Tuberculosis as

infectious disease.
Lecture № 1.
The Department of Tuberculosis of KSMA.

Doc. Fydorova S.V.

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 Tuberculosis
is infectious disease caused by
Mycobacterium tuberculosis. Cellular
hypersensitivity, specific granulomas
(tubercles) in different organs and
tissues and various clinical picture
develop. TB can affect lymphatic
system, bones, joints, genitourinary
system, nervous system and other
organs, but especially lungs. TB is a
social disease, because it’s rate depends
on social and economical live in the
country.

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 Tuberculosis
• The genus Mycobacterium
originated more than 150 million
years ago (Daniel, 2006)
• The modern members of M.
tuberculosis complex seem to have
originated from a common
progenitor about 15000 - 35000
years ago (Gutierrez, 2005)

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 Tuberculosis
• was documented in Egypt, India,
and China as early as 5000, 3300,
and 2300 years ago, respectively
(Daniel 2006)
• Typical skeletal abnormalities,
including Pott’s deformities, were
found in Egyptian mummies

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 Tuberculosis
• Mummy, Museum
«Arqueológico de la
Casa del Marqués de
San Jorge», Bogota,
Colombia.
• Right: Computerized
tomography showing
lesions in the
vertebral bodies of
T10/T11.

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 Ancient doctors
described typical symptoms of TB
(severe cough, sputum production,
haemoptysis, loss of the body weight,
fever etc). These symptoms fastly
caused patient's exhaustion. So some
Russian names of disease means:
«чахотка» (from the Russian word
«чахнуть», this word is translated as
«consumption, to wither»); and «фтиза»
(from the Greece word «phthysis», it
means «exhaustion, destruction» too).

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 The greatest scientific
discovery happened in 1882
The famous Germen
microbiologist Robert
Koch discovered the main
reason of TB (M.
tuberculosis). It was
reported at the session
of phthysiological society
on the 24th of March in
1882. Robert Koch was
awarded the Nobel Prize
for his discovery in
1911. Now this day is
International Day of the
Fighting against TB.

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TB classification by WHO
• Pulmonary tuberculosis • Extrapulmonary
• Smear-positive cases tuberculosis
(two specimens of sputum • Tuberculous meningitis
at least are positive, or • Tuberculosis of lymphatic
only one specimen is
positive and there are nodes
typical clinical symptoms • Skeletal tuberculosis
and X-ray findings of TB) • Tuberculosis of kidneys
• Smear-negative cases • Tuberculosis of abdominal
(there are three organs
specimens of sputum at
least and all of them are • Tuberculosis of skin
negative, but there are • Tuberculosis of eyes
typical clinical symptoms etc.
and X-ray findings of TB)

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 Extrapulmonary
tuberculosis

Tuberculous spondylitis (pathological rupture of

affected vertebras)

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 Extrapulmonary
tuberculosis

Tuberculous gonitis (tuberculosis of knee joint)

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 Extrapulmonary
tuberculosis

Fibrous-cavernous tuberculosis of kidney

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 Extrapulmonary
tuberculosis

Tuberculosis of tongue

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 Extrapulmonary
tuberculosis

Tuberculous chorioretinitis

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 Extrapulmonary
tuberculosis

Tuberculosis of skin (lupus tuberculosis)

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 Extrapulmonary
tuberculosis

• Lymph node TB in cervical area

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 Epidemiological
evidence
the level of persons are infected
with MBT –
it is a number (%) of people with
positive tuberculin skin test in
community
Dates of WHO: 1/3 of the world
population is infected with MBT

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 Incidence –
is a number of new active TB cases
within a year counting upon 100
thousand of population
Dates of WHO: there are 8-10
mln of new TB cases in the world
every year

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 Prevalence –
is a general number of active TB
cases at the end of the year
counting upon 100 thousand of
population
Dates of WHO: there are 16-20
mln of TB cases in the world

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 Mortality –
is a number of TB deaths within an
year counting upon 100 thousand of
people
Dates of WHO: there are 3 mln of
TB death in the world every year

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The global epidemiology of
TB
• Every 4 second 1 person in the
world becomes ill with TB
• Every 10 second 1 person in the
world dies from TB
• There are about 95% of all ТB
cases and 98% of TB deaths in the
world in developing countries with
limited resources
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 Estimated TB incidence rates,
2004
(source: WHO report, 2006)

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 Epidemiological
evidence in Kyrgyzstan
140 127,3127,4
121,8 123,2
114,4 114,3 115,7
120 108,9 110,9 108,8
95,3
100 87 102,4
72,4
80
56,5
58 55 59,5
60

40

20 12,413,4 13,5 16 13,5 13,6 12,613,5 13,611,811,2 11 10,2

9,6 9,2

0
19 1
92
93
94
95

19 6
19 7
98
99
00
01

20 2
20 3
04
05
06
07
08
9

9
9

0
0
19

19
19
19
19

19
20
20
20

20
20
20
20
заболеваемость смертность

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 On modern classification МBТ belongs to
the Order of Actinomycetae (radiant
mushrooms), the Family of Mycobacteriaecae,
the Genus of Mycobacterium
There are three related microorganisms
called «MBT-complex» (Mycobacterium
of tuberculosis):
• М. tuberculosis (МBТ) – is especially
pathogenic kind for people
• М. bovis – is especially pathogenic for
the cattle
• М. africanum –the main reason of TB
cases in Africa

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 Basic properties МBТ

• acid-alcohol-
alkalai fastness
• variability
• pathogenicity
• virulence

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 The main types of
MBT-variability
• morphological variability (L–forms,
drug-resistant forms, filtering
forms, granulose forms, BCG-
Calmett-Geren bacilli etc.)
• biological variability
• cultural variability
• staining variability

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 Methods of sputum
microscopy
• Method of simple (direct)
microscopy (Ziehl-Neelsen staining)
• Method of flotation (enrichment) -
raises productivity on 10 %
• Method of luminescent microscopy
• Electron microscopy

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 Method of direct
sputum microscopy
Advantages Lacks
• Fast method • Low sensitiveness (result
• Cheap method is positive when there are
• Simple method more than 5000 of
• Informative method – microorganisms in 1 ml of
detection of MBT is sputum)
confirmation of diagnosis • Impossibility of modified
МBТ detection
• Possibility of health care
workers infection during
the procedure of sputum
collection and examination

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Mycobacterium tuberculosis
looks red by microscopy
(Ziehl-Nilsen staining)

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 Bacteriological method
(cultural examination)
Advantages Lacks
• High sensitiveness (result • High price
is positive when there are • Long time of
20-50 MBT in 1 ml of MBT growth in
sputum) the media (14-90
• Possibility of МBТ type days),
definition, MBT drug- impossibility of
susceptibility to modified МBТ
antituberculous medicines, growth
the level of МBТ • Labour-
elimination etc. intensiveness

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 Bacteriological method
(cultural examination):

Colonies of Mycobacterium tuberculosis in

Löwenstein-Jensen medium

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 Biological method
(infection of experimental
animals)
Advantages Lacks
• The highest • High prices
sensitiveness (from 1 • Long time
to 5 microbe cells • Labour-intensiveness
may cause
generalized
tuberculosis in
experimental animal)

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 Some modern methods
of MBT detection
Biological microchips
• BACTEC MJIT
• polymerase chain
reaction
• biological Positive samples show up
microchips as yellow in the well,
negative samples are
colourless

The BACTEC TB-460 instrument MGIT tube

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 All microbiological
methods
of МBТ detection have specificity,
i.e. detection of MBT is 100%
confirmation of diagnosis «TB»

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 Radiological methods
are important in the diagnosis and
management of TB, especially in smear-
negative cases.
Chest X-ray findings, associated with
pulmonary TB (PTB), are non-specific.
There aren’t chest X-ray findings
absolutely typical for PTB. Diseases
other than PTB can causer both the
«classical» and the «atypical» chest X-
ray findings.

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 X-ray methods
• Roentgenoscopy
• Roentgenography
• Fluorography
• Electroroentgenography
• Tomography
• Roentgenokimography
• Brochography
• Computerized
tomography
etc.

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 X-ray syndromes
• X-ray syndrome of
«total and subtotal
opacity» (the most
frequent X-ray
syndrome):
• infiltrative
tuberculosis
• caseous pneumonia
• pneumonia
• etc.
Caseous pneumonia of the left lung
with destruction and bronchogenous
dissemination

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 X-ray syndromes
• X-ray syndrome of
«round shadow» (may
be caused by about
103 different
diseases):
• tuberculoma
• peripheral cancer
• ecchinococcal cyst
• interlobar pleuritis
• etc.
Tuberculoma of the left upper lobe
with destruction

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 X-ray syndromes
• X-ray syndrome of
«focal shadow»:
• focal tuberculosis
• peripheral cancer at
early stage
• ecchinococcal cyst at
early stage
• focal fibrosis
• focal pneumonia
• etc.
Focal tuberculosis
of the left upper lobe

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 X-ray syndromes
• X-ray syndrome of
«dissemination» (the most
difficult X-ray syndrome,
caused by 140 diseases):
• miliary tuberculosis
• disseminated tuberculosis
• oncological diseases
• professional diseases
• granulomatosis of
nontuberculous nature
• pneumonias
• etc.

Miliary tuberculosis
of the both lungs

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 X-ray syndromes
• X-ray syndrome of
«ring-like shadow»:
• cavernous tuberculosis
• fibrous-cavernous
tuberculosis
• destruction of cancer
• ecchinococcal cyst after
rupture
• abscess after rupture
• bullous emphysema
• etc.
Fibrous-cavernous tuberculosis
of the right upper lobe

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 X-ray syndromes
• X-ray syndrome of
«lung-root pathology and
enlargement of
mediastinal lymph nodes»:
• tuberculosis of
mediastinal lymph nodes
• lymphogranulomatosis
• sarcoidosis
• retentional cyst of
bronchi
• etc.
Tuberculosis of mediastinal
lymphatic nodes with calcification

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 X-ray syndromes
• X-ray syndrome of
«mediastinum
pathology»:
• thymoma
• myxoma of heart
• diverticulum of
esophagus
• hernia of esophageal
foramen of
diaphragm
• etc. Lymphosarcoma

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 X-ray syndromes
• X-ray syndrome of
«lung-picture
pathology»:
• diseases of
connective tissue
• viral pneumonia
• hypostatic pneumonia
• cancer lymphangitis
• pneumosclerosis
• etc.
Sclerodermia

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 X-ray syndromes
• X-ray syndrome of
«pleural pathology»:
• pleuritis
• pleural mesothelioma

Total pleuritis
of the right pleural cavity

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 X-ray syndromes
• X-ray syndrome of
«total transparency»:
• spontaneous
pneumothorax

Spontaneous pneumothorax
of the right lung

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 Thank you
for your attention!

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