Tuberculosis (TB) : Exam point of view in detail

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Tuberculosis (TB) : Exam point of view in detail 

Tuberculosis

1. Definition

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis.

It mainly affects the lungs (Pulmonary TB) but can also affect other organs (Extrapulmonary TB).

T B is the world's second most common cause of death from infectious disease after HIV /AIDS

2. Causative Agent

Organism: Mycobacterium tuberculosis

Type: Acid-fast bacillus (AFB)

Characteristics

Rod-shaped bacterium

Slow growing

Resistant due to waxy cell wall

Can remain dormant in body

3. Risk Factors

Important factors increasing TB risk:

  • HIV infection
  • Diabetes mellitus
  • Malnutrition
  • Low body weight
  • Silicosis
  • End stage kidney disease
  • Cancer and chemotherapy
  • Leukemia
  • Genetic susceptibility
  • Immunosuppressive drugs
  • Overcrowding
  • Poor ventilation

4. Mode of Transmission

Tuberculosis spreads mainly through the airborne route.

When a person with active pulmonary TB coughs, sneezes, laughs, or talks, tiny droplets containing TB bacteria are released into the air. These droplets may remain suspended in the air for a long time.

Healthy individuals become infected when they inhale these contaminated droplets.

Sources of infection:

  • Coughing
  • Sneezing
  • Talking
  • Close contact with TB patient

When infected droplets are inhaled, bacteria enter the lungs.

5. Incubation Period

Usually 2–8 weeks.

Bacteria may remain latent for months or even years.

During this time, the bacteria multiply in the body but symptoms may not appear. In some individuals, the bacteria remain inactive (latent) for months or even years.

When immunity decreases, the bacteria can become active and cause disease.

6. Types of Tuberculosis

1. Pulmonary TB

Affects lungs

Most common form

Main source of transmission

2. Extrapulmonary TB

Affects organs other than lungs:

Examples:

Lymph nodes

Bones and joints

Brain (TB meningitis)

Kidneys

Intestines

7. Stages of TB Infection

1. Exposure

Person inhales TB bacteria.

2. Latent TB Infection

Bacteria remain inactive.

No symptoms.

Person not contagious.

3. Active TB Disease

Bacteria multiply.

Symptoms appear.

Person becomes infectious.

8. Signs and Symptoms

Common symptoms:

  1. Persistent cough (3 weeks)
  2. Fever
  3. Night sweats
  4. Weight loss
  5. Loss of appetite
  6. Fatigue
  7. Chest pain
  8. Shortness of breath
  9. Hemoptysis (blood in sputum)

9. Physical Examination

General Signs

  • Fever
  • Weight loss
  • Weakness
  • Night sweats
  • Respiratory Signs
  • Crackles (rales)
  • Bronchial breathing
  • Dullness on percussion
  • Reduced breath sounds

10. Laboratory Diagnosis

1. Screening Tests

Mantoux Test (Tuberculin Skin Test)

Intradermal injection of tuberculin.

Positive reaction indicates TB exposure.

TB Blood Test (IGRA)

Measures immune response to TB bacteria.

# TB Skin Test (Mantoux/PPD): Tuberculin fluid is injected under the skin; a positive reaction (bump) indicates prior exposure.

# TB Blood Test (IGRA): Measures immune response (interferon-gamma release) in a blood sample when mixed with TB antigens; preferred for vaccinated

2. Diagnostic Tests

Sputum Smear Microscopy

Detects acid-fast bacilli (AFB).

NAAT / PCR

Detects TB DNA rapidly.

Mycobacterial Culture

Gold standard test.

Confirms TB infection.

Chest X-Ray

 Shows lung lesions, cavities and infiltrates.

 #Sputum Smear Microscopy: Stains sputum to detect acid-fast bacilli (AFB), a quick but less sensitive method.

# Nucleic Acid Amplification Tests (NAAT/PCR): Rapidly detects TB DNA in samples (sputum, gastric aspirate, etc.)

 # Mycobacterial Culture: Grows M. tuberculosis from samples, confirming diagnosis but taking weeks.

# Chest X-ray (CXR): Looks for characteristic lung abnormalities in symptomatic patients.

Other Samples & Tests

# Induced Sputum/Bronchoscopy: For hard-to-produce samples, especially in children (gastric aspirate) or difficult cases.

# Molecular Drug Susceptibility Testing (DST): Detects genetic mutations for rapid drug resistance identification, crucial for treatment.

# Other Samples: Urine (genitourinary TB), Cerebrospinal Fluid (CSF) (meningitis)

11. Extrapulmonary TB Signs

  1. Lymph Node TB
  2. Enlarged cervical lymph nodes
  3. Bone TB (Pott's disease)
  4. Spine infection
  5. Back pain
  6. Spinal deformity
  7. Abdominal TB
  8. Abdominal pain
  9. Ascites
  10. Abdominal swelling

12. Prevention

1. BCG Vaccination

Bacillus Calmette–Guérin vaccine

Given at birth

Protects children from severe TB

2. Public Health Measures

Early detection

Isolation of active TB patients

Use of masks

Good ventilation

Avoid overcrowding

13. Treatment

Treatment requires long-term combination therapy.

First Line Anti-TB Drugs

  • Isoniazid
  • Rifampicin
  • Ethambutol
  • Pyrazinamide
Treatment Duration

Usually 6 months.

14. Drug Resistant TB

Types:

MDR-TB

Resistant to Isoniazid and Rifampicin

XDR-TB

Resistant to multiple second-line drugs

Treatment requires specialized therapy.

15. Supportive Management

  1. Proper nutrition
  2. Adequate rest
  3. Regular follow-up
  4. Monitoring drug side effects

16. Complications

If untreated, TB may cause:

  1. Lung damage
  2. Respiratory failure
  3. TB meningitis
  4. Bone deformity
  5. Spread to other organs


* Short Summary * 

Disease: Tuberculosis

Causative Agent: Mycobacterium tuberculosis

Transmission: Airborne droplets

Common Symptoms: Cough, fever, night sweats, weight loss

Diagnosis: Mantoux test, sputum smear, PCR, culture, chest X-ray

Treatment: Combination anti-TB drugs for 6 months

Prevention: BCG vaccination and infection control


Summary

Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. It mainly affects the lungs (pulmonary TB) but can also involve other organs such as lymph nodes, bones, brain, and kidneys (extrapulmonary TB). The disease spreads through airborne droplets when an infected person coughs, sneezes, or talks. Common symptoms include persistent cough, fever, night sweats, weight loss, fatigue, and sometimes coughing up blood. Diagnosis is done through tests such as the Mantoux test, sputum smear microscopy, PCR/NAAT, mycobacterial culture, and chest X-ray. Treatment requires a combination of anti-tuberculosis drugs like isoniazid, rifampicin, ethambutol, and pyrazinamide for about six months. Prevention includes BCG vaccination, early diagnosis, proper ventilation, avoiding overcrowding, and effective infection control measures to reduce the spread of the disease.

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