Department of Physiotherapy, SHUATS, Prayagraj

1. TUBERCULOSI
S
SUBMITTED TO :
MRS SURABHI SRIVASTAVA
ASSISTANT PROFESSOR
DEPARTMENT OF PHYSIOTHERAPY
SHUATS
COMMUNITY
MEDICINE SUBMITTED BY:
NEDA HASEEN
DEPARTMENT OF PHYSIOTHERAPY:
3 YEAR

2. CONTENT
• Introduction
• Definition
• Causative Agents
• Mode of transmission
• Spread of Tuberculosis
• Epidemiology
• Incidence
• Pathophysiology
• Types of Tuberculosis
• Severe symptoms
• Diagnosis
• Preventive measures

3. INTRODUCTION
Tuberculosis (TB) is an ancient human disease caused by
Mycobacterium tuberculosis which mainly affects the lungs,
making pulmonary disease the most common presentation (K
Zaman, 2010). However, TB is a multi-systemic disease with a
protean presentation.
The organ system most commonly affected includes the
respiratory system, the gastrointestinal (GI) system, the
lymphoreticular system, the skin, the central nervous system, the
musculoskeletal system, the reproductive system, and the liver.

4. DEFINITION
Tuberculosis is the infectious disease primarily affecting lung
parenchyma is most often caused by Mycobacterium
Tuberculosis. It may spread to any part of the body including
meninges, kidneys, bones, and lymph nodes.

5. CAUSATIVE AGENTS
Mycobacterium Tuberculosis
Mycobacterium Bovis
Human
Animals

6. OTHER CAUSATIVE AGENTS
• Mycobacterium africanum
• Mycobacterium microti
Non-Mycobacterium Genus
• Mycobacterium leprae
• Mycobacterium avium
• Mycobacterium asiaticum
M.Tuberculosis
complex
M.
africanum
M. Bovis
M.
Canetti
M. microti

7. MODE OF TRANSMISSION
Human beings acquire infections with tubercle
bacilli by one of the following routes:
1. INHALATION : Inhalation of organisms
present in fresh cough droplets or in dried
sputum from an open case of pulmonary
tuberculosis.
2. INGESTION : Ingestion of the organisms
leads to development of tonsillar or intestinal
tuberculosis. This mode of infection of human
tubercle bacilli is from self-swallowing of
infected sputum of an open case of pulmonary
tuberculosis, or ingestion of bovine tubercle

8. 3. INOCULATION: Inoculation of the organisms into the skin may
rarely occur from infected postmortem tissue.
4. TRANSPLACENTAL ROUTE : Transplacental route results in
development of congenital tuberculosis in foetus from infected
mother and is a rare mode of transmission

9. SPREAD OF TUBERCULOSIS
1. Local spread
2. Lymphatic spread
3. Haematogenous spread
4. By the natural passages

10. EPIDEMIOLOGY

11. INCIDENCE
• With the increased incidence of AIDS,
TB has become a great problem in the
US and the world
• India is the highest TB burden country
in the world, has 20% of cases
occuring globally
• Each year 1.8 million develop TB
globally
• In India 0.37 million people die
because of TB each year

13. PATHOPHYSIOLOGY
(Initial infection or primary infection)
Entry of micro organisms through droplet nuclei
Bacteria is transmitted to alveoli through airways
Deposition and multiplication of bacteria
Bacilli are also transported to other parts of the body
via.
Blood stream and phagocytosis by neutrophils and

14. Mycobacterium
Pulmonary alveoli
Immune system has lodged in (Alveolar Macrophages)
Detects presence of pathogen and engulf the bacteria
Mycobacterium bacteria inhibits the Macrophages
(phagosome+Lysosome) to form phagolysosome and remains
protected inside the Macrophages.

15. Starts replication inside Macrophage
Primary infection occurs
Cell mediated immunity gets activated surrounds the cell
to forms granuloma
Leads to necrosis of tissues at infection site
(TERMINUS GONE FOCUS)
Involve nearby lymph nodes (CONE COMPLEX)
Calcification of cone complex (LATENT T.B.)

17. TYPES OF TUBERCULOSIS
Depending upon the type of tissue response and age,
the infection with tubercle bacilli is of 2 main types: primary
and secondary tuberculosis
Primary Tuberculosis
The infection of an individual who has not been previously
infected or immunised is called primary tuberculosis or Ghon’s
complex or childhood tuberculosis

18. Primary complex or Ghon’s complex in lungs consists of 3
components
1. Pulmonary component
2. Lymphatic vessel component
3. Lymph node component
B. Secondary Tuberculosis
The infection of an individual who has been previously infected
or sensitised is called secondary, or post-primary or reinfection,
or chronic tuberculosis.
” endogenous source such as reactivation of dormant primary
complex; exogenous source such as fresh dose of reinfection by
the
tubercle bacilli

19. SYMPTOMS
• Persistent cough
• Chest pain
• Coughing with bloody sputum
• Shortness of breath
• Urine discoloration
• Cloudy and reddish urine
• Fever with chills
• Fatigue

20. DIAGNOSIS
1. Bacteriologica test :
a. Zeil- Neelsen stain
b. Auramine stain (fluorescence microscopy
2. Sputum culture test:
a. Lowenstein-Jensen(LJ) solid medium: 4-18 weeks
b. Liquid medium : 8-14 days
c. Agar medium : 7 to 14 days

21. 3. Radiography:
Chest X-Ray(R)
4. Nucleic acid amplification:
• Species identification ; several hours
• Low sensitivity‚ high cost
Most useful for the rapid confirmation of tuberculosis in
persons with AFB- positive sputa
• Utility
• AFB-negative pulmonary tuberculosis
• Extra pulmonary tuberculosis

22. 5. Tuberculin skin test (PPD)
• Injection of fluid into the skin of the lower arm
• 48-72 hours later - checked for a reaction
• Diagnosis is based on the size of the wheal.
1 dose = 0.1ml contains 0.04μg Tuberculin PPD

23. 6. Other biological examinations
• Cell count (Lymphocytes)
• Protein ( Pandy and Rivalta test)- Ascites, Pleural
effusion and meningitis

25. PREVENTIVE MEASURES
1. Mask
2. BCG Vaccine
3. Regular medical follow up
4. Isolation of patient
5. Ventilation
6. Natural sunlight
7. UV germicidal irradiation