History of Tuberculosis - doc
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Added on 2020-01-28
History of Tuberculosis - doc
Added on 2020-01-28
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Clinical Update done On Tuberculosis 1Clinical Update done On TuberculosisStudent's Name:Instructor's Name:Date:
Clinical Update done On Tuberculosis 2IntroductionTuberculosis is an infectious disease caused by the bacterium, Mycobacterium tuberculosis(Barberis, 2017). Tuberculosis is a contagious infection and the causative bacteria spread from one person to another by droplet infection. Lungs are the most common site of infectionin tuberculosis (pulmonary tuberculosis). Tuberculosis affects other organs of the body too (extrapulmonary tuberculosis). Tuberculosis is a global healthcare burden. Globally, about 9.6 million new incident cases and 1.5 million deaths were reported due to tuberculosis in 2014 (Sulis, 2016). Though predominantly prevalent in developing countries, the infection is also seen in the developed world. In the developing countries, it affects people with low nutritional status and poor immunity. In the developed world, tuberculosis has become rampant due to the increasing prevalence of AIDS (Gopalan, 2016). Aetiology and pathogenesisTransmission of infection: Transmission of infection in tuberculosis occurs through aerosol spread, i.e. through the route of inhalation. Key factors influencing risk of transmission include bacillary load of the patient with tuberculosis, duration of exposure of the contact, and the proximity of the contact with the source. Patients who are sputum smear positive or have cavities in lung are high potential sources of infection (Escombe, 2008). Course of disease: Most individuals exposed to the tubercular bacilli do not develop an infection. In those who become infected, the following are the possible outcomes (Saenz, 2013):1.Individuals may clear the infection.2.Individuals may harbour the infection for long periods of time (Latent tuberculosis).
Clinical Update done On Tuberculosis 33.Individuals may develop progressive tubercular disease.Immune response in tuberculosis: The outcome of an infection with the tuberculosis bacilli is determined by the innate and adaptive immune responses in the body. This immunological army includes several types of cells and mediators, the key ones being macrophages and dendritic cells (Kleinnijenhuis, 2009).Latent tuberculosis: The presence of immunological response to a previously acquired tubercular infection without any clinically evident signs of active tuberculosis is called latent tuberculosis. This remains an important class of patients and calls for treatment to reduce the burden of tuberculosis. Clinical featuresThe most common symptom of tuberculosis is a persistent cough that lasts several weeks to months (Davis, 2014). Other key clinical features include the following (Sulis, 2016): Presence of at least one of the following four suggestive symptoms should raise a suspicion of tuberculosis:oPersistent feveroPersistent cough for 2 weeks or moreoNight sweatsoWeight lossHistory of contact with a case of tuberculosisPresence of risk factors for tuberculosis like AIDS, diabetes, malnutrition The clinical course of pulmonary and extrapulmonary tuberculosis is explained below (Heemskerk, 2015):
Clinical Update done On Tuberculosis 4Figure 1: (a)Chest X-ray with lung cavity and upper lobe opacities; (b)Chest X-ray in military tuberculosis (Scattered milletseed appearance); (c) Spinal tuberculosis with destruction of vertebral bodies; (d) Tubercular meningitis with tuberculoma, meningeal enhancement, and hydrocephalus (Heemskerk, 2015).Pulmonary tuberculosis: The initial or primary infection with tuberculosis may be mild and may go undetected. In response to the infection, a granuloma, called the primary Gohn complex, is formed in the lower or middle lobes of the lungs. This may be accompanied by enlarged draining lymph nodes and inflammation in the overlying pleura. Typically, this primary granulomatous reaction resolves spontaneously in a few weeks. The resultant fibrosisand calcification can be seen on radiological imaging. As a part of natural history of tuberculosis, this primary infection may progress or a reinfection may occur. After a period of latency, reactivation of the disease may occur. This is also called post primary tuberculosis. Reactivation is clinically indistinguishable from the primary tuberculosis and usually occurs in immunocompromised conditions like AIDS, severe malnutrition, and in patients who are receiving immunosuppressive therapy. Patients
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