tB

1. Tuberculosis (TB)
Mohammud Tanvir Ahamed
B.U.M.S(Bachelor of Unani Medicine and Surgery)
Hakim Yousuf h. Hospital ,Hamdard University Bangladesh.

2. • TB is a contagious disease that is transmitted from person to person
through coughing and breathing in airborne droplets that contain
bacteria. TB primarily affects the lungs, but can affect any part of the
body. As one of the most common infections in the world, TB remains
a major problem in many countries and among vulnerable
populations.

3. • Pathogenesis of tuberculosis:
• TB pathogenesis can be divided in four well-defined events. Inhalation of the mycobacteria
is followed by its interaction with resident macrophages through cellular receptors and its
internalization. Macrophage bactericidal mechanisms are then activated, including RNI and
ROI generation. The efficient killing of mycobacteria depends on pathogen and host factors.
Inflammatory cell recruitment: survived mycobacteria proliferate within macrophages
inducing the production of proinflammatory cytokines. The local inflammatory
environment induces the recruitment of several cell types including monocytes,
neutrophils, and dendritic cells to the site of infection. High levels of TNF-α contribute to
control Mtb growth and granuloma formation. Control of mycobacteria proliferation: arrival
of immune cells to the site of infection including T cells, which become organized in
characteristic structures called granulomas efficiently stop mycobacteria proliferation and
contain the mycobacteria within the granuloma walls preventing its spread. Characteristic
of this structure is the presence of foam cells resulting from the differentiation of
chronically activated macrophages. Mycobacteria containment eventually becomes stable
(latent) infection. Postprimary TB: mycobacteria persistence associated with a failure in the
immunosurveillance system increases the risk that latent disease becomes reactivated,
inducing the damage of nearby bronchi and conditioning the spreading of the Mtb to other
areas of the lung and the transmission of the disease.
•

4. • Clinical Features General constitutional features
• • Age
• • contact history ±
• • Anorexia / Failure to thrive / irritable
• • Fever of > 2 weeks / night sweating
• S/S specific to system involved
• • Lungs: Pl effusion / pneumonia / cavity : wheeze /dry cough
• • Spinal TB: stiff spine, spinal hump
• • Bone & Joint TB: -Swelling of joints without injury -Limp on walking
• • TBM: Headache & irritability
• • Lymph Node: Swelling/abscess/sinus Diagnosis: Pr. Tuber

5. • Epidemiology
• In 2011, there were 8.7 million new cases of active tuberculosis worldwide (13% of
which involved coinfection with the human immunodeficiency virus [HIV]) and 1.4 million
deaths, including 430,000 deaths among HIV-infected patients1 representing a slight
decrease from peak numbers in the mid-2000s . It has been estimated that there were
310,000 incident cases of multidrug-resistant tuberculosis, caused by organisms resistant
to at least isoniazid and rifampin, among patients who were reported to have
tuberculosis in 2011 . More than 60% of these patients were in China, India, the Russian
Federation, Pakistan, and South Africa.1,2 A total of 84 countries have reported cases of
extensively drug-resistant tuberculosis, a subset of multidrug-resistant tuberculosis with
added resistance to all fluoroquinolones plus any of the three injectable antituberculosis
drugs, kanamycin, amikacin, and capreomycin.1-3 Sub-Saharan Africa has the highest
rates of active tuberculosis per capita, driven primarily by the HIV epidemic.1 The
absolute number of cases is highest in Asia, with India and China having the greatest
burden of disease globally.1 In the United States and most Western European countries,
the majority of cases occur in foreign-born residents and recent immigrants from
countries in which tuberculosis is endemic.

6. • Diagnosis: Pr. Tuberculosis Investigations :apart from routine •
Mantoux Test • CXR : PA view • Demonstration of AFB; -in Sputum
smear -in other specimens -Laryngeal swab -Gastric aspirate -Pus - L N
aspirate [FNA]

7. • General principles of drug treatment of pulmonary TB
• Some general principles of pulmonary TB drug treatment (sometimes referred to as TB chemotherapy) are:
• Drug treatment is the only effective treatment for TB;
• Single drug treatment for active TB is associated with a substantial relapse rate.
• A patient is said to have a relapse if they improve whilst taking TB treatment but become ill again after they have finished their treatment;
• Patients with active TB disease should receive at least three drugs as their initial TB drug treatment. Fewer than three drugs can result in the
development of resistance;
• Never add a single TB drug to a failing regimen. A regimen simply means the course of treatment, in this instance the combination of TB drugs;
• Compliance with TB treatment is the responsibility of the treating physician as well as the patient.
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• First line drugs for TB treatment
• The first line drugs are:
• Isoniazid
• Rifampicin
• Pyyrazinamide
• & Ethambutol
• which are the TB drugs that generally have the greatest have the greatest activity against TB bacteria when used for TB treatment. The amount of
drug that a TB patient needs to take depends on the patient's weight. There is more about this on the page about TB drugs.
• TB treatment categories

8. • Thank you