Pulmonary tuberculosis (PTB)

Pulmonary tuberculosis PTB lecture video recorded free class loksewa

Pulmonary tuberculosis

Dr Chaitanya Joshi
Introduction to Pulmonary tuberculosis

  • Communicable disease
  • Chronic granulomatous condition
  • Causative agents
  • Mycobacterium tuberculosis
  • M. bovis
  • M. africanum
  • M. tuberculosis = tubercle bacilli or AFB
  • Can remain dormant for years in our body

Epidemiology of Pulmonary tuberculosis

  1. In 2010 8.8 million incident cases occurred of tuberculosis
  2. 1.5 million deaths 
  3. Second most common cause of death among infective causes
  4. 1/3rd of world population has latent TB
  5. Most cases in poor part of world
  6. TB had largely driven by HIV in Africa

Pathophysiology of Pulmonary tuberculosis

  1. M tuberculosis- droplet infection
  2. M bovis- unsterilized milk
  3. Once inhaled they lodge into the alveoli and initiate the recriutement of macrophages and lymphocytes
  4. They then form tubercular granuloma
  5. Numerous granuloma form “Ghon focus”
  6. Then the infection is spread to nearby lumphnode and is collectively called “Primary complex of ranke”

Pathophysiology of Pulmonary tuberculosis contd

  1. Fibrous capsule and other mechanism prevent spread from primary complex- latent TB
  2. If nothing happens later the lesion is calcified- seen in X-ray
  3. But sometimes lymphatic or hematogenic or local spread may occur
  4. Secondary loacations- LN, serous menbranes, meninges, bones, liver, kidneys, lungs etc
  5. Cell mediated/type 4/montuex test/TST may come positive in dormant infection 
  6. Lifetime riskof developing disease after primary TB is around 10%

Clinical features of Pulmonary tuberculosis

  1. Primary TB( in previously uninfected, tuberculin neg)
  2. Self limiting febrile illness

DDx of Pulmonary tuberculosis

  1. Miliary TB
  2. Blood borne dissiminated TB
  3. 2-3 weeks of symptoms
  4. Fever
  5. Night sweats
  6. Anorexia
  7. Weight loss
  8. Hepatospleenomegaly
  9. Widespread crackles
  10. X ray

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  11. Anemia and leukopenia (bone marrow involvement)

Post-primary pulmonary TB

  1. New or endogenous infection 
  2. Most commonly in apex of an upper lobe
  3. Oxygen tension favors strictly aerobic organism
  4. Insidious onset, over severalweeks
  5. Fever, night sweats, malaise, losss of appetite and weight
  6. Pulmonary symptoms
  7. Cough, sob, chest pain, hemoptysis

X ray of Pulmonary tuberculosis

  1. Opacification
  2. Consolidation
  3. Collapse
  4. Cavity
  5. Lymph node opacity
  6. Occasionally tuberculosis pneumonia (caseated content drained into bronchus and then distal migration)

Tb cavity of Pulmonary tuberculosis

  1. Tb apex
  2. Ranke complex

Diagnosis of PTB

lungs anatomy
Lungs anatomy

Treatment  of Pulmonary tuberculosis

National protocol of Nepal for PTB

Drugs used for treatment of Tuberculosis

Here's a list of drugs used for the treatment of pulmonary tuberculosis (PTB), categorized into first-line and second-line drugs:

First-line drugs for PTB:

  • Isoniazid (INH)
  • Rifampicin (RIF)
  • Pyrazinamide (PZA)
  • Ethambutol (EMB)
  • Streptomycin (SM)

Second-line drugs for PTB (used in case of drug resistance or treatment failure):

  • Amikacin
  • Capreomycin
  • Kanamycin
  • Levofloxacin
  • Moxifloxacin
  • Ethionamide
  • Cycloserine
  • Para-aminosalicylic acid (PAS)
  • Linezolid
  • Bedaquiline
  • Delamanid
It's important to note that the choice of drugs depends on factors such as drug susceptibility testing results and the specific resistance patterns of the tuberculosis strain. Treatment regimens are determined by healthcare professionals based on individual patient circumstances.

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