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Tuberculosis (TB)
• Tuberculosis (TB) is a dangerous and highly contagious bacterial disease
caused by Mycobacterium tuberculosis. It primarily affects the lungs, but
if left untreated, it might spread to different parts of the body.
• There are two different types of tuberculosis:
Pulmonary Tuberculosis- infection affecting the lungs.
Extra pulmonary Tuberculosis- It is usually seen in immunocompromised
patients. There are several types:
• Tuberculosis Meningitis
• Osteal Tuberculosis
• Lymph Node Disease
• Renal Tuberculosis
• Adrenal Tuberculosis
Causes of TB
• Tuberculosis is a contagious airborne disease, which can be acquired
from close contact with an infected person.
• Mycobacterium tuberculosis is one of the leading causes of this
dreadful infectious disease. It is a pathogenic bacterial species and
mainly comprises four other types of TB-causing bacteria, namely:
– Mycobacterium bovis,
– Mycobacterium canettii,
– Mycobacterium microti,
– Mycobacterium africanum.
Pathogenesis
• TB infection begins when the mycobacteria reach the alveolar air
sacs of the lungs, where they invade and replicate within
endosomes of alveolar macrophages.
• Macrophages identify the bacterium as foreign and attempt to
eliminate it by phagocytosis.
• During this process, the bacterium is enveloped by the macrophage
and stored temporarily in a membrane-bound vesicle called a
phagosome.
• The phagosome then combines with a lysosome to create a
phagolysosome.
• In the phagolysosome, the cell attempts to use reactive oxygen
species and acid to kill the bacterium. However, M. tuberculosis has
a thick, waxy mycolic acid capsule that protects it from these toxic
substances.
• M. tuberculosis is able to reproduce inside the macrophage and will
eventually kill the immune cell.
• Tuberculosis is classified as one of the granulomatous inflammatory
diseases. Macrophages, epithelioid cells, T lymphocytes, B
lymphocytes, and fibroblasts aggregate to form granulomas, with
lymphocytes surrounding the infected macrophages.
• When other macrophages attack the infected macrophage, they fuse
together to form a giant multinucleated cell in the alveolar lumen. The
granuloma may prevent dissemination of the mycobacteria and provide
a local environment for interaction of cells of the immune system.
• The bacteria use the granulomas to avoid destruction by the host's
immune system. Macrophages and dendritic cells in the granulomas are
unable to present antigen to lymphocytes; thus the immune response is
suppressed.
• Bacteria inside the granuloma can become dormant, resulting in latent
infection. Another feature of the granulomas is the development of
abnormal cell death (necrosis) in the center of tubercles. To the naked
eye, this has the texture of soft, white cheese and is termed caseous
necrosis.
Symptoms of Tuberculosis
TB bacteria or Mycobacterium tuberculosis multiply once it gets into the
lungs cause severe symptoms such as:
• Coughing up blood and mucus from deep inside the lungs
• A bad cough that lasts three weeks or longer
• Weakness or fatigue
• Sweating at night
• Pain in the chest
• Weight loss
• No appetite
• Chills and Fever
Diagnosis
• Blood Test: In this procedure, Blood samples are collected and
tested in the laboratories for the presence or absence of TB germs
in the blood cells. The tuberculosis (TB) blood test, also called an
Interferon Gamma Release Assay or IGRA, is a way to find out if
you have TB germs in your body.
• Skin Test: It is the most common type of test. In this procedure, a
small sample of Tuberculin – a purified protein is injected under
the patient’s skin. If the skin around the site of the injection gets
swollen more than five millimetres, then it is a clear indication of
TB infection.
Imaging tests
• If you've had a positive skin test, your doctor is likely to order a
chest X-ray or a CT scan. This might show white spots in your lungs
where your immune system has walled off TB bacteria, or it might
reveal changes in your lungs caused by active tuberculosis.
Sputum tests:
• If the chest X-ray shows signs of tuberculosis, samples of the
sputum (the mucus that comes up when you cough) are collected.
The samples are tested for TB bacteria.
• Sputum samples can also be used to test for drug-resistant strains
of TB. This helps your doctor choose the medications that are most
likely to work. Getting results of these tests can take four to eight
weeks.
• TB bacteria cultured in Egg-enriched media with glycerol and
asparagine Lowenstein- Jensen medium or media supplemented
with bovine albumin Middlebrook medium
Prevention and Control
BCG vaccination
• The BCG (Bacille Calmette-Guérin) is a live vaccine against
tuberculosis. The vaccine is prepared from a strain of the weakened
bovine tuberculosis bacillus, Mycobacterium bovis.
• The BCG is currently the only licensed vaccine against TB, and has
been in use since 1921. It is one of the most widely used vaccines
worldwide.
• 80% effective in preventing TB for 15 years and more effective
against complex forms of TB in children.
A healthy immune system
• Having a healthy immune system is the best form of defence
against TB: 60% of adults with a healthy immune system can
completely kill TB bacteria.
Early diagnosis
• Early diagnosis and treatment is the most effective way to prevent
the spread of tuberculosis.
• A person with infectious tuberculosis can infect up to 10–15 other
people per year. But once diagnosed with TB, and started on
treatment, the majority of patients are no longer infectious after
just two weeks of taking the medication.
Managing your environment
As TB is an airborne infection, TB bacteria are released into the air
when someone with infectious TB coughs or sneezes. The risk of
infection can be reduced by using a few simple precautions:
• good ventilation: as TB can remain suspended in the air for several
hours with no ventilation
• natural light: UV light kills off TB bacteria
• good hygiene: covering the mouth and nose when coughing or
sneezing reduces the spread of TB bacteria.
Treatment of Tuberculosis
• Drug treatment is one of the most efficient ways to treat this
infectious disease. For patients with Latent TB infections, doctors
generally prescribe an antibiotic called isoniazid, Rifampin for
preventing the latent infection from becoming active.
• Active TB Diseases will be deadly if left untreated. The procedure
involved is taking a combination of ethambutol, INH, Priftin and
Pyrazinamide for a term of three months, followed by a mix of INH
and pyrazinamide for 12 months.
• Isoniazid, also known as isonicotinic acid hydrazide (INH)

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Tuberculosis (TB)-Notes.pdf microbiology notes

  • 2. • Tuberculosis (TB) is a dangerous and highly contagious bacterial disease caused by Mycobacterium tuberculosis. It primarily affects the lungs, but if left untreated, it might spread to different parts of the body. • There are two different types of tuberculosis: Pulmonary Tuberculosis- infection affecting the lungs. Extra pulmonary Tuberculosis- It is usually seen in immunocompromised patients. There are several types: • Tuberculosis Meningitis • Osteal Tuberculosis • Lymph Node Disease • Renal Tuberculosis • Adrenal Tuberculosis
  • 3. Causes of TB • Tuberculosis is a contagious airborne disease, which can be acquired from close contact with an infected person. • Mycobacterium tuberculosis is one of the leading causes of this dreadful infectious disease. It is a pathogenic bacterial species and mainly comprises four other types of TB-causing bacteria, namely: – Mycobacterium bovis, – Mycobacterium canettii, – Mycobacterium microti, – Mycobacterium africanum.
  • 4. Pathogenesis • TB infection begins when the mycobacteria reach the alveolar air sacs of the lungs, where they invade and replicate within endosomes of alveolar macrophages. • Macrophages identify the bacterium as foreign and attempt to eliminate it by phagocytosis. • During this process, the bacterium is enveloped by the macrophage and stored temporarily in a membrane-bound vesicle called a phagosome. • The phagosome then combines with a lysosome to create a phagolysosome.
  • 5. • In the phagolysosome, the cell attempts to use reactive oxygen species and acid to kill the bacterium. However, M. tuberculosis has a thick, waxy mycolic acid capsule that protects it from these toxic substances. • M. tuberculosis is able to reproduce inside the macrophage and will eventually kill the immune cell. • Tuberculosis is classified as one of the granulomatous inflammatory diseases. Macrophages, epithelioid cells, T lymphocytes, B lymphocytes, and fibroblasts aggregate to form granulomas, with lymphocytes surrounding the infected macrophages.
  • 6. • When other macrophages attack the infected macrophage, they fuse together to form a giant multinucleated cell in the alveolar lumen. The granuloma may prevent dissemination of the mycobacteria and provide a local environment for interaction of cells of the immune system. • The bacteria use the granulomas to avoid destruction by the host's immune system. Macrophages and dendritic cells in the granulomas are unable to present antigen to lymphocytes; thus the immune response is suppressed. • Bacteria inside the granuloma can become dormant, resulting in latent infection. Another feature of the granulomas is the development of abnormal cell death (necrosis) in the center of tubercles. To the naked eye, this has the texture of soft, white cheese and is termed caseous necrosis.
  • 7.
  • 8. Symptoms of Tuberculosis TB bacteria or Mycobacterium tuberculosis multiply once it gets into the lungs cause severe symptoms such as: • Coughing up blood and mucus from deep inside the lungs • A bad cough that lasts three weeks or longer • Weakness or fatigue • Sweating at night • Pain in the chest • Weight loss • No appetite • Chills and Fever
  • 9. Diagnosis • Blood Test: In this procedure, Blood samples are collected and tested in the laboratories for the presence or absence of TB germs in the blood cells. The tuberculosis (TB) blood test, also called an Interferon Gamma Release Assay or IGRA, is a way to find out if you have TB germs in your body. • Skin Test: It is the most common type of test. In this procedure, a small sample of Tuberculin – a purified protein is injected under the patient’s skin. If the skin around the site of the injection gets swollen more than five millimetres, then it is a clear indication of TB infection.
  • 10. Imaging tests • If you've had a positive skin test, your doctor is likely to order a chest X-ray or a CT scan. This might show white spots in your lungs where your immune system has walled off TB bacteria, or it might reveal changes in your lungs caused by active tuberculosis. Sputum tests: • If the chest X-ray shows signs of tuberculosis, samples of the sputum (the mucus that comes up when you cough) are collected. The samples are tested for TB bacteria. • Sputum samples can also be used to test for drug-resistant strains of TB. This helps your doctor choose the medications that are most likely to work. Getting results of these tests can take four to eight weeks. • TB bacteria cultured in Egg-enriched media with glycerol and asparagine Lowenstein- Jensen medium or media supplemented with bovine albumin Middlebrook medium
  • 11.
  • 12. Prevention and Control BCG vaccination • The BCG (Bacille Calmette-Guérin) is a live vaccine against tuberculosis. The vaccine is prepared from a strain of the weakened bovine tuberculosis bacillus, Mycobacterium bovis. • The BCG is currently the only licensed vaccine against TB, and has been in use since 1921. It is one of the most widely used vaccines worldwide. • 80% effective in preventing TB for 15 years and more effective against complex forms of TB in children. A healthy immune system • Having a healthy immune system is the best form of defence against TB: 60% of adults with a healthy immune system can completely kill TB bacteria.
  • 13. Early diagnosis • Early diagnosis and treatment is the most effective way to prevent the spread of tuberculosis. • A person with infectious tuberculosis can infect up to 10–15 other people per year. But once diagnosed with TB, and started on treatment, the majority of patients are no longer infectious after just two weeks of taking the medication. Managing your environment As TB is an airborne infection, TB bacteria are released into the air when someone with infectious TB coughs or sneezes. The risk of infection can be reduced by using a few simple precautions: • good ventilation: as TB can remain suspended in the air for several hours with no ventilation • natural light: UV light kills off TB bacteria • good hygiene: covering the mouth and nose when coughing or sneezing reduces the spread of TB bacteria.
  • 14. Treatment of Tuberculosis • Drug treatment is one of the most efficient ways to treat this infectious disease. For patients with Latent TB infections, doctors generally prescribe an antibiotic called isoniazid, Rifampin for preventing the latent infection from becoming active. • Active TB Diseases will be deadly if left untreated. The procedure involved is taking a combination of ethambutol, INH, Priftin and Pyrazinamide for a term of three months, followed by a mix of INH and pyrazinamide for 12 months. • Isoniazid, also known as isonicotinic acid hydrazide (INH)