Tuberculosis

• Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis.
• Primarily affects the lungs (pulmonary TB) but can affect other parts of the body (extrapulmonary TB).
• Spread through airborne droplets from coughs or sneezes of an infected person.

• Global burden with 10 million new cases annually.
• High prevalence in Sub-Saharan Africa, Southeast Asia, and parts of Eastern Europe.
• In the UK, around 4,000 cases are reported annually.
• Higher incidence in urban areas with diverse populations.
• Risk factors include HIV infection, immunosuppression, and close contact with TB patients.

• Caused by Mycobacterium tuberculosis, a slow-growing aerobic bacillus.
• Transmission occurs via inhalation of airborne droplets.
• Bacteria reach the alveoli, where they are ingested by macrophages.
• Infected macrophages form granulomas to contain the infection.
• Latent TB occurs when the immune system contains the infection without symptoms.
• Active TB develops when the immune system fails to contain the infection.

• Pulmonary TB: affects the lungs, most common form.
• Extrapulmonary TB: affects other organs such as lymph nodes, bones, and CNS.
• Miliary TB: disseminated form with widespread involvement, severe.
• Latent TB: asymptomatic, non-infectious, positive TB test.
• Active TB: symptomatic, infectious.

• Persistent cough, lasting more than 3 weeks.
• Haemoptysis (coughing up blood).
• Fever and night sweats.
• Unintentional weight loss.
• Fatigue and malaise.
• Chest pain, worse with breathing or coughing.
• Loss of appetite.

• Tachypnoea and dyspnoea.
• Crackles or rales on lung auscultation.
• Clubbing of fingers in chronic cases.
• Lymphadenopathy in extrapulmonary TB.
• Pallor and signs of anaemia.
• Evidence of pleural effusion.
• Spinal tenderness or deformities in skeletal TB.

• Chest X-ray: primary imaging tool, shows cavitations, infiltrates, or nodules.
• Sputum microscopy and culture: detect acid-fast bacilli, gold standard.
• Sputum PCR (e.g., GeneXpert): rapid detection of TB and rifampicin resistance.
• Tuberculin skin test (Mantoux test): indicates prior exposure, not diagnostic.
• Interferon-gamma release assays (IGRAs): for latent TB diagnosis.
• CT scan: for detailed imaging if X-ray is inconclusive.
• Biopsy of affected tissues in extrapulmonary TB.

• First-line treatment: RIPE regimen (Rifampicin, Isoniazid, Pyrazinamide, Ethambutol) for 2 months, followed by Rifampicin and Isoniazid for 4 months.
• Directly observed therapy (DOT) recommended to ensure adherence.
• Adjust treatment based on drug susceptibility testing.
• Supportive care: hydration, nutrition, and management of symptoms.
• Treat latent TB infection in high-risk individuals to prevent progression to active TB.
• Consider public health measures: contact tracing and vaccination with BCG.
• Follow UK guidelines for specific management protocols.

• Respiratory failure due to extensive lung damage.
• Miliary TB: widespread dissemination leading to multiple organ involvement.
• Tuberculous meningitis: severe form affecting the central nervous system.
• Pleural effusion and empyema.
• Paradoxical reaction during treatment (immune reconstitution inflammatory syndrome).
• Drug-resistant TB: requires longer and more complex treatment regimens.
• Chronic pulmonary aspergillosis following TB.
• Hepatotoxicity from anti-TB medications.
• Social stigma and psychological impact.

• Good prognosis with early diagnosis and adherence to treatment.
• Delayed treatment increases risk of complications and mortality.
• HIV co-infection worsens prognosis.
• Drug-resistant TB has a poorer prognosis and requires longer treatment.
• Regular follow-up essential to monitor treatment response and manage side effects.
• Recurrence possible, particularly in immunocompromised patients.
• Public health interventions crucial for control and prevention.

• TB is a serious infectious disease caused by Mycobacterium tuberculosis.
• Early diagnosis and treatment are critical for good outcomes.
• RIPE regimen is the cornerstone of TB treatment.
• Public health measures including contact tracing and vaccination are vital for prevention.
• Drug-resistant TB requires specialised management and longer treatment.
• Follow UK guidelines for the latest management protocols.
• Awareness and education on TB are essential to reduce stigma and improve adherence to treatment.
• Regular follow-up is important to monitor for complications and ensure treatment success.

For more detailed guidelines, refer to the latest UK guidelines such as those from NICE:

• NICE Guidelines on Tuberculosis