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Tuberculosis

  • Tuberculosis is common throughout the world
  • Causes significant morbidity and mortality particularly in Africa and Asia
  • Over 10,000 cases per year occur in United Kingdom
  • Accounts for 1,000 deaths mainly in immigrant Asian population
  • Usually due to Mycobacterium tuberculosis or Mycobacterium bovis infection

Primary tuberculosis

  • Usually a respiratory infection that occurs in childhood
  • Infection results in sub-pleural Ghon focus and mediastinal lymphadenopathy
  • Regarded as the primary complex
  • Symptoms are often few
  • Resolution of infection usually occurs
  • Complications include:
    • Haematogenous spread causing miliary TB affecting lungs, bones, joints, meninges
    • Direct pulmonary spread resulting in TB bronchopneumonia

Post-primary tuberculosis

  • Occurs in adolescence or adult life
  • Due to reactivation of infection or repeat exposure
  • Results in more significant symptoms
  • Reactivation may be associated with immunosuppression (e.g. drugs or HIV infection)
  • Pulmonary infection accounts for 70% of cases of post-primary TB
  • Usually affects apices of upper or lower lobes
  • Cavitation of infection into the bronchial tree results in 'open' TB
  • Clinical features include cough, haemoptysis, malaise, weight loss and night sweats
  • Infection of lymph glands results in discrete, firm and painless lymphadenopathy
  • Confluence of infected glands can result in a 'cold' abscess
  • Infection of the urinary tract can cause haematuria and 'sterile pyuria'


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Antibiotics
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