Pulmonary tuberculosis is an infectious disease caused by slow- growing bacteria that resembles a fungus,

Myobacterium tuberculosis, which is usually spread from person to person by droplet nuclei through the air. The lung
is the usual infection site but the disease can occur elsewhere in the body. Typically, the bacteria from lesion (tubercle)
in the alveoli. The lesion may heal, leaving scar tissue; may continue as an active granuloma, heal, then reactivate or
may progress to necrosis, liquefaction, sloughing, and cavitation of lung tissue. The initial lesion may disseminate
bacteria directly to adjacent tissue, through the blood stream, the lymphatic system, or the bronchi.

ANATOMY AND PHYSIOLOGY

Prognosis

Progression from TB infection to TB disease occurs when the TB bacilli overcome the immune system defenses and
begin to multiply. In primary TB disease—1–5% of cases—this occurs soon after infection. However, in the majority
of cases, a latent infection occurs that has no obvious symptoms. These dormant bacilli can produce tuberculosis in 2–
23% of these latent cases, often many years after infection. The risk of reactivation increases with immunosuppression,
such as that caused by infection with HIV. In patients co-infected with M. tuberculosis and HIV, the risk of reactivation
increases to 10% per year.

The current clinical classification system for tuberculosis (TB) is based on the pathogenesis of the disease.[citation needed]

Classification System for TB

Class Type Description
No TB exposure No history of exposure
0
Not infected Negative reaction to tuberculin skin test
TB exposure History of exposure
1
No evidence of infection Negative reaction to tuberculin skin test
Positive reaction to tuberculin skin test
TB infection
2 Negative bacteriologic studies (if done)
No disease
No clinical, bacteriologic, or radiographic evidence of TB
 M. tuberculosis cultured (if done)
3 TB, clinically active
Clinical, bacteriologic, or radiographic evidence of current disease
History of episode(s) of TB
or
Abnormal but stable radiographic findings
TB
4 Positive reaction to the tuberculin skin test
Not clinically active
Negative bacteriologic studies (if done)
and
No clinical or radiographic evidence of current disease
Diagnosis pending
5 TB suspect
TB disease should be ruled in or out within 3 months

Transmission

When people suffering from active pulmonary TB cough, sneeze, speak, or spit, they expel infectious aerosol droplets
0.5 to 5 µm in diameter. A single sneeze can release up to 40,000 droplets.[37] Each one of these droplets may transmit
the disease, since the infectious dose of tuberculosis is very low and inhaling less than ten bacteria may cause an
infection.[38][39]

People with prolonged, frequent, or intense contact are at particularly high risk of becoming infected, with an estimated
22% infection rate. A person with active but untreated tuberculosis can infect 10–15 other people per year.[4] Others at
risk include people in areas where TB is common, people who inject drugs using unsanitary needles, residents and
employees of high-risk congregate settings, medically under-served and low-income populations, high-risk racial or
ethnic minority populations, children exposed to adults in high-risk categories, patients immunocompromised by
conditions such as HIV/AIDS, people who take immunosuppressant drugs, and health care workers serving these high-
risk clients.[40]

Transmission can only occur from people with active — not latent — TB [1]. The probability of transmission from one
person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation,
the duration of exposure, and the virulence of the M. tuberculosis strain.[9] The chain of transmission can, therefore, be
broken by isolating patients with active disease and starting effective anti-tuberculous therapy. After two weeks of such
treatment, people with non-resistant active TB generally cease to be contagious. If someone does become infected, then
it will take at least 21 days, or three to four weeks, before the newly infected person can transmit the disease to others.
[41]
TB can also be transmitted by eating meat infected with TB. Mycobacterium bovis causes TB in cattle. (See details
below.)

Risk factors

Persons with silicosis have an approximately 30-fold greater risk for developing TB.[21] Silica particles irritate the
respiratory system, causing immunogenic responses such as phagocytosis which consequently results in high lymphatic
vessel deposits.[22] It is this interference and blockage of macrophage function which increases the risk of tuberculosis.
[23]
Persons with chronic renal failure who are on hemodialysis also have an increased risk: 10—25 times greater than
the general population. Persons with diabetes mellitus have a risk for developing active TB that is two to four times
greater than persons without diabetes mellitus, and this risk is likely greater in persons with insulin-dependent or poorly
controlled diabetes. Other clinical conditions that have been associated with active TB include gastrectomy with
attendant weight loss and malabsorption, jejunoileal bypass, renal and cardiac transplantation, carcinoma of the head or
neck, and other neoplasms (e.g., lung cancer, lymphoma, and leukemia).[24]

Given that silicosis greatly increases the risk of tuberculosis, more research about the effect of various indoor or
outdoor air pollutants on the disease would be necessary. Some possible indoor source of silica includes paint, concrete
and Portland cement. Crystalline silica is found in concrete, masonry, sandstone, rock, paint, and other abrasives. The
cutting, breaking, crushing, drilling, grinding, or abrasive blasting of these materials may produce fine silica dust. It can
also be in soil, mortar, plaster, and shingles. When you wear dusty clothing at home or in your car, you may be carrying
silica dust that your family will breathe.[25]

Low body weight is associated with risk of tuberculosis as well. A body mass index (BMI) below 18.5 increases the
risk by 2—3 times. On the other hand, an increase in body weight lowers the risk.[26][27] Patients with diabetes mellitus
are at increased risk of contracting tuberculosis,[28] and they have a poorer response to treatment, possibly due to poorer
drug absorption[29]

Other conditions that increase risk include IV drug abuse; recent TB infection or a history of inadequately treated TB;
chest X-ray suggestive of previous TB, showing fibrotic lesions and nodules; prolonged corticosteroid therapy and
other immunosuppressive therapy; Immunocompromised patients (30-40% of AIDS patients in the world also have TB)
hematologic and reticuloendothelial diseases, such as leukemia and Hodgkin's disease; end-stage kidney disease;
intestinal bypass; chronic malabsorption syndromes; vitamin D deficiency;[30] and low body weight.[1][9]

Twin studies in the 1940s showed that susceptibility to TB was heritable. If one of a pair of twins got TB, then the
other was more likely to get TB if he was identical than if he was not.[31] These findings were more recently confirmed
by a series of studies in South Africa.[32][33][34] Specific gene polymorphisms in IL12B have been linked to tuberculosis
susceptibility.[35]

Some drugs, including rheumatoid arthritis drugs that work by blocking tumor necrosis factor-alpha (an inflammation-
causing cytokine), raise the risk of activating a latent infection due to the importance of this cytokine in the immune
defense against TB.[36]

Symptoms

The primary stage of the disease usually doesn't cause symptoms. When symptoms of pulmonary TB occur, they may
include:

• Cough (sometimes producing phlegm)

• Coughing up blood
• Excessive sweating, especially at night
• Fatigue
• Fever
• Unintentional weight loss

Other symptoms that may occur with this disease:

• Breathing difficulty
• Chest pain
• Wheezing

Possible Complications

Pulmonary TB can cause permanent lung damage if not treated early.

Medicines used to treat TB may cause side effects, including liver problems. Other side effects include:

• Changes in vision
• Orange- or brown-colored tears and urine
• Rash

A vision test may be done before treatment so your doctor can monitor any changes in your eyes' health over time.
Prevention

TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing (PPD) for TB is
used in high risk populations or in people who may have been exposed to TB, such as health care workers.

A positive skin test indicates TB exposure and an inactive infection. Discuss preventive therapy with your doctor.
People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date, if the
first test is negative.

Prompt treatment is extremely important in controlling the spread of TB from those who have active TB disease to
those who have never been infected with TB.

Some countries with a high incidence of TB give people a BCG vaccination to prevent TB. However, the effectiveness
of this vaccine is controversial and it is not routinely used in the United States.

People who have had BCG may still be skin tested for TB. Discuss the test results (if positive) with your doctor.

Surgical Management
 Pneumonectomy
 Indications: bronchiectasis, tuberculoma,
cavitary lesions, pulmonary cirhosis,
atolectasis
 Contraindication: active parenchymal lesions

& endobronchial tuberculosis

nursing management to this sickness is to:

1. Maintain respiratory isolation until patient respond to treatment
2. Administer medicines as ordered
3. Check sputum always for blood or purulent expectoration
4. Encourage questions, conversation, to air their feelings
5. Teach or educate patient all about PTB
6. Encourage to stop smoking
7. Teach patient to cough or sneeze into to tissue paper and dispose secretions properly
8. Advise patients to have plenty of rest and eat balanced meals
9. Be alert on signs of drug reaction
10. Emphasize the importance of regular follow-up examination

incubation period: 2-10 weeks ,from the first entry until the appearance of the first signs
and symptoms

incidence rate in the phil.

Tuberculosis (TB) is still a major public health concern in the Philippines, ranking as the
sixth (previously fifth) leading cause of morbidity and mortality based on recent local
data.1,2
Globally, the Philippines is ninth, previously ranked seventh, among 22 high burden
countries and ranks third, previously second, in the Western Pacific region based on its
national incidence of 133 new sputum smear-positive cases per 100,000 population in
2004
(from 145 new cases per 100,000 in 2002)3
The Philippine Health Statistics recorded a total of 27,000 deaths from tuberculosis, at
the
turn of the century.1 The National Tuberculosis Program (NTP) reported 130,000 to
140,000 TB cases, mainly discovered and treated in government health units, of which
60%
are highly infectious smear-positive cases.4 As of 2004, the case detection rate (CDR)
improved from 53% in 2003 to 68% and the cure rate increased from 75% in 2003 to
80.6%. Both are however still below global targets of 70% and 85% respectively.

How is Pulmonary TB transmitted?

Tuberculosis of the lungs is transmitted by inhalation of the M. tuberculosis organism

dispersed as droplet nuclei from a person with pulmonary TB whose sputum is positive.
The bacteria may float in the air for several hours. Other modes of transmission is by
direct hand or mouth (kissing) contact with infected saliva. The preventive measures are
obvious. If one is near a person known to have active TB, one should cover his/her nose
and avoid handling items previously touched by the patient, including eating utensils.
Washing hands following an unavoidable contact is a good practice. If one suspects the
possibility of having TB, it is most prudent to consult a physician without delay.

Mode of transmission

TB is transmitted mainly by inhalation of infectious droplets produced by persons with

pulmonary or laryngeal tuberculosis during coughing, laughing, shouting or sneezing.

Invasion may occur through mucous membranes or damaged skin.

Extrapulmonary tuberculosis, other than laryngeal infection, is generally not

communicable. Urine is infectious in cases of renal tuberculosis. Bovine tuberculosis
results mainly from ingestion of unpasteurised milk and dairy products. Aerosol
transmission has been reported among abattoir workers.

Period of communicability

In theory, the patient is infectious as long as viable bacilli are being discharged from the
sputum. In practice, the greatest risk of transmitting infection is in the period prior to
diagnosis of an open case. A sputum smear positive case is more infectious than a case
only positive on culture. The risk of transmitting the infection is significantly reduced
within days to two weeks after commencing appropriate chemotherapy.