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.