Tuberculosis

CHRONIC PNEUMONIAPULMONARY TUBERCULOSIS

March. 6. 2016
Ch. 12 (p459 – 512)

Chronic Pneumonias

TB HISTO-PLASMOSIS COCCIDIO-MYCOSIS BLASTO-MYCOSIS

TB
“If you know TB, you know medicine” Sir William Osler.1/3 world population is infected.8,000 die/day, 2-3 million/year. >AIDS& malaria.Accounts for 1/3 AIDS deaths.

EPIDEMIOLOGY(HIGH RISK)

Extremes of age. Contacts with open TB. Over crowded populations. Health workers. Low immunity. Low socioeconomic

Sequence of events in the natural history of primary pulmonary tuberculosis

Primary TB

1* & 2* TB

The natural history and spectrum of tuberculosis
Weeks
Years
Ranke complex

Erythema Nodosum

Conjuctivitis
TB CLINICAL FEATURES

TB CLINICAL FEATURES

LN
Pleural TB
Bone & Sp C
Bone

Pleural fluid smear

Pleural TB

Tuberculin Test

Ghon complex
Primary T.B

Secondary TB: tons of caseating, cavitating necrosis

Miliary T.B of the spleen

GRANULOMA

Mic of caseous necrosis

Epitheloid cells

TB organisms (acid-fast stain)


H. capsulatum: round to oval, small yeast forms C. immitis: thick-walled, nonbudding spherules, filled with small endospores B. dermatitidis: round to oval and larger than Histoplasma reproduce by characteristic broad-based budding

HISTOPLASMOSIS

H. Capsulatum Spores in bird or bat droppings Mimics TB Pulmonary granulomas, often large and calcified Tiny organisms live in macrophages Ohio, Mississippi valley MANY other organs can be affected

COCCIDIOMYCOSISC. immitis

Spores in soil Mimics TB Pulmonary granulomas, large & calcified Tiny organisms live in macrophages American SOUTHWEST MANY other organs can be affected
Thick wall non buddingSpherules



BLASTOMYCOSIS
Spores in soil Mimics TB, Pulmonary granulomas large and calcified Large distinct SPHERULES Ohio, Mississippi valley, WORLDWIDE MANY other organs can be affected, especially SKIN


Affect immunosuppressed patients (patients with AIDS, cancer, post-transplant) Unusual organisms: Pneumocystis jiroveci , ( formerly P. Carinii) Aspergillus Candidiasis Cytomegalovirus Bact.
Opportunistic pneumonias
Fungal


Cytomegalovirus (two kinds of inclusions)All ages, many routes (Placenta – organ transplant)

Crescent shaped organisms

Crushed Ping-Pong ball shaped organisms
Pneumocystis jiroveci

Aspergillus

Allergic bronchopulmonary aspergillosis; type I HR Aspergilloma (“fungus ball”)