Pulmonary tuberculosis

A 20-year-old girl had fever, cough with purulent expectoration and anorexia for the past 6 weeks. Chest auscultation revealed crepitations in both lung fields. There was no lymphadenopathy, and oxygen saturation on pulse oximeter was 98% on room air. Blood investigations showed elevated erythrocyte sedimentation rate (95 mm in the first hour, normal < 20) and C-reactive protein (48 mg/l, normal < 10). Total leucocyte count, procalcitonin, liver and kidney function tests were normal. Inhomogeneous opacities were observed in both upper zones and left middle zone on chest radiograph. A computed tomogram of the chest showed scattered nodules in both lungs distributed in centrilobular pattern. Some areas showed clustering of nodules around prominent airways in branching pattern, which is called the ‘tree-in-bud’ appearance ( 1 Inflammation of the terminal airways or collection of secretions in their lumen leads to thickening of the bronchioles which appear on computed tomogram as linear branching structures. Involvement of the lung parenchyma around peripheral airways gives rise to centrilobular nodules. Combined appearance of centrilobular nodules along with thickened airways is likened to a tree with budding branches ( Mycobacterium tuberculosis, which was sensitive to all the first-line anti-tubercular drugs. Pyrazinamide was discontinued after 2 months; rifampicin, isoniazid and ethambutol were continued for the next 4 months. Six months later, there was disappearance of t...

• Overview   • • Theory   • Epidemiology • Etiology • Case history • Diagnosis   • Approach • History and exam • Investigations • Differentials • Criteria • Screening • Management   • Approach • Treatment algorithm • Emerging • Prevention • Patient discussions • Follow up   • Monitoring • Complications • Prognosis • Resources   • Guidelines • Images and videos • • Patient leaflets • Evidence Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Key risk factors include exposure to infection, birth in an endemic country, and HIV infection. Symptoms may include cough, fever, and weight loss. If pulmonary TB is suspected, the patient should be isolated, a chest x-ray obtained, and three sputum samples collected for acid-fast bacilli smear and culture; nucleic acid amplification test should be performed on at least one respiratory specimen. Directly observed therapy is highly recommended and is particularly indicated in groups where adherence cannot be assumed. Early recognition and implementation of effective treatment for infectious TB is crucial in interrupting TB transmission. Definition In many patients, Mycobacterium tuberculosis becomes dormant before it progresses to active TB. TB most commonly involves the lungs (pulmonary TB) and is communicable in this form, but may affect almost any organ system including the lymph nodes, central nervous system, liver, bones, genitourinary tract, and gastrointestinal tract. See Histo...

Tuberculosis is caused by a group of organisms, Mycobacterium tuberculosis, M bovis, M africanum and a few other rarer subtypes. Tuberculosis usually appears as a lung (pulmonary) infection. However, it may infect other organs in the body. Recently, antibiotic-resistant strains of tuberculosis have appeared. With increasing numbers of immunocompromised individuals with AIDS, and homeless people without medical care, tuberculosis is seen more frequently today. (Image courtesy of the Centers for Disease Control and Prevention.) Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, and can cause tissue death. These chest X-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying size that run together (coalesce). Arrows indicate the location of cavities within these light areas. The X-ray on the left clearly shows that the opacities are located in the upper area of the lungs toward the back. The appearance is typical for chronic pulmonary tuberculosis but may also occur with chronic pulmonary histiocytosis and chronic pulmonary coccidioidomycosis. Pulmonary tuberculosis is making a comeback with new resistant strains that are difficult to treat. Pulmonary tuberculosis is the most common form of the disease, but other organs can be infected. This picture shows reddish-purple, hard (indurated), painful nodules (erythema nodosum) that occur most commonly on the shins. T...

Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis Published CID, 8/10/2016 Clinical Infectious Diseases, Volume 63, Issue 7, 1 October 2016, Pages e147–e195, Published: 10 August 2016 An update to this guideline is in development (est. publication 12/2023), combined with an update to the Payam Nahid, Susan E. Dorman, Narges Alipanah, Pennan M. Barry, Jan L. Brozek, Adithya Cattamanchi, Lelia H. Chaisson, Richard E. Chaisson, Charles L. Daley, Malgosia Grzemska, Julie M. Higashi, Christine S. Ho, Philip C. Hopewell, Salmaan A. Keshavjee, Christian Lienhardt, Richard Menzies, Cynthia Merrifield, Masahiro Narita, Rick O'Brien, Charles A. Peloquin, Ann Raftery, Jussi Saukkonen, H. Simon Schaaf, Giovanni Sotgiu, Jeffrey R. Starke, Giovanni Battista Migliori, Andrew Vernon For full document, including tables and references, please visit the PDF Abstract The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the...