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Causative agent: Mycobacterium tuberculosis/ mycobacterium bovis/ tubercle bacilli/

Mode of transmission: airborne droplets


Pathophysiology:
A susceptible person inhales mycobacterium bacilli and becomes infected. The
bacteria are transmitted through the airways to the alveoli, where they are deposited and
begin to multiply. The bacilli also are transported via the lymph system and bloodstream to
other parts of the body (kidneys, bones, cerebral cortex) and other areas of the lungs
(upper lobes). The body’s immune system responds by initiating an inflammatory reaction.
Phagocytes (neutrophils and macrophages) engulf many of the bacteria, and TB-specific
lymphocytes lyse (destroy) the bacilli and normal tissue. This tissue reaction results in the
accumulation of exudate in the alveoli, causing bronchopneumonia. The initial infection
usually occurs 2 to 10 weeks after exposure.
Granulomas, new tissue masses of live and dead bacilli, are surrounded by
macrophages, which form a protective wall around the granulomas. Granulomas are then
transformed to a fibrous tissue mass, the central portion of which is called a Ghon tubercle.
The material (bacteria and macrophages) becomes necrotic, forming a cheesy mass. This
mass may become calcified and form a collagenous scar. At this point, the bacteria become
dormant, and there is no further progression of active disease.
After initial exposure and infection, the person may develop active disease because
of a compromised or inadequate immune system response. Active disease also may occur
with reinfection and activation of dormant bacteria. In this case, the Ghon tubercle
ulcerates, releasing the cheesy material into the bronchi. The bacteria then become
airborne, resulting in further spread of the disease. Then the ulcerated tubercle heals and
forms scar tissue.
This causes the infected lung to become more inflamed, resulting in further development of
bronchopneumonia and tubercle formation.
Unless the process is arrested, it spreads slowly downward to the hilum of the lungs
and later extends to adjacent lobes. The process may be prolonged and characterized by
long remissions when the disease is arrested, only to be followed by periods of renewed
activity. Approximately 10% of people who are initially infected develop active disease.
Some people develop reactivation TB (also called adult-type TB). This type of TB results
from a breakdown of the host defenses. It most commonly occurs within the lungs, usually
in the apical or posterior segments of the upper lobes, or the superior segments of the
lower lobes.

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