Pathophysiology
- Tuberculosis (TB) is a chronic infectious disease caused by the bacterium Mycobacterium tuberculosis. TB mainly affects the lungs, but can also spread to other organs through the bloodstream or lymphatic system.
- TB is transmitted through airborne droplets that are expelled when a person with active pulmonary TB coughs, sneezes, speaks, or sings.
- These droplets contain M. tuberculosis and can remain suspended in the air for several hours.
- People who inhale these droplets may become infected with TB.
- When M. tuberculosis enters the lungs, it reaches the alveoli, where it encounters macrophages, which are immune cells that try to engulf and destroy the bacteria.
- However, some bacteria survive and multiply within the macrophages, forming granulomas, which are clusters of infected cells surrounded by other immune cells.
- Granulomas can prevent the bacteria from spreading further, but they can also damage the lung tissue and cause scarring or cavities.
- Most people who are infected with TB do not develop active TB disease, but remain in a latent state, where the bacteria are dormant and do not cause any symptoms. This is called latent TB infection (LTBI).
- People with LTBI are not contagious and cannot spread TB to others.
- However, they have a 5-10% lifetime risk of developing active TB disease, especially if their immune system is weakened by factors such as HIV infection, diabetes mellitus, malnutrition, corticosteroid use, or aging.
- Active TB disease occurs when the bacteria become active and multiply rapidly, causing symptoms such as persistent cough, hemoptysis (coughing up blood), chest pain, night sweats, weight loss, fatigue, and fever.
- Active TB disease can be pulmonary (affecting the lungs) or extrapulmonary (affecting other organs such as the lymph nodes, bones, kidneys, brain, or spine).
- Active TB disease is contagious and can spread TB to others through respiratory droplets.
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