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Pulmonary Tuberculosis

Mycobacterium tuberculosis is the causative agent of pulmonary tuberculosis, a highly contagious infectious disease that is characterized by a granulomatous inflammation of the lungs. The disease may spread to other organs and requires a long-term antibiotic treatment.


Presentation

Even in cases of active pulmonary TB, symptoms are rather unspecific. The most common symptom is cough. Furthermore, patients suffer from general discomfort, fatigue, anorexia and weight loss [11]. Fever may be observed, but is not always present.

Cough is initially only productive after waking up in the morning but becomes more productive as the disease progresses. The sputum is usually of yellowish or greenish color. If the disease does progress to cavitary pulmonary TB, an extensive necrosis with cavitation, the inflammation may damage vessels and hemoptysis may occur [12].

Extensive lung damage, pneumothorax or pleural effusion may lead to dyspnea.

HIV patients may not show typical pulmonary TB symptoms due to their impaired immune system. Pulmonary TB tends to spread in these patients and extrapulmonary symptoms may then be present.

Splenomegaly
  • USG abdomen showed a liver of normal size and echo pattern with intrahepatic biliary radicle dilatation (IHBRD) in the left lobe, splenomegaly (18 cm), normal common bile duct and gallbladder with minimal free fluid. There were no focal lesions.[termedia.pl]
  • Physical findings are also variable and in descending order of frequency are: fever, wasting, hepatomegaly, pulmonary findings, lymphadenopathy, splenomegaly.[southsudanmedicaljournal.com]
Fever
  • Abstract Post-operative fever is common following emergency surgery. Investigation and management of post-operative fever can be challenging when a clear source of sepsis is not evident or the underlying source of infection is not recognised.[ncbi.nlm.nih.gov]
  • Abstract A 33-year-old woman presented with a 1-month history of dry cough, fever, reduced appetite and weight loss. She had taken antitubercular therapy about a year prior with partial improvement in symptoms.[ncbi.nlm.nih.gov]
  • Abstract A 53-year-old man with a significant smoking history presented with chronic cough, exertional breathlessness, intermittent fever, weight loss and anorexia.[ncbi.nlm.nih.gov]
  • A 42-year-old female with goitre since childhood was evaluated for dry cough, occasional wheezing and low grade fever. Imaging showed patchy airspace opacities with cavitation in left lung.[ncbi.nlm.nih.gov]
  • However, the patient suffered from low-grade fever, progressive dyspnea, and cough after 7 weeks of the therapy. The findings of chest plain films were relapse and progression of left lung haziness.[ncbi.nlm.nih.gov]
Weight Loss
  • The first case was a 13-year-old patient who was admitted with a 2-month history of fever, weight loss, night sweats, and cough.[ncbi.nlm.nih.gov]
  • The patient presented with cough, vomiting, weight loss and respiratory distress. Journal of the Association of Physicians of India 2011.[ncbi.nlm.nih.gov]
  • His symptoms and clinical signs were thoracic pain, weight loss, latero-cervical, mediastinal, and abdominal lymphadenopathy. Smear microscopy and PCR were negative for Mycobacterium tuberculosis.[ncbi.nlm.nih.gov]
  • Several factors were associated with an increased risk of tuberculosis, such as male gender, having a smoking history, liver cirrhosis, or subjective body weight loss.[diabetesincontrol.com]
  • Abstract A 33-year-old woman presented with a 1-month history of dry cough, fever, reduced appetite and weight loss. She had taken antitubercular therapy about a year prior with partial improvement in symptoms.[ncbi.nlm.nih.gov]
Fatigue
  • Case presentation: A 40-year-old female patient (nonsmoker, diabetic, with previous exposure to chemicals) was admitted to the hospital for weight loss, dry cough, loss of appetite, pallor, and fatigue.[ncbi.nlm.nih.gov]
  • . • Fatigue. • Fever. • Weight loss. • Wheezing. Click to receive news links via WhatsApp . Or for the latest news, visit our webpage or follow us on Facebook and Twitter[estcourtnews.co.za]
  • In addition, the symptoms can be vague, including only mild fatigue and cough.[mdedge.com]
  • Fatigue: Person experiences fatigue and loss of stamina. Pain in chest while coughing or breathing The latent phase of Tuberculosis: People having latent Tuberculosis DO NOT SUFFER FROM ANY SYMPTOMS.[askdrshah.com]
Malaise
  • Symptoms vary by site but generally include fever, malaise, and weight loss. Diagnosis is most often by sputum smear and culture and, increasingly, by rapid molecular-based diagnostic tests.[msdmanuals.com]
  • At this time, mild fever and malaise develop, and occasionally other hypersensitivity manifestations are noted.[link.springer.com]
  • In symptomatic patients, constitutional symptoms are prominent with fever, malaise and weight loss. A productive cough which is often blood-stained may also be present 1.[radiopaedia.org]
  • In symptomatic patients, constitutional symptoms are prominent with fever, malaise and weight loss. A productive cough which is often blood-stained may also be present 1 .[radiopaedia.org]
  • The fevers may be associated with sweating, and that sweating often is most prominent at nighttime, I'm not sure why, but that's so called night sweats, and this combination, of course, makes somebody just feel generally unwell, they have so-called malaise[khanacademy.org]
Anemia
  • Direct Coombs' test was positive with mild anemia and the cold agglutinin titer was high. Sputum showed numerous acid fast bacilli per high power field.[ncbi.nlm.nih.gov]
  • Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia.[ncbi.nlm.nih.gov]
  • Severe immune hemolytic anemia in dissemirated tuberculosis with response to antituberculosis therapy. Chest 2001; 119:1961-3. Blance P, Rigolet A, Massault PP, et al. Autoimmune hemolytic anemia revealing miliory tuberculosis.[siicsalud.com]
  • Even though this patient was anemic it was unlikely to be due to mycoplasma induced hemolytic anemia as she had normal bilirubin levels, with normal retic count & negative Coombs test.[bmcresnotes.biomedcentral.com]
  • Hematologic studies might show anemia and leukocytosis. Extrapulmonary disease can affect any organ in the body including bones, joints, and the genitourinary system, so maintain a high index of suspicion.[journals.lww.com]
Cough
  • The first case was a 13-year-old patient who was admitted with a 2-month history of fever, weight loss, night sweats, and cough.[ncbi.nlm.nih.gov]
  • The patient presented with cough, vomiting, weight loss and respiratory distress. Journal of the Association of Physicians of India 2011.[ncbi.nlm.nih.gov]
  • Affected people may suffer from overall discomfort, loss of appetite, loss of body weight and cough. Fever may be present, but not necessarily. Some more severe cases are associated with difficulties to breathe, coughing up blood and chest pain.[symptoma.com]
  • When symptoms of pulmonary TB occur, they can include: • Breathing difficulty. • Chest pain. • Cough (usually with mucus). • Coughing up blood. • Excessive sweating, especially at night. • Fatigue. • Fever. • Weight loss. • Wheezing.[estcourtnews.co.za]
  • Symptoms of active, pulmonary TB include: A cough that lasts for more than three weeks A cough that produces green or yellow sputum (phlegm) that may also be streaked with blood Shortness of breath or chest pain Fatigue Loss of appetite and weight loss[copd.about.com]
Pleural Effusion
  • Abstract A Somali patient with previous tuberculosis presented clinically unwell with features consistent with a right-sided pleural effusion.[ncbi.nlm.nih.gov]
  • Enlarged heart and hilar shadows, bilateral massive cavitary pulmonary opacities and pleural effusion were found at chest radiography. Sputum smears were Mycobacteria negative on direct microscopy.[ncbi.nlm.nih.gov]
  • In some cases the infection may break into the pleural space between the lung and the chest wall, causing a pleural effusion, or collection of fluid outside the lung. Particularly among infants, the elderly, and immunocompromised… Read More[britannica.com]
  • He was admitted for progression of left pleural effusion and consolidation in the left upper lobe.[ncbi.nlm.nih.gov]
  • A large pleural effusion, when you see that, you should think of tuberculosis as sort of one cause. Pleural effusions result in an extension of the pulmonary symptoms.[khanacademy.org]
Hemoptysis
  • Abstract Massive hemoptysis is a life-threatening complication of pulmonary tuberculosis. In the presence of pulmonary tuberculosis, massive hemoptysis can result from a number of different causes, with an artery aneurysm being rarely reported.[ncbi.nlm.nih.gov]
  • The patient presented with a one-week history of nonmassive hemoptysis about 1 month after completion of treatment for smear-negative pulmonary tuberculosis (sputum polymerase chain reaction positive for Mycobacterium tuberculosis).[ncbi.nlm.nih.gov]
  • The patient’s medical history also revealed a two-day episode of subfebrile temperature with scanty hemoptysis three weeks prior to admission. The episode had not provoked him to seek medical care.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The presence of intractable hemoptysis among patients with tuberculosis even after completion of anti-tuberculosis course should raise an index of suspicion for pulmonary artery aneurysm.[ncbi.nlm.nih.gov]
  • Erosion into vasculature can lead to hemorrhage and is manifested as frank hemoptysis.[pathwaymedicine.org]
Persistent Cough
  • When your immune system isn't strong enough to do so, latent TB becomes active TB, the most common symptom of which is a persistent cough that may produce blood-tinged phlegm.[copd.about.com]
  • Symptoms and Diagnosis Breathing becomes laboured, a persistent cough accompanied by bloody sputum and night fevers develop.[hsl.mcmaster.libguides.com]
  • TB that affects the lungs (pulmonary TB) Most TB infections affect the lungs, which can cause: a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody breathlessness that gradually gets worse TB outside the[nhs.uk]
Productive Cough
  • CASE PRESENTATION: A 37 year old Sri Lankan Sinhalese female presented with fever of one month's duration with productive cough and two weeks painless left lower limb swelling.[ncbi.nlm.nih.gov]
  • A productive cough which is often blood-stained may also be present 1. Occasionally patients may present with massive hemoptysis due to an erosion of a bronchial artery 1,3.[radiopaedia.org]
  • A productive cough which is often blood-stained may also be present 1 . Occasionally patients may present with massive hemoptysis due to an erosion of a bronchial artery 1,3 .[radiopaedia.org]
  • She complaints of productive cough of three week’s duration with no history of haemoptysis or breathlessness. Fever was associated with anorexia and weight loss.[bmcresnotes.biomedcentral.com]
Chest Pain
  • Acute virus myocarditis presents with a wide range of symptoms, from mild dyspnea or chest pain to cardiogenic shock and death. Case Outline: A 26-year-old Caucasian man non-smoker presented with one-week history of lower extremities’ swelling.[ncbi.nlm.nih.gov]
  • When to See a Doctor If you have been exposed to someone with TB, have chest pain or a persistent cough with or without phlegm, call your doctor, who will give you a skin test. TB is a serious illness and can be fatal if not treated.[copd.about.com]
  • . • Chest pain. • Cough (usually with mucus). • Coughing up blood. • Excessive sweating, especially at night. • Fatigue. • Fever. • Weight loss. • Wheezing. Click to receive news links via WhatsApp .[estcourtnews.co.za]
  • Among adult tuberculosis patients, the percentages of symptoms reported for cough more than 2 weeks, chest pain, anorexia, and body weight loss were 48.2%, 41.0%, 40.6%, and 44.5%, respectively.[diabetesincontrol.com]
  • When symptoms of pulmonary TB occur, they can include: Breathing difficulty Chest pain Cough (usually with mucus) Coughing up blood Excessive sweating, particularly at night Fatigue Fever Weight loss Wheezing The health care provider will perform a physical[nlm.nih.gov]
Night Sweats
  • The first case was a 13-year-old patient who was admitted with a 2-month history of fever, weight loss, night sweats, and cough.[ncbi.nlm.nih.gov]
  • Reactivation of Pulmonary Tuberculosis often begins insidiously with non-specific constitutional symptoms such as fever, anorexia, weight loss, and characteristically night sweats.[pathwaymedicine.org]
  • The symptoms of active disease include cough, blood in sputum, night sweating, fatigue and severe weight loss. No specific guidelines for nutrition recommendations for these patients exist.[livestrong.com]
  • sweats Fever Rare Symptoms Occasionally, active TB will spread beyond the lungs into the lymph nodes, kidneys, bones, brain, abdominal cavity, membrane around the heart (pericardium), joints (especially weight-bearing joints, such as the hips and knees[copd.about.com]

Workup

Patients usually present with unspecific general or respiratory symptoms that prompt radiographic imaging of the chest.

If lung alterations are detected, the suspected diagnosis may be further corroborated by a medical history of possible exposure to M. tuberculosis, by presence of chronic cough, weight loss and lymphadenopathy.

Sputum should be examined and cultured [2]. While  a positive tuberculin skin test or an interferon-γ release assay may be conducted after possible exposure and initiate TB diagnosis, these tests may also be carried out in order to confirm a hypothetically existent diagnosis [7]. Unclear cases may benefit from molecular biological diagnostic techniques such as PCR [13].

After TB diagnosis, the patient should be tested for immunosuppressive conditions such as HIV. Also, hepatic and renal functions should be checked.

Pulmonary Infiltrate
  • This case report highlights the risk of misdiagnosis in patients with generalized lympho-adenopathy and pulmonary infiltrates, particularly in Africans young patients. Copyright 2018. Published by Elsevier Ltd.[ncbi.nlm.nih.gov]
  • TB is characterized by pulmonary infiltrates, formation of granulomas with caseation, fibrosis, and cavitation. People living in crowded and poorly ventilated conditions and who are immunocompromised are most likely to become infected.[nurseslabs.com]
  • Considering presence of pulmonary infiltrate that accompanied the cavity lesions, we found that 105 patients (68.6%) of our sample had the presence of pulmonary infiltrate.[scielo.br]
  • infiltrates, pleural effusion, and/or lymphadenopathy should undergo TB screening.[journals.lww.com]
X-Ray Abnormal
  • Radiographic features Chest X-ray abnormalities are nearly always found. However in the presence of HIV infection, a normal X-ray is more common.[southsudanmedicaljournal.com]
Chest X-Ray Abnormal
  • Radiographic features Chest X-ray abnormalities are nearly always found. However in the presence of HIV infection, a normal X-ray is more common.[southsudanmedicaljournal.com]
Cavitary Lesion
  • LESIONS: With control of the infection and elimination of tubercle bacilli cavitary lesions undergo a healing process which results in their linings undergoing transformation to scar tissue.[granuloma.homestead.com]
Hyponatremia
  • Blood tests showed iron deficiency anemia, prolonged bleeding time, and mild hyponatremia.[ncbi.nlm.nih.gov]
  • Hyponatremia, which may occur in 11% of patients [8], is caused by the production of an antidiuretic hormone-like substance in affected lung tissue [9].[southsudanmedicaljournal.com]
Thrombocytosis
  • Hypercoagulability in tuberculosis is attributed to decreased antithrombin lll and protein C, elevated plasma fibrinogen level, increased platelet aggregation and reactive thrombocytosis [ 7, 8 ].[bmcresnotes.biomedcentral.com]
Acid-Fast Bacilli in the Sputum
  • BAL was performed in 228 of the 347 patients with chest X-ray suggestive of PT and negative acid-fast bacilli (AFB) in sputum (or missing specimen) for determination of M. tuberculosis -specific ELISpot (T-SPOT.TB test) and amplification of M. tuberculosis[archbronconeumol.org]
  • There is a relationship between the presence of acid fast bacilli in sputum and pulmonary cavity lesions. Keywords: Tuberculosis; Pulmonary tuberculosis; Bacilloscopy; Radiology; Mycobacterium tuberculosis.[scielo.br]
Granulomatous Tissue
  • Histological examination of the lesions showed granulomatous tissue with caseaous necrosis consistent with tuberculosis. A chest x-ray and computed to- mography of the chest showed miliary tuberculosis of both lungs.[ncbi.nlm.nih.gov]
Pleural Effusion
  • Abstract A Somali patient with previous tuberculosis presented clinically unwell with features consistent with a right-sided pleural effusion.[ncbi.nlm.nih.gov]
  • Enlarged heart and hilar shadows, bilateral massive cavitary pulmonary opacities and pleural effusion were found at chest radiography. Sputum smears were Mycobacteria negative on direct microscopy.[ncbi.nlm.nih.gov]
  • In some cases the infection may break into the pleural space between the lung and the chest wall, causing a pleural effusion, or collection of fluid outside the lung. Particularly among infants, the elderly, and immunocompromised… Read More[britannica.com]
  • He was admitted for progression of left pleural effusion and consolidation in the left upper lobe.[ncbi.nlm.nih.gov]
  • A large pleural effusion, when you see that, you should think of tuberculosis as sort of one cause. Pleural effusions result in an extension of the pulmonary symptoms.[khanacademy.org]

Treatment

Common M. tuberculosis strains are sensitive towards several antibiotics. However, long-term treatments are necessary to eliminate these slowly metabolizing and growing pathogens. Compliance with the treatment regimen is of utmost importance and patients should generally take antibiotics for more than six weeks and in any case long after they are feeling well. Otherwise, relapses are likely and resistance development is possible. Patients have to be advised repeatedly on this risk and some physicians even prefer supervised drug intake. This directly observed therapy assures compliance and is presumably accompanied by shorter-term medication schemes and fewer relapses [14].

Since antibiotic resistance is a common feature of mycobacteria, treatment always includes the administration of at least two antibiotic drugs with different mechanism of action. A one-antibiotic regimen may not eliminate all pathogens and immunosuppressed patients may not be able to clear the remaining bacteria, which would lead to a relapse with mycobacteria resistant to that particular antibiotic.

In order to shorten the overall medication time, TB therapy is usually initialized with three or four different antibiotics. This approach drastically reduces bacterial load and increases chances of success.

The most commonly used antibiotics are isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin [2]. These antibiotics are able to cure the vast majority of pulmonary TB cases (approximately 95%). Other drugs are only indicated if antibiotic resistance is detected or if there are other, absolute contraindications against the antibiotics of first choice.

Antibiotics against TB are usually taken all at once, once a day. There are formulations including more than one of these antibiotics, so the number of pills to be taken every day can be reduced. Dose schedules vary.

If pharmacological treatment does not suffice to treat pulmonary TB due to severe drug resistance, parts of the lung may be surgically removed. Surgery may also become necessary if other organs are involved and are severly compromised.

Prognosis

Provided that the patient is not infected with an extensively drug-resistant M. tuberculosis strain or a strain with multiple resistance, compliance with the antibiotic treatment regimen makes a complete cure very likely. Recurrence rates have been reported to range from 0 to 14%. In countries with a high prevalence of TB, recurrences might be confused with reinfections [9].

Prognosis worsens with age, immunosuppressive conditions, resistance to antibiotics and multiple organ infection. In a recent study, a limited innate immune response, an elevated respiratory rate at TB diagnosis and a decline in general health have been identified as poor prognostic markers [10].

Etiology

Saliva and mucus of a person affected by pulmonary TB does contain mycobacteria and is contagious. Microorganisms can be expelled while speaking, sneezing or coughing. These bacteria may be inhaled by another person, who will subsequently become infected themselves [3].

Once mycobacteria reach the alveoli of the as of yet unaffected person, alveolar macrophages take them up. The bacteria, however, are able to evade the host's defense mechanisms and survive within the macrophages' phagosome. If the immune system is able to withhold the infection, a granuloma may develop and the affected person may not even show any symptoms of TB. They are then merely considered infected with M. tuberculosis or as suffering from latent TB. Clinical tests for TB may produce positive results, but the patient is not able to transmit the disease. However, as soon as the person develops clinical symptoms, they are considered to suffer from TB.

In severe cases, mycobacteria may reach the lymphatic system and the bloodstream of the host and subsequently establish infections of other organs such as liver and spleen.

Any intrinsic or environmental factor weakening the immune system is considered a risk factor for TB [4]. Those factors comprise an HIV infection, diseases that weaken the immune system and alcoholism. Also, someone in prolonged, close contact to other people suffering from TB has a high risk of contracting TB, e.g. someone working in health care, someone living in or coming from a country with a high prevalence of the disease and someone living in poor or crowded conditions.

Epidemiology

TB is one of the major health concerns worldwide. Case numbers amount to several millions. In 2013, for instance, approximately 9 million new infections took place, mainly in Africa, South East Asia and the Western Pacific region. About 1.5 million people died from TB, a large share of whom were HIV positive.

But TB is by far no health problem restricted to developing countries. With regards to the United States, presumably almost 10 million people are infected with M. tuberculosis and nearly 10,000 new cases or 3 cases per 100,000 people have been reported in 2013 [5]. Of note, the case rate was significantly higher among people born abroad, particularly among those who immigrated from Asia [6].

Due to the immunosuppression associated with HIV infections, infections with M. tuberculosis display a particularly severe course in countries with a high HIV prevalence. Most infections with M. tuberculosis manifest as pulmonary TB.

Sex distribution
Age distribution

Pathophysiology

TB is an infectious disease spread by droplet infection and M. tuberculosis has to be inhaled for bacteria to reach its host's alveoli [7]. Here, the pathogens are engulfed by alveolar macrophages and taken up into phagosomes. However, the phagosome of an infected cell does not fuse with a lysosome and therefore does not progress to the elimination of the bacteria. M. tuberculosis inhibits phagosome-lysosome-fusion and does also evade further host defense mechanisms. It does survive inside the phagosome, multiplies and eventually kills its host cell. Mycobacteria are then released and prompt a reaction of the immune system that may continue to eliminate the pathogen, to restrain the infection (patient develops latent TB) or completely fail to do so (patient develops pulmonary TB).

If the infection can be restrained but not eliminated, macrophages and T-helper cells form a caseating granuloma with a necrotic center. Mycobacteria can be found inside this granuloma which is delimited on the outside by a lymphocytic wall. The affected person does not transmit the disease, but rather suffers from latent TB. In this condition, radiographic images of the lungs do not show any alterations but the tuberculin skin test shows positive results [7][8].

Latent TB may be re-activated and progress to active pulmonary TB. The probability for this to occur is particularly high during the first two years after infection and increases after receiving immunosuppressive treatment with corticosteroids or similar drugs as well as after acquiring immunosuppressive diseases such as HIV.

Prevention

The BCG vaccine is an attenuated live vaccine extensively used to prevent TB. Vaccination with the BCG strain does not prevent pulmonary TB, but does significantly reduce TB meningitis and dissemination in children [15]. TB vaccinations are no longer routinely administered, but may be indicated in specific cases of high risk due to unavoidable exposure, particularly to resistant strains.

Physicians should be aware of the local regulations regarding suspected or confirmed cases of TB.

Summary

Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis (M. tuberculosis). It still represents one of the major concerns for health care authorities worldwide.

The disease is spread by droplet transmission. Mycobacteria reach the alveoli, are taken up by alveolar macrophages and frequently survive inside their host cells. The immune system may be able to limit the infection and to prevent any further spreading, in which case the affected person does not develop any symptoms and does not expel contagious material either. Mycobacteria are then preserved in granulomas. On the other hand, if the infection cannot be withheld or becomes re-activated, a primary pulmonary TB develops: the patient usually presents unspecific respiratory and general symptoms, whereby cough is the leading one. Here, saliva and sputum contain mycobacteria and are highly contagious. Most cases of primary pulmonary TB result from re-activated latent forms of the disease [1]. Reactivation may occur years after infection.

Although TB may spread to other organs, the vast majority of cases is limited to the lungs. A generalized immunosuppression may strongly increase the risk for re-activation and dissemination.

Besides the clinical examination, a chest X-ray, sputum culture, tuberculin skin test and interferon-γ release assay are valuable diagnostic measures [2].

If left untreated, about 50% of all patients suffering from pulmonary TB die. On the contrary, compliance with a long-term treatment regimen including several antibiotics is associated with a good prognosis.

Patient Information

Pulmonary tuberculosis (TB) is an infectious disease transmitted from man to man by droplet infection, i.e. by saliva and sputum. It mainly compromises the lungs but can spread to other organs.

Causes

Pulmonary TB is a bacterial infectious disease caused by M. tuberculosis. A person suffering from pulmonary TB harbors inflammatory spots in his or her lung and may expel bacteria when sneezing or coughing or even when speaking. If another person inhales these contagious droplets, they may contract TB.

Depending on the current state of the immune system and other factors, the body's immune defence may be able to eliminate or withhold the infection. If the infection is merely withheld, bacteria stay alive but inactive inside the patient's lung. In this condition, the person cannot transmit the disease. However, it is possible that the infection will be reactivated and in this case, the patient will expel contagious material. They may then infect other people.

Symptoms

Pulmonary TB is typically not accompanied by characteristic symptoms. Affected people may suffer from overall discomfort, loss of appetite, loss of body weight and cough. Fever may be present, but not necessarily. Some more severe cases are associated with difficulties to breathe, coughing up blood and chest pain.

Diagnosis

A clinical examination will be carried out and may reveal swollen and tender lymph nodes as well as unusual breath sounds.

Because pulmonary TB symptoms are not easily distinguished from those caused by other diseases, further diagnostic measures have to be undertaken in order to confirm the condition.

Those diagnostic measures may include imaging of the chest by X-rays or other techniques, a bronchoscopy (looking inside the bronchial tubes), a tuberculin skin test and an examination of the patient's sputum, among others.

Treatment

Pulmonary TB is a potentially curable disease. Therapy success depends largely upon the patient's compliance with long-term antibiotic therapy. Several antibiotics have to be administered at the same time because the pathogenic M. tuberculosis frequently shows resistance towards some antibiotics. Antibiotics have to be taken until long after symptoms have disappeared. Pulmonary TB is generally treated with isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin. Provided that the treatment regimen is followed precisely, about 95% of all pulmonary TB cases are cured.

References

Article

  1. Woodring JH, Vandiviere HM, Fried AM, et al. Update: the radiographic features of pulmonary tuberculosis. AJR 1986; 146:497-506

  2. American Thoracic Society. Control of tuberculosis in the United States. Am Rev Respir Dis 1992; 146:1623-1632.

  3. Lienhardt C. From exposure to disease: the role of environmental factors in susceptibility to an development of tuberculosis. Epidemiol Rev. 2001; 23:288-301.

  4. Lin HH, Ezzati M, Murray M. Tobacco smoke, indoor air pollution and tuberculosis: a systematic review and meta-analysis. PLoS Med. 2007; 4:e20. 

  5. Khan K, Wang J, Hu W, et al. Tuberculosis infection in the United States: national trends over three decades. Am J Respir Crit Care Med. 2008; 177:455-460.

  6. Alami NN, Yuen CM, Miramontes R, et al. Trends in tuberculosis - United States, 2013. MMWR Morb Mortal Wkly Rep. 2014; 63:229-233.

  7. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care facilities. MMWR Morb Mortal Wkly Rep. 1994; 43(RR-13):1-132.

  8. MacGregor RR. Tuberculosis: from history to current management. Semin Roentgenol 1993; 28:101-108.
  9. van Rie A, Warren R, Richardson M, et al. Exogenous reinfection as a cause of recurrent tuberculosis after curative treatment. N Engl J Med. 1999 Oct 14; 341(16):1174-9.

  10. Waitt CJ, Peter K Banda N, White SA, et al. Early deaths during tuberculosis treatment are associated with depressed innate responses, bacterial infection, and tuberculosis progression. J Infect Dis. 2011 Aug; 204(3):358-62.

  11. Bass JR, Jr, Farer LS, Hopewell PC, et al. Diagnostic standards and classification of tuberculosis. Am Rev Respir Dis 1990; 142:725-735.

  12. Ramakantan R, Bandekar VG, Gandhi MS, et al. Massive hemoptysis due to pulmonary tuberculosis: control with bronchial artery embolization. Radiology 1996; 200:691-694.

  13. Herold CD, Fitzgerald RL, Herold DA. Current techniques in mycobacterial detection and speciation. Crit Rev Clin Lab Sci 1996; 33:83-138.

  14. Bass JB, Jr, Farer LS, Hopewell PC, et al. Treatment of tuberculosis open link and tuberculosis infection in adults and children. Am J Respir Crit Care Med 1994; 149:1359-1374.

  15. Colditz GA, Brewer TF, Berkley CS, et al. Efficacy of BCG vaccine in the prevention of tuberculosis. JAMA. 1994; 271:698-702.

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Last updated: 2018-06-22 00:05