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Clinical Update done On Tuberculosis1Clinical Update done On TuberculosisStudent's Name:Instructor's Name:Date:
Clinical Update done On Tuberculosis2IntroductionTuberculosis is an infectious disease caused by the bacterium,Mycobacterium tuberculosis(Barberis, 2017). Tuberculosis is a contagious infection and the causative bacteria spreadfrom 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 casesand 1.5 million deaths were reported due to tuberculosis in 2014 (Sulis, 2016). Thoughpredominantly prevalent in developing countries, the infection is also seen in the developedworld. In the developing countries, it affects people with low nutritional status and poorimmunity. In the developed world, tuberculosis has become rampant due to the increasingprevalence of AIDS (Gopalan, 2016).Aetiology and pathogenesisTransmission of infection:Transmission of infection in tuberculosis occurs through aerosolspread, i.e. through the route of inhalation. Key factors influencing risk of transmissioninclude 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 orhave cavities in lung are high potential sources of infection (Escombe, 2008).Course of disease:Most individuals exposed to the tubercular bacilli do not develop aninfection. 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 Tuberculosis33.Individuals may develop progressive tubercular disease.Immune response in tuberculosis:The outcome of an infection with the tuberculosis bacilliis determined by the innate and adaptive immune responses in the body. This immunologicalarmy includes several types of cells and mediators, the key ones being macrophages anddendritic cells (Kleinnijenhuis, 2009).Latent tuberculosis:The presence of immunological response to a previously acquiredtubercular infection without any clinically evident signs of active tuberculosis is called latenttuberculosis. This remains an important class of patients and calls for treatment to reduce theburden of tuberculosis.Clinical featuresThe most common symptom of tuberculosis is a persistent cough that lasts several weeks tomonths (Davis, 2014). Other key clinical features include the following (Sulis, 2016):Presence of at least one of the following four suggestive symptoms should raise asuspicion 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, malnutritionThe clinical course of pulmonary and extrapulmonary tuberculosis is explained below(Heemskerk, 2015):
Clinical Update done On Tuberculosis4Figure 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 andmay go undetected. In response to the infection, a granuloma, called the primary Gohncomplex, is formed in the lower or middle lobes of the lungs. This may be accompanied byenlarged draining lymph nodes and inflammation in the overlying pleura. Typically, thisprimary 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 areinfection may occur. After a period of latency, reactivation of the disease may occur. Thisis also called post primary tuberculosis. Reactivation is clinically indistinguishable from theprimary tuberculosis and usually occurs in immunocompromised conditions like AIDS,severe malnutrition, and in patients who are receiving immunosuppressive therapy. Patients