TUBERCULOSIS – understanding the WHY & HOW of this disease!!




The most common route of spread of tuberculi bacilli is via DROPLET FROM DISEASED PERSON. When a person coughs, the bacilli present in his/her airway is thrown out into air. This travels via air into other persons airway system.

Some other causes of spread of tuberculosis is via lymph and blood. however these routes are responsible for spread of tuberculii from lungs to other organs leading to tuberculosis of organs other than lungs.

Tuberculosis is one of the most prevalent micro organisms present in a developing country such as India.
There are very high chances that you might have been infected with tuberculosis but showed no symptoms or successfully eliminated the disease. All Thanks to the immunity you possess.
The immunity system in our body is present in almost every part of our body- right from skin, lungs, urinary tract to gastro intestinal tract and reproductive system.
The immunity system is present in our lungs which includes the Microglia (small hair like process which pushes out dust), Macrophages called the Alveolar Macrophages (which eat the disease causing micro organisms), Surfactant released by the type 2 pulmonary cells all form an army to protect you from every organism you inhale through your nose.
Tuberculosis or most disease occurs when our immunity is insufficient to kill that micro organism completely or partially. This leads to a series of events which causes signs and symptoms such as fever, cough, breathlessness and others

Types of Tuberculosis

Tuberculosis is often co-related with lungs. Which is true. Most of the times lungs are the organs which are affected with tuberculosis.
But, not in every case.
Tuberculosis enters our body through the lungs but can spread to other organs such as intestine or spine or kidney
Accordingly, Tuberculosis can be of 2 main types

  1. Primary Tuberculosis
    This indicates the first site of contact between body and the micro organism. Lungs are the only organs affected in case of primary tuberculosis.
    As discussed earlier, in most cases the primary tuberculosis may go un-noticed because immunity of a normal healthy individual is successful in killing the micro-organism. Hence symptoms of primary tuberculosis are rare.
    Symptoms occurs in people who have less immunity such as people who belong to any of following categories-
    old aged and children
    regular smoking
    regular heavy alcohol consumers
    people taking steroids – either as medical treatment or not
    cancer patients – certain cancers may decrease the immunity while in others the radiotherapy or chemotherapy treatment leads to decreased immunity
    chronic liver or kidney diseases
    Uncontrolled diabetes or hypertension
    HIV patients are at more risk of developing tuberculosis than the common people. Tuberculosis has higher chances of developing complications in HIV patients
    Malnutrition and under nourished
    Malnourishment is one of the most common causes of tuberculosis in underdeveloped and developing countries such as India
    In such patients, the body soldiers fail to engulf and kill the mycobacterium tuberculae. This leads to collection of macrophages in a particular place. This shows in chest X RAY or CT SCAN as a white patch in particular region.
    The site of primary lung tuberculosis is usually around the middle lobes
  2. Secondary tuberculosis
    In most cases, our immunity might not be able to completely eliminate the infection and in such cases, tuberculous infection will remain as an inactive form. This will now wait as an opportunistic insect in your lungs and wait for its opportunity.
    When anytime in life, your immunity decreases the inactive tuberculosis organism will now become active and will cause SYMPTOMS. (RE-INFECTION)
    Secondary tuberculosis may also occur when a person gets infected with tuberculosis or the second time in his life (RE-INFECTION)
    In India, secondary tuberculosis occurs usually when the person is infected with tuberculosis for the second time.
    Site of secondary infection-
    Due to re-activation or re-infection of old tuberculosis
    Secondary tuberculosis in lungs usually presents in the upper segments of lungs.
    Lymph Nodes near the lungs
    This is one of the most common locations in secondary tuberculosis.
    Lymph nodes near the starting of bronchus are usually site of lymph nodes inaction.
    But tuberculosis has a tendency to spread through the lymph vessels in your body. Hence this secondary tuberculosis may or not always be present in lungs. This can be in locations other than lungs as well, such as:
    Abdominal tuberculosis
    Abdominal tuberculosis is the most common site of tuberculosis outside the lungs
    Most common location is ileum (the last pat of small intestine)
    Spine tuberculosis
    Most commonly location for spine tuberculosis is T12 and L1
    Brain tuberculosis
    Pericardium tuberculosis
    Tuberculosis in the space around heart
    Kidney tuberculosis
    Spine tuberculosis
    Tuberculosis of reproductive organs
    Epididymis, prostate, fallopian tube
    Presence of tuberculosis in locations other then lungs indicates that this is a case of secondary tuberculosis. And that patient has suffered from tuberculosis earlier in life also. That primary tuberculosis may have symptoms or may have a normal short lasting cough or may even not have any symptoms.
    Secondary tuberculosis always occurs after lung infection.

Symptoms of Tuberculosis
The most common symptom that a person infected with tuberculosis might have is – No symptoms
In most cases the immunity of the body is sufficient enough to kill the bacteria and cause no symptoms.
But in people with lower immunity, there is presence of symptoms. These may depend on the location where it is present
General symptoms of tuberculosis-
Evening fever is typical of tuberculosis
Rapid weight loss
sweating in evening or night
Secondary infections
Most commonly suspected to infection from agents such as hemophilus influnzae and moraxella catarralis
Most common and the most famous symptoms of lung tuberculosis
recurrent cough for more than 2 weeks can be tuberculosis
Blood in cough (hemoptysis)
This indicates the rupture of lung blood vessel. This can be a major or minor blood vessel depending on the location
Abdominal pain
Recurrent urine infections
Pus in urine

Complication of Tuberculosis
Complication occurs when people ignore the signs and symptoms of disease. They also occur when people go for non medical means of treatment which is common in rural population in India.
In such cases long standing tuberculosis may cause the following complication
Fibrosis of lungs
In common languages this can be called as lungs becoming stone like. This can be a permanent or temporary change depending on the case progression.
If it becomes permanent, a part of lungs remains non functional for life time. the only way to treat this is lung transplant
Miliary tuberculosis
spread of tuberculosis throughout the lungs in form of small small spots
This can be even in other organs such as liver, kidney etc.
Collection of pus in lungs. The usual reaction of most infection in body is formation of pus. Pus is collection of dead bacteria plus dead WBC (soldier cells)
this needs to removed using means such as lung tapping
Broncho-Pulmonary fistula
Tuberculosis has a capacity to spread to nearby regions. During this process it forms a pathway to spread. This is when there is formation of connection between alveoli and bronchus.
(alveoli are bubbles where air exchanges occur and bronchus is the path through which air reached the alveoli, these are a part of wind pipe)
Pleural effusion
collection of blood plasma (part of blood other than RBC and WBC)
Kidney Tuberculosis
permanent kidney damage
Spine tuberculosis
bending of spine known as KYPHOSCOLIOSIS

Prevention from tuberculosis
The most important way to protect from tuberculosis is to keep your immunity high
For those who belong to the high risk categories such as those with low immunity, it is necessary to make sure of following points-
Stay away from people with diagnosed lung tuberculosis
Stay away from people with long standing cough
Stay away from locations where tuberculosis is prevalent
Make sure you use mask when you are in any of above situations
Keep in mind – Tuberculosis can be spread by people with lung tuberculosis only.
It cannot be spread through droplets or contact with people diagnosed with abdominal tuberculosis or kidney tuberculosis or tuberculosis of any other organ.

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