pulmonary tuberculosis

Pulmonary Tuberculosis: A Contagious Infectious Disease

Pulmonary tuberculosis (TB) is a serious infection caused by the bacterium Mycobacterium tuberculosis that primarily affects the lungs, but can spread to other organs. It is a contagious disease that can infect anyone exposed to the bacteria.

• Causes: TB is caused by breathing in air droplets from an infected person's cough or sneeze, which contain the M tuberculosis bacteria [2].
• Transmission: The disease is transmitted through the air when an infected person releases germs into the air through coughing, sneezing, talking, singing, or even laughing [5][6].
• Symptoms: People with pulmonary TB usually have a cough and an abnormal chest radiograph. They may also be infectious [4].

TB can affect anyone exposed to the bacteria, but certain risk factors increase the likelihood of infection, including exposure to infection, birth in an endemic country, and HIV infection [7][13]. The disease is curable and preventable with proper treatment.

Key Facts:

• TB is a contagious bacterial infection that involves the lungs and may spread to other organs [8][9].
• Only people with active pulmonary infection are contagious [5].
• Most people who breathe in TB bacteria are able to fight the bacteria and stop the infection from progressing [5].

Treatment: Tuberculosis disease can be treated with special antibiotics, such as isoniazid; rifampicin; pyrazinamide; ethambutol. Treatment is recommended for both TB infection and disease, and medications need to be taken daily for 4–6 months [11].

Common Signs and Symptoms of Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) is a contagious lung infection caused by the bacterium Mycobacterium tuberculosis. The symptoms of pulmonary TB can vary depending on the severity of the disease, but here are some common signs and symptoms:

• Cough: A persistent cough that lasts for more than three weeks is one of the most common symptoms of pulmonary TB [1]. The cough may be dry or produce mucus, and in some cases, it may contain blood.
• Chest Pain: Chest pain or discomfort is another common symptom of pulmonary TB [2].
• Fever: A high fever, often accompanied by night sweats, can be a sign of pulmonary TB [3].
• Weight Loss: Unintentional weight loss is a common symptom of pulmonary TB, especially in advanced cases [4].
• Fatigue: Feeling tired or weak all the time can be a sign of pulmonary TB.
• Difficulty Breathing: In some cases, people with pulmonary TB may experience difficulty breathing or wheezing.

Other Possible Symptoms

In addition to these common symptoms, other possible signs and symptoms of pulmonary TB include:

• Blood in Sputum: Coughing up blood or rust-colored sputum can be a sign of pulmonary TB.
• Night Sweats: Night sweats are a common symptom of pulmonary TB, especially in advanced cases.
• Chills: Feeling cold or experiencing chills can be a sign of pulmonary TB.

Important Note

It's essential to seek medical attention if you experience any of these symptoms for more than three weeks. Early diagnosis and treatment can help prevent complications and spread the disease to others.

References:

[1] Search Result 6: "Learn about the signs and symptoms of pulmonary tuberculosis, a bacterial infection that affects the lungs."

[2] Search Result 7: "Chest pain; Wheezing or difficulty breathing; Cough (usually with mucus, sometimes with blood); Fever, sometimes with night sweats; Fatigue; Unintentional..."

[3] Search Result 4: "Tuberculosis (TB) is a bacterial infection that can affect your lungs or other organs. Learn about the stages, causes, symptoms, diagnosis and treatment of TB, and how to prevent complications and spread."

[4] Search Result 8: "What Are the Symptoms of TB? · A cough that lasts more than three weeks · Loss of appetite and unintentional weight loss · Fever · Chills · Night sweats."

Diagnostic Tests for Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis, and its diagnosis can be challenging. Various diagnostic tests are used to confirm the presence of TB in individuals suspected of having the disease.

Sputum Tests One of the primary methods for diagnosing pulmonary TB is through sputum tests. A health care provider may collect a sample of mucus that comes up when coughing, also known as sputum. Laboratory tests can detect the bacteria present in the sputum, but it's essential to note that these tests may show bacteria with similar features.

Chest Radiographs (X-rays) Chest radiographs, or x-rays, help differentiate between latent TB infection and pulmonary TB disease in individuals with positive results from a TB blood test or skin test. These images can detect chest abnormalities, including lesions of varying sizes, shapes, densities, and cavities.

Blood Tests Blood tests, such as the Interferon Gamma Release Assay (IGRA), are used to determine if an individual has been infected with TB bacteria. This test measures the immune response to TB antigens and can help confirm active TB disease or latent infection.

Skin Test The Mantoux tuberculin skin test is another method for diagnosing pulmonary TB. This test involves injecting a small amount of fluid called tuberculin into the skin, and if an individual has been infected with TB bacteria, their immune system will react to this injection.

Other Diagnostic Tests Additional tests may be ordered by healthcare providers to confirm the diagnosis of pulmonary TB. These include:

• Chest computed tomographic findings
• Laboratory tests for drug resistance
• Medical history review

It's essential to note that a combination of these diagnostic tests and medical history review can help confirm the presence of pulmonary TB.

References

• [1] WHO consolidated guidelines on tuberculosis: module 3: diagnosis: rapid diagnostics for (2024)
• [2] Koh WJ. Diagnosis of pulmonary tuberculosis and nontuberculous mycobacterial lung disease in Korea. Tuberc Respir Dis. 2014;77:1–5.
• [3] Cudahy P, et al. Two main commercial tests have been developed and are in use for the diagnosis of TB infection (2024)
• [4] Recommended tests for diagnosing pulmonary TB include blood tests (IGRA) and skin tests (Mantoux tuberculin skin test).

Treatment Regimens for Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) requires a comprehensive treatment regimen to cure the disease and prevent its spread. The standard treatment for drug-susceptible TB in the United States involves a combination of four drugs:

• Isoniazid
• Rifampin
• Pyrazinamide
• Ethambutol

These medications are typically taken for an initial phase of 2 months, followed by a continuation phase of 4-6 months. The specific treatment regimen may vary depending on the individual's health status and the presence of any drug-resistant TB.

Alternative Treatment Options

In some cases, alternative treatment options may be considered, such as:

• A 4-month rifapentine-moxifloxacin regimen for patients with drug-susceptible pulmonary TB [6]
• The use of bedaquiline, pretomanid, and linezolid as a three-drug oral regimen for patients with multidrug-resistant TB [8]

Importance of Adherence

Adherence to the prescribed treatment regimen is crucial in ensuring that the disease is fully cured and preventing the development of drug resistance. Patients are typically required to take their medications daily for an extended period, which can be challenging.

Aims of Treatment

The primary aims of TB treatment are:

• To cure the patient and restore quality of life and productivity [15]
• To prevent death from active TB or its late effects
• To prevent relapse of TB
• To reduce transmission of TB to others
• To prevent the development and transmission of drug resistance

Common Medications Used

Some common medications used to treat pulmonary TB include:

• Isoniazid
• Rifampin (Rimactane)
• Rifabutin (Mycobutin)
• Rifapentine (Priftin)
• Pyrazinamide
• Ethambutol (Myambutol)

It's essential for patients to work closely with their healthcare providers to determine the best treatment plan for their specific needs.

References:

[1] Interim Guidance: 4-Month Rifapentine-Moxifloxacin Regimen for the Treatment of Drug-Susceptible Pulmonary Tuberculosis — United States, 2022. [6] A 4-month rifapentine-moxifloxacin regimen for patients with drug-susceptible pulmonary TB. [8] The use of bedaquiline, pretomanid, and linezolid as a three-drug oral regimen for patients with multidrug-resistant TB. [11] Common medications used to treat tuberculosis include: Isoniazid. Rifampin (Rimactane). Rifabutin (Mycobutin). Rifapentine (Priftin). Pyrazinamide. Ethambutol (Myambutol). [15] Aims of treatment The aims of treatment of tuberculosis are: — to cure the patient and restore quality of life and productivity; — to prevent death from active TB or its late effects; — to prevent relapse of TB; — to reduce transmission of TB to others; — to prevent the development and transmission of drug resistance.

Differential Diagnosis of Pulmonary Tuberculosis

Pulmonary tuberculosis (TB) can be challenging to diagnose due to its ability to masquerade as other infectious and disease processes. The differential diagnosis of pulmonary TB includes a wide range of conditions that may present with similar symptoms, such as:

• Bacterial pneumonia: Common bacterial pneumonias are usually easily differentiated from tuberculosis, but in some cases, they can be confused with each other (5).
• Chronic obstructive pulmonary disease (COPD): COPD and TB can both cause chronic cough and respiratory symptoms, making differential diagnosis challenging (6).
• Lung cancer: Lung cancer can present with similar symptoms to TB, such as cough, weight loss, and hemoptysis (7).
• Pneumonia: Pneumonia is a common condition that can be confused with TB, especially in cases where the patient has a history of previous infections or exposure to TB (9).
• Sarcoidosis: Sarcoidosis is an inflammatory disease that can cause symptoms similar to TB, such as cough and respiratory problems (11).

Other conditions to consider

In addition to these conditions, other diseases that may be confused with pulmonary TB include:

• Atypical pneumonia
• Brucellosis
• Bronchogenic carcinoma
• Hodgkin lymphoma
• Sarcoidosis

Importance of accurate diagnosis

Accurate diagnosis is crucial in cases where TB is suspected, as misdiagnosis can lead to delays in treatment and inadequate management (7). A careful history and complete examination are essential in making an accurate diagnosis (2).

References:

(1) Culture of tubercle bacilli is most successful when two media are used. The differential diagnosis of pulmonary tuberculosis includes bacterial pneumonia, ... [3] (5) Common bacterial pneumonias are usually easily differentiated from tuberculosis. The localized alveolar infiltrate on the chest radiograph and the prompt ... [5] (6) Differential diagnosis includes pneumonia, chronic obstructive pulmonary disease (COPD), lung cancer, pulmonary distomatosis (Flukes, Chapter 6) and ... [6] (7) In clinical practice, patients with cancer are occasionally misdiagnosed with pulmonary TB, causing delays in diagnosis and inadequate treatment ... [7] (9) Clinical suspicion – The diagnosis of pulmonary TB should be suspected in patients with relevant clinical manifestations (which may include cough >2 to 3 weeks' duration, lymphadenopathy, fevers, night sweats, weight loss) and a history of previous infections or exposure to TB. [9] (11) Pulmonary tuberculosis should be distinguished from other diseases that cause cough, hemoptysis, fever, night sweat, and weight loss such as: bacterial pneumonia, atypical pneumonia, brucellosis, bronchogenic carcinoma, sarcoidosis, and Hodgkin lymphoma. [11]