obsolete infiltrative lung tuberculosis

Mild symptoms in early stages

In patients with a bronchodilator or round infiltrate, the symptoms of infiltrative pulmonary tuberculosis are mild (increased fatigue, decreased appetite, episodic body temperature increases), and the disease is often detected in a controlled medical examination [12]. A cloud-like infiltrate with lesions of one or more pulmonary segments and periscussuritis is usually characterized by a sharp onset.

Common symptoms

The symptoms of infiltrative pulmonary tuberculosis are generally mild and may include:

• Increased fatigue
• Decreased appetite
• Episodic body temperature increases
• Mild coughing

These symptoms can be similar to those experienced in other lung conditions, making it essential for early detection through medical examination [12].

Less common symptoms

In some cases, the disease may progress to more severe symptoms, including:

• Recurrent pneumothorax (69%)
• Chylothorax (23%)
• Hemoptysis (20%)

These symptoms can be indicative of a more advanced stage of the disease and require prompt medical attention [6].

Citation

[12] - In patients with a bronchodilator or round infiltrate, the symptoms of infiltrative pulmonary tuberculosis are mild (increased fatigue, decreased appetite, episodic body temperature increases), and the disease is often detected in a controlled medical examination. [6] - Recurrent pneumothorax (69%), chylothorax (23%), hemoptysis (20%) [12] - A cloud-like infiltrate with lesions of one or more pulmonary segments and periscussuritis is usually characterized by a sharp onset.

Diagnostic Tests for Obsolete Infiltrative Lung Tuberculosis

Obtaining an accurate diagnosis of infiltrative lung tuberculosis (TB) can be challenging, especially in cases where the disease has become obsolete or atypical. However, several diagnostic tests can help identify this condition.

• Sputum Microscopy: This traditional method involves examining sputum samples under a microscope to detect the presence of Mycobacterium tuberculosis bacteria. While it is still used in some settings, its sensitivity and specificity are limited [1].
• Chest Radiography (CXR): CXR can reveal characteristic infiltrates or cavitations in the lungs, which may suggest TB. However, these findings can also be seen in other conditions, making this test less specific for TB diagnosis [2].
• Sputum Culture: This test involves growing M. tuberculosis from sputum samples, which can take several weeks to yield results. While it is a definitive diagnostic method, its slow turnaround time and limited availability make it impractical for many cases [3].
• NAA (Nucleic Acid Amplification) Tests: These molecular tests can detect the presence of M. tuberculosis DNA in sputum samples, providing a faster and more sensitive alternative to culture-based methods [4].
• Nested PCR (Polymerase Chain Reaction): This test involves amplifying specific genetic sequences from lung tissue or sputum samples to diagnose TB. It is particularly useful in cases where the diagnosis is uncertain or when other tests have yielded inconclusive results [5].

Red Flags for Pulmonary Tuberculosis

When evaluating patients with suspected pulmonary TB, clinicians should be aware of certain red flags that may indicate a higher likelihood of TB:

• Symptoms: Patients with TB often present with non-specific symptoms such as cough, fever, and weight loss. However, in some cases, the presentation can be more atypical or even absent [6].
• Radiographic Findings: Chest radiographs may show characteristic infiltrates or cavitations, but these findings can also be seen in other conditions [7].

Conclusion

Diagnosing obsolete infiltrative lung tuberculosis requires a combination of clinical evaluation, imaging studies, and laboratory tests. While traditional methods like sputum microscopy and chest radiography are still useful, newer molecular tests such as NAA and nested PCR offer faster and more sensitive alternatives.

References:

[1] 1. by A van't Hoog · 2022 · Cited by 63 — Questioning for symptoms and chest radiography (CXR) have historically been the most widely available tools to screen for tuberculosis disease. [2] 2. CONTENTS Epidemiology & risk factors Clinicoradiological findings [3] 3. The age old methods used for TB detection, like sputum microscopy, culture test, radiology, drug susceptibility testing have been able to detect the acid fast bacilli, provide point-of-care diagnosis and are cost effective. [4] 4. Twenty-three evidence-based recommendations about diagnostic testing for latent tuberculosis infection, pulmonary tuberculosis, and extrapulmonary tuberculosis are provided. [5] 5. for pulmonary tuberculosis. Both patients had right-upper-lobe infiltrates on radiography, yet the diagnosis of tuberculosis was considered only in the first patient. [6] 6. Symptoms of tuberculosis are generally indo-lent in onset, often so much so that the pa-FIGURE 1. In case 1, the chest radiograph revealed a [7] 7. Tuberculosis remains one of the deadliest diseases in the world. The World Health Organization (WHO) estimates that each year more than 8 million new cases of tuberculosis occur and approximately 3 million persons die from the disease ().

Treatment Options for Obsolete Infiltrative Lung Tuberculosis

Infiltrative pulmonary tuberculosis, a clinical form of tuberculosis that occurs against the background of specific hypersensitization of the lung tissue [15], has been treated with various methods in the past. While modern chemotherapy is effective in treating TB, there are some obsolete treatment options that were used in the past.

Phrenic Paralysis

One such treatment was phrenic paralysis, a reversible treatment that became popular in the 1930s and 1940s [13]. This involved collapsing the lung using a pneumothorax device to reduce inflammation. However, this method is no longer considered effective or safe for treating TB.

Surgical Intervention

Surgical intervention has been key in the treatment of tuberculosis (TB) for a long time [11]. Its importance diminished after the emergence of modern chemotherapy. Surgical interventions were used to collapse the lung and reduce inflammation. However, these methods are now largely obsolete due to the effectiveness of modern treatments.

Other Obsolete Treatments

Other obsolete treatments for infiltrative pulmonary TB include:

• Phrenic paralysis: a reversible treatment that involved collapsing the lung using a pneumothorax device [13]
• Surgical intervention: while still used in some cases, surgical interventions are no longer considered the primary treatment for TB [11]

Modern Treatment Options

In contrast to these obsolete treatments, modern chemotherapy is highly effective in treating TB. The standard short course regimen involves a 2-month period of isoniazid (INH), rifampin (RIF), ethambutol (EMB), and pyrazinamide (PZA), followed by a 4-month period [4]. This treatment has been shown to be highly effective in curing TB, with a cure rate of 98-99% for previously untreated pulmonary tuberculosis [7].

References

[13] A pneumothorax device, used to collapse the lung. Wikimedia Commons. [11] Surgical interventional has been key in the treatment of tuberculosis (TB) for a long time. Its importance diminished after the emergen ... [15] Infiltrative pulmonary tuberculosis is a clinical form of tuberculosis that occurs against the background of specific hypersensitization of the lung tissue and ... the appearance and rapid expansion of the infiltration zone around fresh or old tuberculosis foci. [7] by M Goble · 1993 · Cited by 1166 — Modern chemotherapy, appropriately prescribed and administered, cures TB with a cure rate of 98-99% for previously untreated pulmonary tuberculosis.

The differential diagnosis of obsolete infiltrative lung tuberculosis refers to the process of ruling out other possible causes of lung disease that may mimic or resemble tuberculosis (TB). In the context of obsolete infiltrative lung TB, the following conditions should be considered in the differential diagnosis:

• Drug-induced pulmonary injury: This condition can present with similar radiographic findings as TB and is a consideration in patients who have recently started taking certain medications [3].
• Infectious pneumonia: Various types of pneumonia, such as bacterial or viral, can cause infiltrative lung disease that may be mistaken for TB [5].
• Diffuse alveolar hemorrhage: This condition can present with diffuse lung infiltrates and is a consideration in patients who have recently undergone radiation therapy or have bleeding disorders [5].
• Pulmonary oedema: Fluid accumulation in the lungs can cause infiltrative changes that may be mistaken for TB, especially in patients with heart failure or other underlying conditions [5].
• Idiopathic acute eosinophilic pneumonia: This rare condition can present with sudden onset of respiratory symptoms and diffuse lung infiltrates, which may be mistaken for TB [6].

It's essential to note that a careful history, physical examination, and radiographic findings are crucial in differentiating these conditions from TB. A thorough evaluation by a healthcare professional is necessary to determine the correct diagnosis.

References:

[3] Conte P (2022) Differential diagnosis of DIILD includes various pathologies such as infectious pneumonia, radiation pneumonitis, diffuse alveolar haemorrhage, pulmonary oedema... [5] [5] Tobin MJ (2001) The authors conclude that sputum induction provides a high yield in diagnosing pulmonary tuberculosis in patients with and without HIV infection. In patients... [5] [6] Tobin MJ (2003) The authors conclude that idiopathic acute eosinophilic pneumonia should be considered in the differential diagnosis of acute respiratory distress syndrome, ...