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Tuberculosis
K. Brat
Dept. of Respiratory Diseases, Faculty of Medicine and University Hospital Brno

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nTuberculosis
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nInfectious disease caused by M. tuberculosis, M. africanum, M. bovis, M. BCG, M. microti, M.
canetti , M. caprae. M. pinnipedii
nM.bovis  eradicated in the 1960s
nLungs – most frequently affected organ (80 - 90%)
n= most frequent type of transmission is by coughing
nOther organs include the kidneys, bones, urogenital organs, intestine

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TB in the Czech Rep. and in the world
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n10.4 million TB cases worldwide (in 2016)
n1.9 billion people infected (= latent TB infection)
n1.7 million deaths worldwide in 2016 (0.25 million children)
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nIn the Czech Rep.: incidence 4.9 cases/100 000 persons (2016) = ca 510 cases
nPersons at higher risk of TB: HIV-positive, immigrants, homeless

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n Clinical symptoms of TB
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nChronic cough (4 and more weeks)
nChest pain
nWeight loss, anorexia
nFatigue
nHemopytsis
nNight sweat and fevers
nContact with an infected person
nCXR finding compatible with TB diagnosis

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Forms of TB
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nPrimary TB
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nPost-primary TB (progression of latent TB) – in chronic diseases, malignancies, older age
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nSecondary TB (infection by other TB strain)
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Diagnosis
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nAnamnesis
nEpidemiology
nCXR finding
nTuberculin skin test
nBacteriology (sputum, bronchoalveolar lavage fluid, other)
nHistology

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TB – upper lobes (typical)
12 22

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TB pleurisy
x4 x1

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TB pleurisy and pulmonary TB
Pa010805 Pa010810

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Miliary TB
n

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Pulmonary TB – less typical forms
17 28

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Complicated TB
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n

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nBacteriology - methods
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nMicroscopy
nCultivation – 6 weeks!
nRapis bacteriology tests – detection of metabolic activity of M.tuberculosis : Bactec and MGIT
tests – 10-14 days
nPCR method

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HISTORY OF TB TREATMENT
nUntil 1882: climatotherapy
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nSince 1882: iatrogenic pneumothorax, thoracic surgery
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nMortality of untreated TB: ca 50%
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nIn the 1940s and 50s: discovery of antituberculotic drugs (ATDs)
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nSince 1970s: WHO-recommended treatment regimen: Directly Observed Treatment Short-Course = DOTS
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Phases of TB treatment
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nIntensive phase (initial) – 2 months, usually hospitalization: 4-combination of 1st class ATDs
n= combined of INH,RMP,PZA,EMB
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nContinuation phase – 4 months, usually outpatient care
n= combined of INH+RMP
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TB in the world
n>80% of cases occur in 8 countries (India, Indonesia, China, Pakistan, Bangladesh, The
Philippines, RSA, Nigeria) nHighest incidence rate in the world (2017): Lesotho, Eswatini and RSA
nHighest incidence rate in Europe: Greenland and Republic of Moldova nHighest incidence rates –
other continents: Bolivia, Haiti, Mexico, Vanuatu
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Be aware of…
nCoincidence of TBC and HIV
n40% of HIV-related deaths are caused by TB
nIncreasing rate of drug-resistant forms worldwide nMDR-TB: resistance to RMP+INH (ca 0.5mil.cases
reported in 2017 worldwide) nXDR-TB: res.to  RMP+INH+fluoroqinolone+aminoglycoside nTDR-TB:
resistance to all first-class drugs + a number of ATDs of the 2nd to 5th classes
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