Atypical mycobacteria produce different disease
Course dependant on host immunity & organism virulence
Histology always same
- Worldwide epidemic
- Incidence rising (w/ HIV & drug resistance)
- 1ry infection *lung
- Gut/skin/lymph nodes rare 1ry sites
Classification
1ry Pulm TB
2ry Pulm TB
Progressive Pulm TB
- cavitatory fibrocaseous TB
- tuberculous bronchopneumonia
Extra-Pulm TB
- single organ TB
- miliary TB
1ry Pulmonary TB
1st contact with bacillus
Initial lesion parenchymal & sub-pleural
Involvement of draining hilar lymph nodes
Usually asymptomatic
Most cases heal by scar formation
Occ progression - * infants/imm-supp
Pathology
Ghon complex - yellow, necrotic areas in parenchyma & nodes
2ry pulmonary TB
Occurs in 5% of 1ry TB cases
Usu due to reactivation
2ry pulmonary TB
Occurs in 5% of 1ry TB cases
Usu due to reactivation
Assoc/ with debilitation
Occ re-inf/post-BCG
Occ re-inf/post-BCG
Apices due to high O2 tension
Often symptomatic
May heal by scar formation
May heal by scar formation
Progression more common than 1r TB
Pathology
Assmann focus - more ext parenchymal involvement of upper lobes
- Progressive pulmonary TB
Cavitatory fibrocaseous TB
Usu seen with 2ry TB
Usu seen with 2ry TB
Drainage into bronchus/bronchiole
Formation of cavity
Extension of local inflammation
Spread of inflammation w/i lungs
Spread into upper airways & gut = open TB
Gd prognosis w/ Tx
Pathology
Large parenchymal lesion
W/ central cavity & surrounding necrosis
Tuberculous bronchopneumonia
Usu seen with 2ry TB
Formation of cavity
Extension of local inflammation
Spread of inflammation w/i lungs
Spread into upper airways & gut = open TB
Gd prognosis w/ Tx
Pathology
Large parenchymal lesion
W/ central cavity & surrounding necrosis
Tuberculous bronchopneumonia
Usu seen with 2ry TB
Rapid parenchymal spread via airways = open TB
Rare with Tx h/e prognosis poor
Pathology
Scattered but ext parenchymal inflammation
Scattered but ext parenchymal inflammation
- Extra-pulmonary TB
Single organ TB
Usu seen with 2ry TB
Single episode of Hg spread
*Bone/kidney/adrenals/memnges/genital tract
Prognosis gd with Tx
Pathology
Single focus of destruction
eg spine = pott's disease
Miliary TB
Usu seen with 1ry TB
*Bone/kidney/adrenals/memnges/genital tract
Prognosis gd with Tx
Pathology
Single focus of destruction
eg spine = pott's disease
Miliary TB
Usu seen with 1ry TB
Widespread Hg spread
Assoc/ w/ reduced immunity
*Lungs/spleen/bone marrow/liver
Prognosis poor despite Tx
Assoc/ w/ reduced immunity
*Lungs/spleen/bone marrow/liver
Prognosis poor despite Tx
Pathology
Widespread small necrotic foci
Histology
Epitheloid cell granulomata with central necrosis & Langhans giant cells
Lymphocytes & plasma cells
Coalescence of granuloma w/ extensive central caseous necrosis
Use of ZN (Ziehl-Neelsen)staining
Widespread small necrotic foci
Histology
Epitheloid cell granulomata with central necrosis & Langhans giant cells
Lymphocytes & plasma cells
Coalescence of granuloma w/ extensive central caseous necrosis
Use of ZN (Ziehl-Neelsen)staining
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