallor and cachexia
 Fever
 Tachycardia and tachypnoea
 Finger clubbing(may be)

COMPLICATIONS OF PTB
 Hemoptysis
 Pneumothrax
 Pleural effusion
 Empyema
 Pulmonary fibrosis
 Bronchiectasis
 Persistent of cavities even after treatment

 Scar carcinoma
 Spread of tuberculus to other organs
 Respiratory failure and R-heart failure
 Amyloidosis
 Anemia

ANTITUBERCULAR DRUGS
1. Isoniazid-10mg/kg
2. Rifampicin-10mg/kg(max 900mg)
3. Streptomycin-15mg/kg(max 800mg)
4. Pyrazinamide-35mg/kg
5. Ethambutol-30mg/kg

VACCINE
• BCG(Bacillus Calmette Guerin), prtective
against PTB

DOTS(directly observed treatment
short course)
FIVE ELEMENT OF DOTS
 Political commitment with increased and
sustained financing.
 Case detection through quality assured
bacteriology.
 Standardised treatment, with supervision and
patient support.

 An effective drug supply and management
system.
 Monitoring and evaluation system and impact
measurement.

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Pulmonary tuberculosis

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