Pulmonology Book



Aka: Tuberculosis, Mycobacterium tuberculosis, Tb
  1. See Also
    1. Tuberculosis Screening in Children
  2. Epidemiology
    1. Worldwide
      1. Latent Tuberculosis Prevalence: 2 Billion people
        1. One third of world population has latent Tuberculosis
        2. Over half of cases in China, India, and Southeast asia
      2. Active Tuberculosis will develop in 10% of latent cases
        1. Most frequent cause of death for young adults
        2. In 1998, 8 million active cases, 2 million deaths
    2. United States
      1. Incidence rose 74% between 1953 to 1985
      2. Active Tb Incidence has fallen to 13,779 cases in 2006 (4.6 cases per 1000,000)
        1. http://www.cdc.gov/tb/surv/surv2006/pdf/FullReport.pdf
      3. Latent Tb Incidence: 10-15 Million in U.S.
      4. Incidence in U.S. born patients declined since 1992
      5. Incidence in foreign born persons Incidence increasing (4-5x U.S)
        1. Latent TB infection in 30-50% of Minnesota refugees
        2. Drug-resistant TB is twice as likely in refugees
      6. Other factors related to resurgence of Tuberculosis in the United States
        1. HIV epidemic
        2. Multidrug-Resistant Tuberculosis
  3. History
    1. George Orwell died of Tuberculosis in 1950
      1. Shortly after Nineteen Eighty four was published
  4. Transmission
    1. Mycobacterium tuberculosis carried in airborne droplets
    2. Active Pulmonary or Laryngeal Tuberculosis transmitted
      1. Sneeze, cough, speak, or sing
  5. Risk Factors
    1. Latent Tuberculosis
      1. See Tuberculosis Risk Factors
    2. Reactivation to active Tuberculosis Risk Factors
      1. Latent Tuberculosis acquired in last 2 years
      2. Immunocompromised patients (e.g. HIV, Cancer, immunosuppressants, TNF agents)
        1. HIV patients have a 10% annual risk of reactivation
      3. Children under age 4
      4. Substance use (esp. Illicit Drugs, but probably also Tobacco and Alcohol)
      5. Prior Tuberculosis with scarring on Chest XRay (apical fibronodular changes)
      6. Body weight >10% below Ideal Weight
      7. Chronic Kidney Disease (esp. End Stage Renal Disease)
      8. Diabetes Mellitus
      9. Prior Bariatric Surgery (Gastric Bypass surgery)
      10. Silicosis
  6. Course
    1. Tuberculin Skin Test conversion within 2-10 weeks
    2. Latent Tuberculosis initially
      1. Tuberculin Skin Test positive without signs, symptoms
      2. Tubercle bacilli remain dormant and viable for years
    3. Lifetime risk of developing active TB: 10%
    4. Highest risk is greatest within 2 years of exposure (5% of latent cases become active)
      1. See risk factors above
  7. Symptoms
    1. Presentation often mimics cancer presentation
    2. Non-specific presentation (most common)
      1. Fatigue
      2. Weight loss
      3. Cachexia
      4. Night Sweats
    3. Pulmonary Tuberculosis symptoms
      1. Productive cough (typically 2-3 weeks)
      2. Hemoptysis (uncommon)
      3. Pleuritic Chest Pain
      4. Dyspnea
  8. Signs
    1. Sites of Involvement
      1. Primary infection: lung involvement
    2. Disseminated Disease
      1. See Extrapulmonary Tuberculosis
  9. Diagnosis
    1. Tuberculin Skin Test (TST, Purified Protein Derivative, PPD)
    2. Mycobacterium Tuberculosis Antigen-Specific Interferon-Gamma Release Assay (IGRA)
      1. IGRA tests will likely replace the Tuberculin Skin Test
      2. Cost is approaching that of TST
    3. In suspected pulmonary Tuberculosis
      1. Induced Sputum samples on 3 consecutive days or
      2. Gastric aspirate may be used in young children or
      3. Bronchoscopy with bronchoalveolar lavage and biopsy
    4. Detection of organisms
      1. Acid fast stain (Sputum, body fluid, biopsy)
        1. Sensitive to >5000 bacilli per ml
      2. Fluorescent stains and DNA probes for rapid diagnosis
      3. Mycobacterial cultures
        1. Sensitive to 10 bacilli per ml
  10. Labs
    1. HIV Test
      1. Test every person with Tuberculosis
  11. Imaging: Chest XRay
    1. Pleural Effusion
    2. Hilar Adenopathy
    3. Cavitary lung lesion (higher risk for infectious spread to contagious contacts)
    4. Miliary lesions (disseminated spread throughout lung)
      1. Associated with capillary lesions
      2. Associated with immunocompromised conditions (e.g. AIDS)
    5. Upper lobe cavitary lesion or infiltrate
      1. Apical and posterior segments often affected
      2. Superior segment of lower lobes may also be affected
    6. Ghon Complex
      1. Healed primary peripheral lesion
      2. Calcified hilar node
    7. HIV positive Chest XRay correlates with CD4 Count
      1. CD4 Cell Count <200
        1. Mediastinal adenopathy
      2. CD4 Cell Count >200
        1. Upper lobe infiltrates and cavitation
    8. Findings not suggestive of prior Tb fibrotic lesion
      1. Isolated granuloma on Chest XRay
  12. Management
    1. See Latent Tuberculosis Treatment
      1. Positive PPD without signs of active Tb
    2. See Active Tuberculosis Treatment
    3. Protocols for active Tuberculosis management
      1. Susceptible Tuberculosis Treatment
      2. Possibly Resistant Tuberculosis Treatment
      3. Multiple Drug Resistant Tuberculosis Treatment
  13. Complications
    1. See Extrapulmonary Tuberculosis
  14. Prevention
    1. Bacille Calmette-Guerin Vaccine (BCG vaccine)
      1. May be indicated in high risk young children in endemic areas
    2. Post-exposure Prophylaxis
      1. Indications
        1. Exposure to untreated active pulmonary or laryngeal Tuberculosis
        2. Regardless of prior BCG vaccine or prior Tuberculosis treatment
      2. Protocol: Symptomatic (e.g. fever, weight loss, Hemoptysis)
        1. Chest XRay
        2. Sputum acid-fast bacilli smear and culture
        3. Consult with pulmonology or infectious disease
      3. Protocol: Asymptomatic
        1. Treatment indications based on Tuberculosis testing at baseline and 8-12 weeks after exposure
          1. Tuberculin Skin Test (PPD) of 5mm or greater OR
          2. Mycobacterium Tuberculosis Antigen-Specific Interferon-Gamma Release Assay positive
        2. Start treatment if positive testing
          1. Isoniazid (INH) with Vitamin B6 supplementation for 9 months
  15. Resources
    1. See Tuberculosis Resources
  16. References
    1. Frieden (2003) Lancet 362:887-99
    2. Potter (2005) Am Fam Physician 72:2225-35

Mycobacterium tuberculosis (C0026926)

Definition (NCI) An obligate anaerobic, weakly Gram-positive species of mycobacterium that is the cause of most cases of tuberculosis.
Definition (NCI) Any bacterial organism that can be assigned to the species Mycobacterium tuberculosis.
Definition (MSH) A species of gram-positive, aerobic bacteria that produces TUBERCULOSIS in humans, other primates, CATTLE; DOGS; and some other animals which have contact with humans. Growth tends to be in serpentine, cordlike masses in which the bacilli show a parallel orientation.
Definition (CSP) species of gram positive, aerobic bacteria that produces tuberculosis in man, other primates, dogs, and some animals which have contact with man; growth tends to be in serpentine, cordlike masses in which the bacilli show a parallel orientation.
Concepts Bacterium (T007)
MSH D009169
SnomedCT 36354002, 113861009
English Tubercle bacillus, human, Mycobacterium tuberculosis, M TUBERC, MTB - Mycobact tuberculosis, M. tuberculosis, mtb, Mycobacterium tuberculosis NOS, Mycobacterium tuberculosis (Zopf 1883) Lehmann and Neumann 1896, MYCOBACTERIUM TUBERCULOSIS, mycobacterium tuberculosi, m tuberculosis, m. tuberculosis, mycobacterium tuberculosis, tb bacillus, tuberculosis mycobacterium, bacterium tuberculosis, tuberculosis bacillus, Bacillus tuberculosis, Bacterium tuberculosis, Mycobacterium tuberculosis typus humanus, Mycobacterium tuberculosis var. hominis, Koch's bacillus, Human tubercle bacillus, Mycobacterium tuberculosis hominis, TB bacillus, MTB - Mycobacterium tuberculosis, Mycobacterium tuberculosis (organism), Mycobacterium tuberculosis hominis (organism)
Dutch Mycobacterium-tuberculose NAO, Mycobacterium tuberculosis, Tuberkelbacterie
French Tuberculose à Mycobacterium SAI, Bacille de Koch, Mycobacterium tuberculosis
German Mycobacterium tuberculosis NNB, Mycobacterium tuberculosis
Italian Mycobacterium tuberculosis NAS, Mycobacterium tuberculosis
Portuguese Mycobacterium tuberculosis NE, Mycobacterium tuberculosis
Spanish Mycobacterium tuberculosis NEOM, Mycobacterium tuberculosis (organismo), Mycobacterium tuberculosis hominis (organismo), bacilo de Koch, bacilo de la tuberculosis humana, Mycobacterium tuberculosis, Mycobacterium tuberculosis hominis
Japanese 結核菌NOS, ケッカクキンNOS, マイコバクテリウム・ツベルクローシス, 結核菌, ヒト型結核菌
Swedish Mycobacterium tuberculosis
Czech Mycobacterium tuberculosis, Infekce způsobená Mycobacterium tuberculosis NOS
Finnish Mycobacterium tuberculosis
Polish Prątki gruźlicze, Mycobacterium tuberculosis
Hungarian Mycobacterium tuberculosis k.m.n.
Derived from the NIH UMLS (Unified Medical Language System)

Tuberculosis (C0041296)

Definition (MEDLINEPLUS)

Tuberculosis (TB) is a bacterial infection caused by a germ called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body. TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.

Symptoms of TB in the lungs may include

  • A bad cough that lasts 3 weeks or longer
  • Weight loss
  • Coughing up blood or mucus
  • Weakness or fatigue
  • Fever and chills
  • Night sweats

If not treated properly, TB can be deadly. You can usually cure active TB by taking several medicines for a long period of time. People with latent TB can take medicine so that they do not develop active TB.

Centers for Disease Control and Prevention

Definition (MSH) Any of the infectious diseases of man and other animals caused by species of MYCOBACTERIUM.
Definition (NCI) A chronic, recurrent infection caused by the bacterium Mycobacterium tuberculosis. Tuberculosis (TB) may affect almost any tissue or organ of the body with the lungs being the most common site of infection. The clinical stages of TB are primary or initial infection, latent or dormant infection, and recrudescent or adult-type TB. Ninety to 95% of primary TB infections may go unrecognized. Histopathologically, tissue lesions consist of granulomas which usually undergo central caseation necrosis. Local symptoms of TB vary according to the part affected; acute symptoms include hectic fever, sweats, and emaciation; serious complications include granulomatous erosion of pulmonary bronchi associated with hemoptysis. If untreated, progressive TB may be associated with a high degree of mortality. This infection is frequently observed in immunocompromised individuals with AIDS or a history of illicit IV drug use. --2004
Definition (CSP) infectious diseases of man and animals caused by Mycobacterium species and characterized by formation of tubercles and caseous necrosis in the tissues; any organ may be affected but in man the lung is the major seat of the disease and the usual portal through which the infection reaches other organs.
Concepts Disease or Syndrome (T047)
MSH D014376
ICD9 010-018.99
ICD10 A15-A19.9, A15-A19
SnomedCT 187285000, 154292008, 154281007, 56717001, 186282009, 373576009, 371569005, 263912007
English Tuberculoses, Tuberculosis, INFECTION TBC, INFECTION TUBERCULOSIS, TUBERCULOSIS, Tuberculosis, NOS, MTB - Mycobacter tuberculosis, MTB - Mycobacterium tuberculosis infection, Mycobacter tuberculosis, Mycobacterium tuberculosis infection, Tuberculosis NOS, TB, tuberculosis (diagnosis), tuberculosis, E-148-14B TUBERCULOSIS, TB (tuberculosis), tb, tbc, Tuberculosis NOS (disorder), Infection TBC, Infection tuberculosis, Tuberculosis [Disease/Finding], Kochs Disease, Disease, Koch's, Koch's Disease, Koch Disease, Disease, Kochs, infection tuberculosis, tuberculous, tuberculosis (TB), TBC, tuberculosis infection, Tuberculosis (A15-A19), Tuberculous infections, Infection due to Mycobacterium tuberculosis, TB - Tuberculosis, Tuberculous, Infection due to Mycobacterium tuberculosis (disorder), Tuberculosis (disorder), Tuberculous (qualifier value), Koch; infection, infection; Koch, infection; tuberculous, tuberculosis; general, tuberculosis; infection, Tuberculous (disorder)
Italian Infezioni tubercolari, Tubercolosi NAS, TB, Infezione tubercolare, Tubercolosi
Dutch TBC, infectie tuberculose, infectie TBC, tuberculose NAO, Koch; infectie, infectie; Koch, infectie; tuberculeus, tuberculose; algemeen, tuberculose; infectie, tuberculose-infecties, tuberculose, Tuberculose
French Tuberculose SAI, TB, Infection à la tuberculose, Infection à TBC, INFECTION TUBERCULEUSE, Infections tuberculeuses, Tuberculose
German Infektion TBC, Infektion mit Tuberkulose, TB, Tuberkulose NNB, TUBERKULOSE INFEKTION, Tuberkuloese Infektionen, Tuberkulose
Portuguese Infecção TBC, Infecção tuberculosa, Tuberculose NE, TB, INFECCAO TUBERCULOSA, Infecções tuberculosas, Tuberculose
Spanish Tuberculosis NEOM, Infección TBC, Infección tuberculosa, Tuberculosis, Tuberculous, Tuberculous (disorder), INFECCION TUBERCULOSA, Tuberculosis NOS, infección por Mycobacterium tuberculosis (trastorno), infección por Mycobacterium tuberculosis, tuberculosis (trastorno), tuberculosis, SAI (trastorno), tuberculosis, SAI, tuberculosis, tubérculo (calificador), tubérculo, Infecciones por Mycobacterium tuberculosis, TB
Japanese 結核感染, 結核, 結核NOS, ケッカク, ケッカクカンセン, ケッカクNOS
Swedish Tuberkulos
Czech tuberkulóza, TBC infekce, Tuberkulóza NOS, Infekce tuberkulózní, Tuberkulóza, TBC, Tuberkulózní infekce
Finnish Tuberkuloosi
Polish Gruźlica, Ftyzjatria
Hungarian tuberculosis k.m.n., tuberculosis, Fertőzés, tuberculotikus, Fertőzés, TBC-s, Tuberculotikus fertőzések, TBC
Derived from the NIH UMLS (Unified Medical Language System)

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