Internal Diseases and Therapy · MU Sofia

10. Pulmonary Tuberculosis

Covers pulmonary tuberculosis from its causative mycobacteria and airborne transmission to the immunopathogenesis of primary, progressive and post-primary disease. It then sets out clinical features, including a table of extrapulmonary sites, followed by imaging, microbiology and tuberculin and interferon-gamma tests, with a table of induration thresholds. Treatment covers the standard drug regimen with a drug table, drug-resistant TB, preventive therapy, BCG and complications.

Inside: 9 sections · 2 labelled pictures · 3 tables · 15 flashcards · 15 min

Topic 10 of 139 in the MU Sofia syllabus for Internal Diseases and Therapy (Medicine, Years 4 and 5). The free AceMed note covers it in 9 sections, about 2,013 words (15 min of reading), with 15 flashcards.

In this note

  1. Definition
  2. Etiology
  3. Transmission and risk factors
  4. Immunopathogenesis
  5. Clinical presentation
  6. Diagnosis
  7. Treatment
  8. Prevention
  9. Complications

Definition

  • Tuberculosis (TB) is a chronic granulomatous infectious disease caused by bacteria of the Mycobacterium tuberculosis complex. The lungs are affected in over 80% of cases; other organs in up to a third.
  • Properly treated, it is curable in almost all cases; untreated, more than half of patients with active pulmonary TB die within 5 years.
  • About a quarter of the world's population carries latent infection; about 10 million new cases and over 1 million deaths a year — the leading infectious killer worldwide.

Etiology

  • M. tuberculosis complex: M. tuberculosis (the main human pathogen), M. bovis (unpasteurised milk; also the BCG vaccine strain), M. africanum, M. microti, M. canettii.
  • Aerobic, non-motile, non-spore-forming rods with a lipid-rich cell wall (mycolic acids) → acid-fast bacilli (AFB): once stained (Ziehl–Neelsen, auramine), they resist decolourisation by acid alcohol.
  • Slow growth (doubling time about 15–20 h) → culture takes weeks and treatment must last months; resistant to drying and many disinfectants, killed by UV light and heat.
  • Other mycobacteria: M. leprae; non-tuberculous (atypical) mycobacteria — M. avium complex, M. kansasii, M. abscessus (rapid growers) — environmental, cause lung disease in patients with COPD, bronchiectasis, CF or HIV; not transmitted person to person.

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