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    TB Natural History

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    res.uditacharya
    The document summarizes the possible outcomes of inhaling Mycobacterium tuberculosis bacteria, which are immediate clearance, primary disease, latent infection, or reactivation disease years later. It then discusses the processes of primary disease, latent infection, and reactivation disease in more detail, including factors that can lead to reactivation and consequences if left untreated.

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    TB Natural History

    Uploaded by

    res.uditacharya
    101 views9 pages
    The document summarizes the possible outcomes of inhaling Mycobacterium tuberculosis bacteria, which are immediate clearance, primary disease, latent infection, or reactivation disease years later. It then discusses the processes of primary disease, latent infection, and reactivation disease in more detail, including factors that can lead to reactivation and consequences if left untreated.

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    TB natural history

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    The document summarizes the possible outcomes of inhaling Mycobacterium tuberculosis bacteria, which are immediate clearance, primary disease, latent infection, or reactivation disease years later. It then discusses the processes of primary disease, latent infection, and reactivation disease in more detail, including factors that can lead to reactivation and consequences if left untreated.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    101 views9 pages

    TB Natural History

    Uploaded by

    res.uditacharya
    The document summarizes the possible outcomes of inhaling Mycobacterium tuberculosis bacteria, which are immediate clearance, primary disease, latent infection, or reactivation disease years later. It then discusses the processes of primary disease, latent infection, and reactivation disease in more detail, including factors that can lead to reactivation and consequences if left untreated.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 9

    Inhalation of aerosol droplets containing M.

    tuberculosis with
    subsequent deposition in the lungs leads to one of four possible
    outcomes:
    • Immediate clearance of the organism
    • Primary disease: immediate onset of active disease
    • Latent infection
    • Reactivation disease: onset of active disease many years
    following a period of latent infection
    • About one fourth of the world’s population is estimated to be
    infected with M. tuberculosis.

    • Clinical illness directly following infection is classified as


    primary TB and is common among children in the first few
    years of life and among immunocompromised persons.

    • When infection is acquired later in life, the chance is greater


    that the mature immune system will contain it at least
    temporarily.
    • Bacilli, however, may persist for years before
    reactivating to produce secondary (or postprimary) TB

    • While the bacilli is in the lungs, macrophages produce


    cytokines and chemokines that attract other phagocytic cells,
    including monocytes, other alveolar macrophages, and
    neutrophils, which eventually form a nodular granulomatous
    structure called a tubercle.

    • If the bacterial replication is not controlled, the tubercle


    enlarges and the bacilli enter local draining lymph nodes,
    leading to lymphadenopathy.
    • The lesion (called Ghon focus) produced by the expansion of
    the tubercle into the lung parenchyma and lymph node
    enlargement or calcification together comprise the Ranke
    complex.

    • The bacilli continue to proliferate until an effective cell-


    mediated immune (CMI) response develops, usually 2 to 10
    weeks following initial infection; this occurs in more than 90
    percent of exposed infected individuals.

    • In the lung, failure of the host to mount an effective CMI


    response and tissue repair leads to progressive destruction of
    lung.
    • Unchecked bacterial growth may lead to hematogenous
    spread of bacilli to produce disseminated TB.

    • Disseminated disease with lesions resembling millet seeds has


    been termed miliary TB.

    • Bacilli can also spread mechanically by erosion of the


    caseating lesions into the airways; at this point, the host
    becomes infectious to others.
    • In the absence of treatment, death ensues in up to 80 percent
    of cases.
    Reactivation TB

    • results from proliferation of a previously latent bacteria seeded at the


    time of the primary infection.

    • Upto 10% of infected persons will eventually develop active TB in


    their lifetime—half of them during the first 18 months after
    infection.

    • The lifetime risk of reactivation disease after an index infection is 5


    to 10 percent, with a 5 percent risk in the two to five years
    following infection and another 5 percent risk over the remaining
    lifetime.

    • Among the approximately 5 to 10 percent of infected individuals


    who develop active disease, approximately half will do so within
    the first two to three years following infection.
    • The risk is much higher among immunocompromised
    individuals and, particularly, HIV-infected persons.

    Immunosuppressive conditions associated with reactivation TB


    include:
    • HIV infection and AIDS
    • Chronic and end-stage kidney disease
    • Diabetes mellitus
    • Lymphoma
    • Corticosteroid use
    • Inhibitors of TNF-alpha and its receptor
    • Diminution in cell-mediated immunity associated with age
    • Cigarette smoking
    • The lesion typically occurs at the lung apices, and
    disseminated disease is unusual unless the host is severely
    immunosuppressed.

    • Individuals with one episode of active TB have noted a two- to


    fourfold increased risk of a second episode of active TB
    compared with individuals without prior active disease
    Untreated TB

    • About one-third of patients died within 1 year after diagnosis.

    • 55% of sputum smear-positive cases were dead within


    5 years and up to 86% within 10 years.

    • A lower case fatality rate, around 20%, was estimated for


    untreated paucibacillary smear-negative cases at 5 years.

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