2. path and clinical feat

PATHOGENESIS AND CLINICAL FEATURES OF TUBERCULOSIS

BY SURENDHAR G

histology

VARIOUS FATE OF TUBERCULOSIS

FACTORS AFFECTING NATURAL COURSE OF TB INFECTION

EVOLUTION OF TB

PRIMARY COMPLEX

Primary progressive

Disseminated or miliary

Secondary or adult type

CLINICAL FEATURES

“Spitting of pus follows the spitting of blood, consumption follows the spitting of this , and death follows consumption”

Pathology behind hemoptysisBronchial circulation-90%Pulmonary circulation-5%Submucosal plexus of arteries-terminal branches

of bronchial arteriesEndarteritis secondary to tbGrnulomas are surrounded by plethora of vessels-

become atrophic and necrosed leading to dilatation-RASMUSSEN’S ANEURYSYSMS

Post tubercular period:Post infection bronchiectasisAspergillomaBroncholith/cavernolith

signs

Extrapulmonary tb

Pleural tb

Genitourinary tb

Skeletal tb

Tuberculous meningitisoften in young children and HIVHematogenous spread or rupture of

subependymal tubercle into subarachnoid space Fever.malaise,anorexia,irritability,head

ache,mental changesMay lead to severe

headache,confusion,letharg,altered sensorium.neck rigidity

Paresis of cranial nerves,hydrocephalus,intracranial hypertension

Gastrointestinal tbSwallowing of

sputum,hematogenous,ingestion of milk from cows

Terminal ileum& caecumAb

pain,swelling,obstruction,hematochezia,massUlcerations & fistulae Tuberculous peritonitis

ab pain,fever & ascitis

Pericardial tbDirect progression of primary

focus,reactivationof latent focus or rupture of subcarinal l.nodes

elderlyFever,dyspnea,dull retrostenal

pain,pericardial frictionEffusion develops

Miliary tbUsually yellowish granulomas 1-2mm

resembling ‘millet seeds’Hepatomegaly,splenomegaly,lymphadenopat

hyChoroidal tuberclesMeningismus <10%Cryptic miliary tb &nonreactive miliary tb

WAKE UP QUESTION!!!

WHAT IS THE ROLE OF NRAMP1 POLYMORPHISM IN THE PATHOGENESIS OF TUBERCULOSIS?

NRAMP 1 PROTEIN- TRANSMEMBRANE PROTEIN IN

LYSOSOMESGENERATION OF ANTI- MICROBIAL

OXYGEN RADICALS