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Types of tuberculosis(TB)

BY
SAJA AL-MARSHAD
Pulmonary Tuberculosis has 3 main
types

post-primary TB

primary TB Miliary or (disseminated TB )


INTRODUCTION:::

tuberculosis varies greatly in different


populations*
improved living standards, population
screening, immunization and effective
drug therapy have very greatly reduced of
all forms of tuberculosis.
Childhood tuberculosis or primary TB will
become significantly rare.
The opportunistic fact of this disease*.
old latent lesions are liable to be activated
by corticosteroid or other
immunosuppressive therapy, by chronic
alcoholism, the development of diabetes
Primary
::
Tuberculosis
In patients who have not previously
had tuberculosis, inhalation of
tubercle bacilli causes a primary or
parenchymal lesion, also termed
the ghon focus*.
This is usually single, 1-2 cm in diameter,
and situated just beneath the pleura
other component of primary TB is
the enlarged lymph node((hilar))
Both of it components are linked
with lymphatics greatly enlarged
and caseous.

Where is primary TB most
active in??
usually at the base of lungs,
and , caused by a very low dose
of infection . Anatomically, the
basal and middle zones of
the lungs are more prone to
infection than the apical zones
because of their volume,
although sometimes ventilation
seems to be favoured in the
How did they proof it??
It is supported by the finding of single
calcified primary lesions observed in
necropsies((autopsy)), in which 66% of
infections were located in the lower
half of the lung and only 12% were
supraclavicular .

Also it takes 4 to 6 weeks


to develop with a limited
progress .
Ghon focus undergoes healing: if small, by fibrous
tissue; if larger, the caseous centre usually persists
and is converted into a hard calcified nodule Visible
in chest radiographs...

How serious is it?


This primary complex resolves spontaneously
with no symptoms in 95%* of infected people,
but 5% develop the disease, which may be
local (i.e. causing pleurisy when there is
rupture into the pleural cavity) or systemic
(i.e. causing meningeal or even miliary TB).
post-primary TB:
Post primary TB result mainly
from the reactivation of the
latent lesion by the
opportunistic fashion
reinfection way from an active
case.

The re-infection lesion result from


proliferation of mycobacterium
tuberculosis in the wall of a
bronchiole(activation of bronchial
spared) or alveolus.
 It was associated with elderly
people
We can say that Post primary infection can be
endogenous , resulting from reactivation of a
dormant primary or post primary lesion, or it may
be exogenous i.e. caused by organisms in inhaled
dust, ets.
The common sites for post-
primary pulmonary tuberculosis
are the posterior or apical
segment of the upper lobe & the
superior segment of the lower lobe
.
the anatomical location of the
lesion is attributed to the good
ventilation but relatively low
blood flow in those areas.
During the primary tuberculosis
infection or following BCG
immunization, the patient
develops cell-mediated immunity
to antigens of the tubercle
bacillus so antibody will be
present either ways.**

So the result of tuberculin test
will be +ve ,,
Radiographic images is
required .
n anteroposterior X-ray of a patient diagnosed with advanced bilateral pulmonary
tuberculosis. This AP X-ray of the chest reveals the presence of bilateral
pulmonary infiltrate (white triangles), and „caving formation “ (black
arrows) present in the right apical region.The diagnosis is far-advanced
tuberculosis.
The infection spreads by the lymphatics, but, because of the
immune state it induces a delayed hypersensitivity

lymphatic spread is strictly localized.


localized Because of the
partial state of immunity which exists. Progress of the
lesion is slow

tubercles are well developed and there is


conspicuous formation of fibrous tissue at their
periphery.

If healing does not now occur, some of the nodules will spread
to involve the wall of a bronchus and blockage of the lumen
follows.
the caseous material within the tubercle may be
gradually discharged along the bronchus, leaving a small
cavity.

Bronchial spread to the upper parts of other lobes and to the


other lung may occur, and chronic pulmonary tuberculosis is
frequently bilateral.

there is considerable overgrowth of fibrous tissue, in this


way the lung shrinks and pulmonary and bronchial blood
vessels involved in the wall of a cavity usually become
occluded
Atelectasis
will formed
wall of the artery may be weakened and rupture; serious
and sometimes fatal hemorrhage results.
This is to be distinguished from the coughing up of blood-
stained sputum.
Development of post primary TB
when there has been breakdown of resistance and extensive
bronchopneumonia

blood dissemination with acute military


tuberculosis may occur

Tuberculosis ulcers may


develop in the larynx or in the
intestine from direct infection
Generalized Miliary Tuberculosis

In developed country where


the prevalence of tuberculosis
is low, miliary tuberculosis
occurs most commonly in the
elderly. In contrast, where the
prevalence of tuberculosis is
high, it occurs most frequently
in childhood.
•Why it is called
miliary??
BECAUSE it is a form of tuberculosis that is characterized by a
wide dissemination into the human body and by the tiny size of
the lesions . Its name comes from a distinctive pattern seen on
a chest X-ray of many tiny spots as a millet seeds shaped
spots.
When it accure?
The pulmonary lesions
are part of an acute
generalized tuberculosis,
which occurs when a
large number of
mycobacterial gain
entrance to the
bloodstream.
bloodstream
miliary tuberculosis
lesions are usually more numerous in the lungs than in any
other organ like liver & spleen.
They consist of grey tubercles which may be too
small to be visible by the naked eye or up to 3mm
in diameter.
How the microorganism gets systemic?
tuberculosis infection in the lung result of erosion of the
infection into a pulmonary vein.
vein the bacteria reach the left
side of the heart and enter the systemic circulation,
circulation the
result may be to seed organs such as the liver and spleen with
said infection. Alternately the bacteria may enter the l ymph
node ( s ), drain into a systemic vein and eventually reach the
r ight side of the heart . From the right side of the heart, the
bacteria may seed - or re-seed as the case within the lungs,
lungs causing
the "miliary " appearance.
appearance
As a review
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