Tuberculosis is a multisystemic disease .It is the most common cause of infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis related worldwide. It typically affects lungs but also affects other parts of body.
TB infection begins when the mycobacterium reach the pulmonary alveoli, where they invade and replicate within endosomes of alveolar macrophages. The primary site of infection in the lungs, known as the “Ghon focus” is generally located in either the upper part of the lower lobe or the lower part of upper lobe. Through hematogenous transmission can spread infection to more distant parts such as peripheral lymph nodes, kidneys, brain, and bones.Age/Sex prevalence of Tuberculosis
No sex prevalence to a male-to-female ratio.
Higher rates of TB infection are seen in young, nonwhite adults than in white adults.
The TB race related demography is as follows:
• Hispanics – 29%
• Asians – 30%
• Non-Hispanic blacks/African Americans – 23%
• American Indians/native Alaskans – 1%
• Native Hawaiians/other Pacific Islanders – 1%
• Tubercular meningitis (TB of brain or meninges)
• Skeletal TB
• Genitourinary TB
• Gastrointestinal TB
TB is caused by M Tuberculosis, a slow growing aerobe and an intercellular parasite. It devides every 16-20 hours. Mycobacterium have an outer membrane lipid bilayer.
The M.tuberculosis complex includes four other TB causing mycobacterium : M.bovis, M.africanum, M.canetti, M.microti.
Symptoms of Pulmonary TB:
• Weight loss
• Night sweats
• Chest pain
Symptoms of tubercular meningitis:
• Persistent or intermittent headache for 2-3 weeks
• Low grade or absent fever
Symptoms of skeletal TB:
• Back pain or stiffness
• Lower extremity paralysis
• Tubercular arthritis
Symptoms of genitourinary TB:
• Flank pain
• Frequent urination
• In men painful scrotal mass, prostatitis. Orchitis, epididymitis
• In women, symptoms like PID
Signs of extrapulmonary TB:
• Cutaneous Lesion
• The primary screening method for TB infection is Mantoux tuberculin skin test.
• Chest radiography
• A computed tomography(CT Scan) of chest may help to better define abnormalities in patients with vague findings on chest radiography
• Start patient on a 4 drug regimen: Isoniazide, rifampin, pyrazinamide, and streptomycin.DOT direct observed therapy is recommended for all patients.
• Patients diagnosed with active TB should undergo sputum analysis for Mycobacterium tuberculosis weekly until sputum conversion is documented.
Isolate patient with possible TB infection in a private room .Continue isolation until sputum smears are negative for 3 consecutive determinations.
• The chance of death from a case of TB is about 4%.
• Lung absess
• Lung cancer
• Potts disease
Arsenic Album at midnight with much wheezing .
• Warm drinks.
• Drinks little and frequently.
• Cough dry as if coming from stomach with stitches in side of chest.
• talking,laughing ,eating ,hot weather, getting into warm room from cold.
• Pain chest night, motion, right side, inspiration.
• rest, lying on painful side, pressure.
• Thirst for large quantities of water at long intervals.
• Leuco-phlegmatic Constitution, takes cold easily
• Fat or very thin
• Sweaty head on sleeping which soaks the pillow
• Desire eggs.
• Affinity for Right middle lobe of lung complaints.
• Dyspnoea ascending stairs,exertion, cold
• Young tall, weak, narrow chest,
• Bleeding tendency, sensitive to odours
• Catches cold easily with desire for open air
• Pain chest lying on left side,inspiration & cough.;
• Tuberculinum Bovinum
• Family History of TB, inter-current remedy.
• Tendency to take cold easily yet desires cold, open air.
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