PULMONARY TUBERCULOSIS PATHOLOGY
What is Pulmonary tuberculosis ❔
Pulmonary tuberculosis is an infectious disease that affects the lung tissue.
The Mycobacterium tuberculosis is the name of bacteria which is the main cause of pulmonary tuberculosis Disease
CLINICAL FEATURES OF PULMONARY TUBERCULOSIS
1-Shortness of breath
2-Hemoptysis ( Blood in sputum)
3-Chronic cough with more sputum production
4-Loss of appetite
5-Weight loss
6-The patient has a mild fever in the evening or at night
7 -Fatigue
ETIOLOGY OF PULMONARY TUBERCULOSIS
1-Mycobacterium tuberculosis – ( This bacterium causes mainly tuberculosis in humans.)
2-Mycobacterium bovis – ( Due to this bacteria tuberculosis occurs in cows)
3-, Mycobacterium avium intracellularedue .-( Pulmonary tuberculosis occur in immunocompromised patient for weak immune system.
Mycobacterium tuberculosis is an aerobic bacterium. means Mycobacterium tuberculosis bacteria need oxygen to grow which is why it commonly affects the lungs
MODE OF TRANSMISSION OF PULMONARY TUBERCULOSIS.
1-INHALATION -when a person infected by Mycobacterium tuberculosis and when he or she sneezes or coughs, tiny droplets come out from the body that contain Mycobacterium tuberculosis.
When these droplets containing Mycobacterium tuberculosis from an infected person are inhaled by a healthy person’s lungs and cause infection.
2 -INGESTION –
Ingestion means eating or drinking by mouth
Any healthy person who ingests unpasteurized milk which contains Mycobacterium bavis that causes tuberculosis in humans.
and if also ingestion of infected sputum which contains Mycobacterium tuberculosis that causes tuberculosis infection in healthy women.
3 -TRANSPLACENTAL
( means through the placenta)
When a fetus is inside the womb he takes oxygen and nutrition through the placenta, if in pregnancy when the fetus is in the womb of the mother and the mother is affected by Pulmonary tuberculosis caused by Mycobacterium tuberculosis bacteria.
and this bacteria pass through the placenta and enters the blood circulation of the fetus. Then the fetus will also be affected by
Tuberculosis. This is called congenital TB (congenital means during pregnancy in the womb)
4-INOCULATION (INTO THE SKIN)
Mycobacterium tuberculosis enters through the broken skin, which is called inoculation into the skin It is rarely seen.
RISK FACTORS OF PULMONARY TUBERCULOSIS
1-Lower socioeconomic group
2-Poor hygiene
3-Immunosuppressed Individual
Normally when other bacteria enter our body our defense cells, macrophages first engulf those bacteria
After engulfing the bacteria is in a sac called a phagosome.
This phagosome joins with the lysosomes of the macrophages.
This is called phagolysosome, and due to this the digestive enzymes from lysosomes are released over the bacteria, and bacteria die ( Normally this occurs but in Mycobacterium tuberculosis phagolysosome does not occur and TB bacteria do not dye easily.
When Mycobacterium tuberculosis enters our body, macrophages engulf that microorganisms and engulf it and try to destroy but can’t destroy for their cell wall .( Their cell wall contain mycolic acid and glycolipid which protects Mycobacterium tuberculosis)this Mycobacterium tuberculosis stays inside the macrophages.and don’t dye
When our immune cells Macrophages, are unable to destroy Mycobacterium tuberculosis then our body starts type IV hepersensitivity reactions .
These infected macrophages breaks the small parts of Mycobacterium which is called antigen, and this small break parts ( antigen pieces ) attaches on MHC class 1 molecule on the surface of the macrophages so that Helper T cell can recognise and destroy it .
And infected macrophages also release cytokines which is protein called interleukins 12 .
This Interleukins 12 activate CD4 or T helper cell
Then T helper cell release two cytokines one is Interferon- gamma and other one is Tumor necrosis factor -alpha.
Interferon–gamma promotes the formation of a phagolysosome. So that lysosomes break down and digestive enzymes which is acid will come into contact with bacteria.
And this acidic environment is unfavorable for their existence.
Interferon gamma also produces nitric acid which has bactericidal action.
These two cytokines inform to other immune cells so other immune cell come and surround the bacteria ( Mycobacterium tuberculosis )so hat it will not infectious to other parts of body . This is called granuloma.
And also When a T helper cell is activated
Activated Macrophage change their shape and become Epithelioid cells.
These epitheloid cell Gather together at one place.
Around them more immune cell Colect
This forms a small wall-like structure called granuLoma
Granulomas form by Macrophages and other immune cell .
When infected person immune system is strong then the Mycobacterium tuberculosis bacteria will be inactive in that immune cell surrounding trap but if that patients immune system is not strong then the granuloma will break down and patient will be infected by Pulmonary tuberculosis.
TYPES OF TUBERCULOSIS
1-Primary tuberculosis
If any person who has no history of previous tuberculosis infection The person is affected for first time that is called primary tuberculosis.
In primary tuberculosis, the first lung lesion is usually single (Solitary) is called Ghon focus .
Commonly occurs in the lower part of the upper lobe.
anf the upper part of the lower lobe
2-Secondary tuberculosis
Secondary tuberculosis is tuberculosis that occurs due to reactivation of old dormant TB infection or reinfection in a person who was previously exposed to TB bacteria.
Secondary tuberculosis is also called post-primary pulmonary tuberculosis.
It occurs due to reactivation of old dormant TB infection present in the body.
The TB bacteria remain hidden in previously healed lesions (old foci).
When immunity becomes weak, the dormant bacteria become active again.
The bacteria spread through the blood (hematogenous spread) to the lungs.
They commonly affect the upper lobes of the lungs.
The upper lobes have higher oxygen levels, which help TB bacteria survive and multiply better.
This causes more severe and damaging lung lesions compared to primary TB.
MILIARY TUBERCULOSIS
When tuberculosis spreads from its original site to other organs by blood and lymph it is called Miliary tuberculosis.
In this type of tuberculosis, the TB lesion is seen as a small round seed like a millet seeds so it is called Miliary tuberculosis.
( Outcomes of primary tuberculosis)
1-Healing by fibrosis ( means healing of damage tissue by forming fibronous scar )
2-Calcification rarely Ossification (. TB lesion heals by forming scar tissue with calcium deposition and rarely bone formation.)
3-Persisting primary infection with an enlarging primary focus spreads to other lungs
4-Secondary tuberculosis
5- Miliary tuberculosis
(Outcomes of secondary tuberculosis)
1-Healing by scarring and calcification
2-Tubercular pneumonia
PATHOGENESIS OF PRIMARY TUBERCULOSIS
Inhalation of infected droplets containing Mycobacterium tuberculosis.
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Engulfment of bacteria by macrophages present in the alveoli
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Macrophages unable to kill Mycobacterium tuberculosis due to its cell wall.
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Persistence of Mycobacterium tuberculosis bacteria within the macrophages.
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Macrophage break down small pieces of bacteria and attach on her surface
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Macrophage release cytokine Interleukins 12
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Due to Interleukins 12 Helper T cell activated
Helper T cell release two cytokines one is Interferon gamma and another one is Tumor necrosis alpha
Communicate with other immune cell and form Granuloma .
Mycobacterium tuberculosis trapped in between granuloma immune cell .
If patients immune system is strong it is inactivate.
If patients immune system is weak then break granuloma and mycobacterium tuberculosis spread to other parts
Pulmonary tuberculosis infection occur.
PATHOGENESIS OF SECONDARY TUBERCULOSIS
Bacteria stay hidden in body will again reactivate due to weak immune system.
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Formation of Ghon complex ( Tuberculosis infection in the lungs along with infection in nearby lymph nodes)
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Protective layer of immune cell enclose the Mycobacterium tuberculosis breakdown due to weak immune system.
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Release of Mycobacterium tuberculosis and spread to outside of the granuloma
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Mycobacterium tuberculosis get activated and multiply
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Symptoms starts ( like chest pain , weight loss ,cough)
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Transmission by droplets and transmission by blood and lymph nodes from lungs to other organs of the body is called extra pulmonary spreads.
DIAGNOSIS OF PULMONARY TUBERCULOSIS
1-Mantoux test
2-Sputum for AFB
3-Sputum culture
4- Hemogram
5-Chest xray
6- FNAC
7- Gene X pert test
8-Drug sensitivity testing
9- CBNAAT
10- Rifampsin resistance detected
11-Line probe easy
PREVENTION OF PULMONARY TUBERCULOSIS
1- Early diagnosis and treatment –
Due to early diagnosis by sputum test after getting positive results start immidiately treatment to recover soon and prevent complication.
2-BCG vaccination-
Two scientists devlop BCG vaccine Albert calmette and Camille Guerin According these scientists Vaccine name devloped BCG ( full form OF BCG if Bacillus calmate Guerin)
In this vaccination live weak bacillus used . BCG vaccine should given at birth as early as possible.
3-Cover mouth and nose while coughing and sneezing.( Advice patient to cover mouth when talking and sneezing because it is droplet infection.and nurse should use mask ,gives ,gown during caring the patient to protect herself.
4-Use of Mask -Nurse should use mask when caring of the tuberculosis patient to protect herself.
5-Balanced nutrition – Balance nutrition necessary to recover from Pulmonary tuberculosis but High rich protein diet is necessary to recover soon.
6-Maintain personal hygiene -If we maintain personal hygiene then Pulmonary tuberculosis can be prevented example .Regular hand washing can reduce jerm from hand
Health education
8-Regular screening of close contact
TREATMENT OF PULMONARY TUBERCULOSIS
1- Rifampicin
2-Isoniazid
3- Ethambutal
4- Pyrazinamide
5-High rich protein diet such as egg , milk , paneer, soya chunks , chicken,fish ,meat ,Rajma ,chana , Dal , Almond
NURSING MANAGEMENT OF PULMONARY TUBERCULOSIS
1-check vital sign such as temperature,pulse , Respiration regularly to find out any abnormality.
2-Use mask and Gown at the time giving medicine to the patient.
3-Mode of transmission of Pulmonary tuberculosis is by inhalation so teach me patient to cover mouth and nose while coughing and sneezing.
4-Give antitubercular drug Such as Rifampsin, Isoniazid, Ethambutal, Pyrazinamide, according to Doctors order and doses.
7-Give information regarding antitubercular drugs effect in body such as during taking Rifampsin medicine patient pass red or orange colour urine which is normal.
8-Observ for any side effects of medicine.
9-Advice to take High rich protein diet to take so that patients will recover faster .
10-Advice patient to take antitubercular drug regularly ,not to miss or forgot the medicine.if the patient will forgot the medicine then the tubercular microorganisms ( Mycobacterium tuberculosis) Will resist and may be patient have to take medicine longer time , means duration of medicine will be increased due this small mistake,so please don’t forget to take antitubercular drugs regularly.
11- Advice to Avoid alcohol and smoking
11-Advice to take adequate rest and sleep is necessary.
14-Isolate the patient to prevent spread of infection to other patient.
Pulmonary Tuberculosis – Important MCQs
For AIIMS, NORCET, RRB, ESIC & Nursing Entrance Exams
1. Pulmonary tuberculosis is mainly caused by:
A. Streptococcus pneumoniae
B. Mycobacterium tuberculosis
C. Staphylococcus aureus
D. Klebsiella pneumoniae
Answer: B. Mycobacterium tuberculosis
2. The most common route of transmission of pulmonary TB is:
A. Blood transfusion
B. Fecal-oral route
C. Airborne droplets
D. Skin contact
Answer: C. Airborne droplets
3. Which organ is primarily affected in pulmonary tuberculosis?
A. Liver
B. Kidney
C. Lungs
D. Brain
Answer: C. Lungs
4. A characteristic histological feature of tuberculosis is:
A. Fat necrosis
B. Granuloma formation
C. Hemorrhage
D. Fibrosis only
Answer: B. Granuloma formation
5. The central area of a tuberculous granuloma commonly shows:
A. Liquefaction necrosis
B. Caseous necrosis
C. Fat necrosis
D. Coagulative necrosis
Answer: B. Caseous necrosis
6. Which cells are commonly seen in tuberculous granuloma?
A. Plasma cells
B. Giant cells
C. Mast cells
D. Basophils
Answer: B. Giant cells
7. The confirmatory test for pulmonary tuberculosis is:
A. Urine examination
B. Sputum examination for AFB
C. ECG
D. Blood glucose test
Answer: B. Sputum examination for AFB
8. Which stain is commonly used to identify tubercle bacilli?
A. Gram stain
B. Ziehl–Neelsen stain
C. PAS stain
D. Leishman stain
Answer: B. Ziehl–Neelsen stain
9. Which symptom is most commonly associated with pulmonary TB?
A. Sudden blindness
B. Persistent cough
C. Severe diarrhea
D. Joint deformity
Answer: B. Persistent cough
10. Night sweats and weight loss are commonly seen in:
A. Asthma
B. Tuberculosis
C. Hypertension
D. Migraine
Answer: B. Tuberculosis
11. The vaccine used for prevention of tuberculosis is:
A. OPV
B. DPT
C. BCG
D. MMR
Answer: C. BCG
12. BCG vaccine is usually given:
A. At birth
B. At 10 years
C. During pregnancy
D. At old age
Answer: A. At birth
13. Which investigation is useful for screening tuberculosis?
A. CT brain
B. Mantoux test
C. EEG
D. Colonoscopy
Answer: B. Mantoux test
14. Pulmonary tuberculosis mainly affects which part of the lungs?
A. Lower lobes only
B. Apex of lungs
C. Middle lobe only
D. Pleura only
Answer: B. Apex of lungs
15. Which of the following is a risk factor for tuberculosis?
A. Good nutrition
B. Strong immunity
C. Malnutrition
D. Regular exercise
Answer: C. Malnutrition
16. Which drug is commonly used in anti-tubercular therapy?
A. Penicillin
B. Rifampicin
C. Paracetamol
D. Cetirizine
Answer: B. Rifampicin
17. DOTS therapy is related to:
A. Malaria treatment
B. TB control program
C. Diabetes management
D. Hypertension control
Answer: B. TB control program
18. Hemoptysis in a TB patient means:
A. Vomiting blood
B. Blood in urine
C. Coughing blood
D. Bleeding gums
Answer: C. Coughing blood
19. Which of the following is NOT a common symptom of pulmonary TB?
A. Fever
B. Chronic cough
C. Weight loss
D. Increased appetite
Answer: D. Increased appetite
20. Untreated pulmonary TB may lead to:
A. Lung destruction
B. Improved immunity
C. Hair loss only
D. Cataract
Answer: A. Lung destruction
