Tuberculosis, Pleural effusion - Pathology - Nursing

Topic: Tuberculosis, Pleural effusion
Faculty: Pathology
Course: Nursing 2nd year

1. TUBERCULOSIS PLEURAL EFFUSION Dr. Salman Ansari(MBBS) Tutor, Dept. of Pathology Kanachur Institute of Medical Sciences

2. TB Pleural effusion

3. TUBERCULOSIS

4. History Also called “Koch’s disease” Dr. Robert Koch - discovered tubercle bacilli Other names: Consumption, White Death

5. Tuberculosis “ Chronic granulomatous disease caused by Mycobacterium tuberculosis”

6. Etiology Causative organism : Mycobacterium tuberculosis Aerobic bacteria Rod-shaped bacilli does not get stained by Gram’s stain Gets stained pink with Ziehl-Neelsen(ZN) stain Acid-fast bacilli(AFB): it is resistant to decolourisation by sulphuric acid

7. Predisposing factors for TB Common in India, due to: Poverty Overcrowding Malnutrition Alcoholism Chronic lung disease: silicosis Tobacco smoke Chronic illnesses: DM poor immunity: HIV

8. Mode of infection Inhalation : airborne - most common mode of transmission - TB patients coughing, sneezing Ingestion : drinking milk from infected cows Inoculation : extremely rare - handling postmortem cases

9. Classification of TB Primary TB Secondary TB or Post-primary TB

10. Primary TB It is the first infection with tubercle bacilli in a previously unexposed person Source of infection : exogenous - contact with patient usually Sites affected : lung, intestine, tonsils , very rarely skin

11. M orphology Lung most common site of primary TB Lower part of upper lobe OR upper part of lower lobe Why? Primary lesion : Circumscribed grey-white lesion 1-1.5 cm in subpleural area of lung - called Ghon focus

12. Ghon complex : Ghon focus + regional LNs

13. Fate of Ghon complex In 90% of cases primary TB heals by fibrosis and calcification 10%: primary progressive TB(usually children younger than 5 years of age) or spreads to other parts of the body

14. Other sites of primary complex Small intestine - ileum with mesenteric LN involvement Pharynx/tonsils with cervical LN involvement Skin(rare)

15. Microscopy Lesion is called a “ granuloma ”, which consists of: Caseous necrosis in the centre Surrounded by modified macrophages, called epithelioid cells Some epithelioid cells fuse together to form Langhans giant cells Epithelioid cells are surrounded by rim of lymphocytes Surrounded by fibroblasts

16. RIM OF LYMPHOCYTES GRANULOMA

17. Secondary TB/Post primary TB When disease develops in a person previously exposed to TB - due to reactivation of initial infection Source of infection : Endogenous usually - reactivation of latent infection Sites involved : any organ - most commonly lungs

18. Morphology Gross : Apex of upper lobe - rich oxygen concentration Lesion is subpleural Cavitation (hollow space) LN involvement is not as prominent

19. Cavitation

20. Fate of secondary TB Complications of TB : Due to incomplete treatment or poor host immunity, it may spread to: to other parts of lung, like pleural( pleural effusion ) By coughing it spreads to bronchi, trachea, larynx If infected sputum is swallowed it can spread to GI tract - intestinal TB Heal Spread

21. Through blood vessels it may reach other lung or other organs like liver, bone marrow, speel, meninges, kidneys, fallopian tubes, spine(Pott disease) - disseminated TB or miliary TB Reaches lymph nodes - TB lymphadenitis

22. Clinical features Low grade fever - with evening rise of temperature Loss of appetite Weight loss Night sweats Dry cough Breathlessness Hemoptysis(blood in sputum)

23. D iagnosis Based on history, physical examination Chest X-ray : - Ghon’s focus in primary TB Cavitation in secondary TB Sputum examination : for acid-fast bacilli Tuberculin/Mantoux skin test : positive in TB Sputum culture PCR amplification of M.tuberculosis

24. Treatment Anti-tubercular treatment(ATT) for at least 6 months 4 drugs: Isoniazid(H) Rifampicin(R) Pyrazinamide(Z) Ethambutol(E)

25. PLEURAL EFFUSION

26. Pleura Pleura: thin covering of the lungs 2 layers Fluid present between layers called pleural fluid Less than 15 ml normally

27. Pleural effusion Accumulation of fluid in the pleural space

28. Causes Congestive heart failure Pneumonia Nephrotic syndrome Liver cirrhosis Mediastinal tumours

29. Types of pleural effusion Inflammatory pleural effusion Non-i nflammatory pleural effusion

30. Inflammatory pleural effusion Serous and fibrinous pleuritis : in TB, pneumonia Purulent pleural exudate(empyema) : pus in pleural space - in bacterial or fungal infections spread from lung infections - Hemorrhagic pleuritis : pleural tumours

31. 2. Non-inflammatory pleural effusion Hydrothorax : clear fluid - due to heart failure, liver cirrhosis Hemothorax : blood in fluid - aortic aneurysm, trauma Chylothorax : milky fluid - obstruction of lymphatic duct

32. For notes, scan: References: Ramadas Nayak - Textbook of Pathology for Allied Health Sciences Dr. Purnima S. Rao - Textbook of Pathology & Genetics For Nursing Questions: [email protected] For PPT, scan: