Pulmonary Tuberculosis

Pulmonary Tuberculosis

Question.  Write etiology, diagnosis and management of pulmonary tuberculosis.
Or
Write in brief sign, symptoms and treatment of pulmonary tuberculosis

Answer. Involvement of lungs by tuberculosis is known as pulmonary tuberculosis.

Etiology pulmonary tuberculosis.

1. Mycobacterium tuberculosis leads to the pulmonary tuberculosis.
2. In immunocompromised patients or in children tuberculosis can be caused by atypical Mycobacterium.

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Diagnosis pulmonary tuberculosis.

It is based on clinical signs and symptoms as well as investigations.

Symptoms pulmonary tuberculosis.

1. Evening rise of temperature
2. Night sweats
3. Malaise and cachexia
4. Irritability and diffilty in concentration.
5. Cough and expectoration for more than three weeks.
6. Pleuritic chest pain
7. Breathlessness is the feature of advanced disease.
8. Indigestion and dyspnea
9. Amenorrhea often in young women
10. Hoarseness of voice.
11. Sputum can be mucoid, purulent or blood stained.
12. Hemoptysis is a classical feature
13. Presence of localized wheeze from local ulcer or narrowing of major bronchus.
14. Presence of recurrent cold.

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Lung Disease Emphysema

Physical signs pulmonary tuberculosis.

1. Fever and weight loss
2. Tachycardia and tachypnea
3. Rapid pulse rate
4. Physical signs of collapse, consolidation, cavitation, firosis, bronchiectasis, pleural effsion or pneumothorax.
5. In some cases only localized *rhonchi or rales are present.
6. Clubbing of figers is present in chronic disease.
7. Most common physical sign of chest is fie crepitation in the upper part of one or both the lungs. This is heard on
   taking a deep breath after coughing.
8. Later on, there can be presence of dullness to percussion or bronchial breathing in upper part of one or both the lungs.
9. In chronic cases, there is evidence of volume loss and mediastinal shift.
10. Hilar, mediastinal and cervical groups lymph nodes are enlarged with splenomegaly.

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Investigations pulmonary tuberculosis.

Serology: In this ELISA, technique is used which helpful in diagnosis of tuberculosis in children. PCR technique is more specifi and sensitive serological test than ELISA, but PCR is less used due to its high cost.

Chest X-ray:

Multiple nodular infiltrations or ill-defined opacities in one of the upper lobes are characteristic for pulmonary tuberculosis. An area of translucency in radiopacities is indicative of cavitation.

Presence of cavity is indicative of an active lesion. In some of the patients multiple thick­walled cavities can be seen. At the time of firosis, trachea and mediastinum shift to same side.

Fibrosis can also cause calcifiation.

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Pathological tests:
Blood examination: Peripheral blood examination shows monocytosis, i.e. 8 to 12%

ESR is elevated.

Tuberculin test: It is a test to recognize prior tubercular infection, and is done by injecting one unit of purified protein derivative (PPD) on the forearm and readings taken after 48 hours. Induration of more than l5 mm indicates a positive test.

The younger the patient, the greater the significance of a positive test. A negative test does not always exclude tubercular infection since it may be negative in patients with blood malignancies, malnourishment, and immunosuppressive therapy. The tuberculin test is nonspecific and only indicates prior infection. Its sensitivity wanes with age.

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Management pulmonary tuberculosis.

Chemotherapy: For details, refer to Ans18 of same chapter.
Corticosteroids: They are to be given in the severe cases to enable them to survive till antitubercular drugs become effctive. Oral prednisolone is given in doses of 20 mg orally for 6 to 8 weeks. Steroids produce euphoria and increase appetite in the patients.
Surgery: Surgical resection of infected lobe is feasible.

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Symptomatic treatment:
Cough: If it is irritative, linctus codeine is given.
Smoking should be stopped.
Laryngitis: Rest is given to the voice. If pain is present anesthetic powders, spray and lozenges are given.

Lung Disease Emphysema