TUBERCULOSIS

Synonyms
• Phthisis ('Consumption' - Tissue wasting), Pearl disease (Grape-like lesions in the
peritoneum and pleura), Scrofula (King's evil), Pott's disease (paralysis of the hind
limbs due to TB nodules of the spine), 'Rajajakshman' (the King of diseases as per
Hindu texts), Acnitis, Lupus Vulgaris.
Etiology
• Tuberculosis is caused by bacillus of the bacteria belong to the genus Mycobacterium.
Mycobacterium organisms are facultative intracellular pathogens, Gram positive,
acid fast (because Mycobacterium has mycolic acid in its cell wall) and aerobic.
• The most common zoonotic species of Mycobacteria are:
– M.bovis - Cattle, dogs and swine
– M.tuberculosis
– M.avium complex (MAC)
– M.marinum, M.fortuitum, M.platypolcitis
– MAC is composed of 28 serotypes. MAC includes M.avium - intracelluare
(MAI) and M.avium - intracellulare - scrofulaceum (MAIS). The disease
produced by MAC complex is called as Mycobacteriosis in man.
Host range
• Man is the main reservoir host for the M. tuberculosis.
• Bovines are the important hosts for the M. bovis and it is also cause infection in man,
sheep, goat, buffalo, dog, cat, horse, pig, badgers, elephants, marsupials, mink, moles
cackattoo, parrot etc…
Incidence
• The disease is discovered more than 100 years ago.
• Morbidity and mortality rates continue to be higher among urbanites, minorities, the
poor, the homeless, and persons infected with HIV.
• The incidence of TB is influenced by many factors, are:
– Poor or inadequate health care
– Poor standard of living and socioeconomic conditions
– Malnutrition
– Higher population density
– Occupational contraction
– Poor personal hygiene
– Lack of education and awareness
– Other diseases like, HIV/AIDS, Diabetes mellitus.
– Close confinement of the human population.
In India
– India globally ranks first in tuberculosis.
– TB is one of the biggest public health problems in India. As per the statistics,
every year approximately 1.8 million people develop TB, of which 4.17 lakhs
people die with TB.
– It is estimated that loss of an average about 83 work-days annually due to TB.
Reservoir
– M.bovis - Cattle, dogs and swine
– M.avium complex (MAC) - Birds, swine and sheep
– M.tuberculosis - Man, nonhuman primates, cattle, dogs, swine and psittacines
– M.marinum, M.fortuitum, M.platypolcitis - Fish
Source of infection
• Human source: Sputum.
• Bovine source: Milk and faeces.
• Environmental source: Water, soil and dust contaminated with human and animal
sources. Mycobacterium multiply in the water and soil.
• Infected patients are infective as long as they remain untreated.
• Effective treatment for TB reduces infectivity by 90% with in 48 hrs.
Transmission
In humans
– Ingestion and inhalation are the most common mode of transmission.
– Mycobacterium bacilli are transmitted from infected animals or infected tissue
primarily via the aerosol route.
– Inhalation of droplets or droplet nuclei of sputum-positive patients, coughed
up materials and fomites contaminated with droplets of sputum.
– Contracted via ingestion or cutaneous inoculation of the bacilli.
– Exposure to dusty bedding of infected animals, coughing of infected animals
and aerosolization of the organism during sanitation procedures may also be
sources of the disease in the laboratory environment.
– Consumption of infected milk and contaminated food products.
In animals
– Directly through contact with tuberculosis animals or their discharges or their
sputum.
– Contact with tuberculosis peoples.
– Calves by ingestion of contaminated milk.
– Congenital infection.
– Through artificial insemination with infected semen.
Clinical signs
In Man
• M. bovis can cause the similar clinical infection as M. tuberculosis. The most
prevalent forms caused by M. bovis were extrapulmonary particularly in childrens.
• The patient may be asymptomatic for years. General signs may include
anorexia, weight loss, lassitude, fatigue, fever, chills and cachexia.
• In humans clinical tuberculosis occurs in 3 stages
1) primary tuberculosis
2) secondary tuberculosis
3) extrapulmonary tuberculosis
– In humans, the clinical signs depend on the organ system involved.
 – Chronic pulmonary TB: The most familiar signs related to pulmonary TB are
cough, sputum production and hemoptysis. It is common in middle aged
people who have preexisting pulmonary lesions.
– Lymphadenitis: It is common in children from 18 months to 5 years of age.
Lymph nodes are primarily those of the neck close to the jaw bone (cervical
lymph nodes) affected.
– Skin or cutaneous TB: Skin lesions are characterized by ulcers or by papular
lesions progressing to dark suppurative lesions.
– Miliary TB is most often seen in the very young and old people.
• M.marinum of fish strain causes granulomas on the extremities as a group of papules
that ulcerate and scab over, is described as
Clinical signs in animals
In cattle:
• Usually superficial lymphnodes will be swollen and chronic TB is the common from
in cattle
• If udder is affected it will show a progressive hardening and swelling. Milk becomes
thin and watery with yellow flakes.
• The generalized TB cases animals becomes emaciated (hide bound condition), cough,
dry and harsh body coat, sunken eyes, sometime diarrhoea, fluctuating body
temperature, snoring due to retropharyngeal lymphnode.
In dogs and cats
• Marked emaciation, Discharge from nose, Cough, Pleurisy, Dyspnoea and Swelling
on chest and abdomen
In poultry
• Severe emciation , pale mucus membrane, severe diarrhoea are common symptoms
Diagnosis
In animals
Microscopic detection of acid-fast bacilli:
Histological examination of tubercle of suspected animals and carcass by using acid-
fast stain(ZN stain).
Delayed type of hyper sensitivity test:
- single intradermal test
- stormant test
- short thermal tets
- subcutaneous teuberculin test
- opthalmic test
Animal inoculation test:
Inoculation of suspected sample particularly milk sample into thighs of guinea pigs
which results into typical lesions of tuberculosis of liver, spleen and lymphnodes of infected
animals.
Isolation and identification:
By using specific media like Dorset egg media, Lowenstein Jensen medium (slants) or
Herold egg yolk media incubated for up to 8 weeks. Identification by growth rate, colonial
appearance.
Molecular techniques:
- Multiplex PCR
-Gamma-interferon assay
- combination of skin test and ELISA.
In man
• Acid-fast staining of sputum or other specimen form the suspected cases.
• Roentogenography: chest X-rays
• Mantoux test:
– 0.1 ml of PPD is injected intradermally into the fore arm to observed for
formation of belb and then measure the size of belb after 48 to 72 hrs.
– Reaction exceeding 10 mm is positive, <6 mm is negative (but having risk of
developing TB), between 6 mm and 9 mm is doubtful and 20 mm is strong
positive.
other tets : gas chromatography, DNA hybridization
Isolation of pathogen: It is the only confirmatory test.
Treatment
• Objective of chemotherapy is to cure and eliminate the bacilli.
• The patient must take the correct drug at the correct dosage for the correct length of
time.
• Incomplete treatment leads to relapse and development of MDR-TB and XDR-TB
(Extreme Drug Resistant TB).
• Anti-tuberculosis drugs are:
– Bactericidal drugs: Rifampicin (10 - 12 mg/kg body weight), Isoniazid (4 - 5
mg/kg body weight), Streptomycin (0.5 - 1 gm/kg body weight) and
Pyrazinamide (30 mg/kg body weight), which kill the bacilli in-vivo.
– Bacteriostatic drugs: Ethambutol (15 mg/kg body weight) and Thioacetazone
(2 mg/kg body weight), which inhibit the multiplication and lead to their
destruction by the cell mediated immune response.
Prevention and control
• Personnel education about wearing of protective clothing when handling infected
animals or humans.
• A regular health surveillance programme for humans.
• Isolation and quarantine of suspect animals.
• Careful disposal of infected animals.
• Consumption of pasteurized milk
• Screening of herd, and segregation and slaughter of positive reactors.
• Curative method: Case finding and chemotherapy
• Preventive method: Vaccination with BCG vaccine (Bacille Calmette-Guerin strain of
M.bovis).
• Control and eradication of bovine tuberculosis.
• World Tuberculosis Day, falling on 24th March each year