Clinical Aspects Of Pulmonary TB

Tuberculosis is world’s most deadly disease. It affects world’s 20-40% of population and each year 3 million people die of this disease worldwide. The infecting organism is M.tuberculosis.

It is commonly seen disease in malnourished, homeless and in those living in substandard housing. Also, there is increased occurrence of TB among HIV positives.

The infection spreads through airborne droplet infection, which contains organism in it. Once the infection reaches the lungs, the stage of infection is called as primary tuberculosis.

Some conditions such as diabetes mellitus, gastrectomy, immuno-suppressive diseases like HIV and immuno-suppressive drugs are also associated with increased risk of reactivation of the infection.

Clinical findings

In pulmonary TB, patient typically presents with constitutional symptoms like malaise, anorexia, lethargy, weight loss and night sweats.

Chronic cough is the most common symptom. It starts as a dry cough and progresses into productive cough, which has purulent sputum. Blood streaked sputum may also be seen.

Hemoptysis is a rare symptom but in later stages it presents as life threatening condition. Dyspnoea may also be an accompanying symptom.

Physical Examination

Patient appears malnourished and chronically ill. On chest examination, classical positive rales (breath sounds) may be heard.

Investigations in TB

Laboratory findings include identification of the organism in sputum culture or DNA / RNA amplification technique.

Three consecutive morning sputum cultures are advised. Positive culture with microscopic examination reveals the diagnosis.

Needle biopsy of pleura reveals inflammation in 60% patients, in cases with pleural effusion.

Imaging shows homogenous infiltrates, hilar and paratracheal lymph node enlargement. In progressive tuberculosis, cavitation and ghon’s complex are seen.

Tuberculin skin test identifies the individuals infected with TB.

Essentials for diagnosis include fatigue, weight loss, fever, night sweats, cough, positive tuberculin test, acid fast bacilli on smear of sputum and pulmonary infiltrates on chest radiograph.

Treatment

The treatment aims to eliminate all tubercle bacilli from the infected individual.

Anti-tubercular drugs are given. There is administration of multiple drugs, to add atleast three anti-tubercular drugs to provide safe and effective therapy.