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• Primary PTB occurs in an individual who has
never been exposed to the tuberculosis
bacteria before. This type of tuberculosis is
very uncommon and usually occurs in the very
young, the very old or those with immune
compromised symptoms, such as AIDS.
• From the primary site of infection, bacilli
are carried to the lymph nodes via lymphatics,
and the hilar nodes enlarge. This parenchymal
lesion(Ghon’s lesion) with its enlarged
rigional(hilar) lymph nodes and inter
connecting lymphangitis is known as primary
complex of Ranke(Ghon’s complex).
• The parenchymal lesion is subpleural and
usually located in lower part of the upper
lobe, upper part of lower lobe or the middle
• Bacilli in alveoli also invade and replicate
within alveolar macrophases that interact with
T-lymphocytes, resulting in differentiation of
macrophases into epithelioid histiocytes.
Epthelioid histiscytes and lymhocytes
aggregate into small clusters resulting in
• In the granuloma, CD4+ T-lymphocytes
secrete cytokines, such as interferon, which
activate macrophages to destroy the bacteria
with which they are infected.
Majority are asymptomatic
A brief ‘flu-like’ febrile illness, which lasts 7-14
Reduced apetite, weight loss, fretfulness
Majority, no abnormal signs
General debility, thin, pale and fretful child
Glossy hair and less elastic skin
May be few crepitations over a large lung
Bluish red, raised tender, cutaneous lesions on
the shins and less on thigh.
Fever and polyarthralgia
a) History of contact with a case of active
b) Tuberculin test
c) Chest radiograph
d) Sputum examination
• It occurs in final stage of the disease. When
macrophases fail to sorround and digest
bacteria, a cheesy form of necrosis occurs in
the center , known as caseation. The caseous
tissue may later become calcified. But if the
lesion progresses, the caseous tissues become
liquefied to form purulent material. This
material may be discharged into bronchi
resulting in cavitation.
• Samples taken from an infected person may
test –ve because the bacteria are hidden in
• Miliary TB is when the PTB becomes chronic
and spreads though either the blood stream
or the lymph system to infect other organs of
Direct progression of a primary lesion
Re-activation of a dormant primary lesion
o Taking steroids(immuno suppresive)
o HIV infection
o Renal failure
Haematogenous spread to the lungs
Common sites are apical and posterior
segment of upper lobe or apical of lower lobe.
Loss of apetite and weight
• BCG(Bacillus Calmette Guerin), prtective
DOTS(directly observed treatment
FIVE ELEMENT OF DOTS
Political commitment with increased and
Case detection through quality assured
Standardised treatment, with supervision and
An effective drug supply and management
Monitoring and evaluation system and impact