Tuberculosis

Tuberculosis (TB) is an infectious disease caused by the

bacterium Mycobacterium tuberculosis (MTB). Tuberculosis generally
affects the lungs, but can also affect other parts of the body. Most
infections do not have symptoms, in which case it is known as latent
tuberculosis. About 10% of latent infections progress to active disease
which, if left untreated, kills about half of those infected. The classic
symptoms of active TB are a chronic cough with blood-
containing sputum, fever, night sweats, and weight loss. The historical
term "consumption" came about due to the weight loss. Infection of
other organs can cause a wide range of symptoms.

Tuberculosis is spread through the air when people who have active TB
in their lungs cough, spit, speak, or sneeze. People with latent TB do not
spread the disease. Active infection occurs more often in people
with HIV/AIDS and in those who smoke. Diagnosis of active TB is based
on chest X-rays, as well as microscopic examination and culture of body
fluids. Diagnosis of latent TB relies on the tuberculin skin test (TST) or
blood tests.

Signs and symptoms

The main symptoms of variants and stages of tuberculosis are given ,
with many symptoms overlapping with other variants, while others are
more (but not entirely) specific for certain variants. Multiple variants may
be present simultaneously.
Tuberculosis may infect any part of the body, but most commonly occurs
in the lungs (known as pulmonary tuberculosis).Extrapulmonary TB
occurs when tuberculosis develops outside of the lungs, although
extrapulmonary TB may coexist with pulmonary TB. General signs and
symptoms include fever, chills, night sweats, loss of appetite, weight
loss, and fatigue.Significant nail clubbing may also occur.
Pulmonary
If a tuberculosis infection does become active, it most commonly
involves the lungs (in about 90% of cases). Symptoms may
include chest pain and a prolonged cough producing sputum. About 25%
of people may not have any symptoms (i.e. they remain
"asymptomatic"). Occasionally, people may cough up blood in small
amounts, and in very rare cases, the infection may erode into
the pulmonary artery or a Rasmussen's aneurysm, resulting in massive
bleeding.Tuberculosis may become a chronic illness and cause
extensive scarring in the upper lobes of the lungs. The upper lung lobes
are more frequently affected by tuberculosis than the lower ones.The
reason for this difference is not clear.It may be due to either better air
flow ,or poor lymph drainage within the upper lungs.

Extrapulmonary

In 1520% of active cases, the infection spreads outside the lungs,

causing other kinds of TB. These are collectively denoted as
"extrapulmonary tuberculosis".Extrapulmonary TB occurs more
commonly in immunosuppressed persons and young children. In those
with HIV, this occurs in more than 50% of cases. Notable
extrapulmonary infection sites include the pleura (in tuberculous
pleurisy), the central nervous system (in tuberculous meningitis),
the lymphatic system (in scrofula of the neck), the genitourinary
system (in urogenital tuberculosis), and the bones and joints (in Pott
disease of the spine), among others.

Spread to lymph nodes is the most common. An ulcer originating from

nearby infected lymph nodes may occur and is painless, slowly enlarging
and has an appearance of "wash leather".

When it spreads to the bones, it is known as "osseous tuberculosis", a

form of osteomyelitis. A potentially more serious, widespread form of TB
is called "disseminated tuberculosis", also known as miliary tuberculosis.
Miliary TB currently makes up about 10% of extrapulmonary cases.

Mycobacteria

The main cause of TB is Mycobacterium tuberculosis (MTB), a

small, aerobic, nonmotile bacillus.The high lipid content of this pathogen
accounts for many of its unique clinical characteristics. It divides every
16 to 20 hours, which is an extremely slow rate compared with other
bacteria, which usually divide in less than an hour. Mycobacteria have
an outer membrane lipid bilayer.[25] If a Gram stain is performed, MTB
either stains very weakly "Gram-positive" or does not retain dye as a
result of the high lipid and mycolic acid content of its cell wall. MTB can
withstand weak disinfectants and survive in a dry state for weeks. In
nature, the bacterium can grow only within the cells of a host organism,
but M. tuberculosis can be cultured in the laboratory.
Using histological stains on expectorated samples from phlegm (also
called "sputum"), scientists can identify MTB under a microscope. Since
MTB retains certain stains even after being treated with acidic solution, it
is classified as an acid-fast bacillus.The most common acid-fast staining
techniques are the ZiehlNeelsen stain and the Kinyoun stain, which dye
acid-fast bacilli a bright red that stands out against a blue background.
Auramine-rhodamine staining and fluorescence microscopy are also
used.

Transmission

When people with active pulmonary TB cough, sneeze, speak, sing, or

spit, they expel infectious aerosol droplets 0.5 to 5.0 m in diameter. A
single sneeze can release up to 40,000 droplets. Each one of these
droplets may transmit the disease, since the infectious dose of
tuberculosis is very small (the inhalation of fewer than 10 bacteria may
cause an infection). People with prolonged, frequent, or close contact
with people with TB are at particularly high risk of becoming infected,
with an estimated 22% infection rate. A person with active but untreated
tuberculosis may infect 1015 (or more) other people per year.
Transmission should occur from only people with active TB those with
latent infection are not thought to be contagious. The probability of
transmission from one person to another depends upon several factors,
including the number of infectious droplets expelled by the carrier, the
effectiveness of ventilation, the duration of exposure, the virulence of
the M. tuberculosis strain, the level of immunity in the uninfected person,
and others.The cascade of person-to-person spread can be
circumvented by segregating those with active ("overt") TB and putting
them on anti-TB drug regimens. After about two weeks of effective
treatment, subjects with nonresistant active infections generally do not
remain contagious to others.If someone does become infected, it
typically takes three to four weeks before the newly infected person
becomes infectious enough to transmit the disease to others.