Tuberculosis pathophysiology and host immunity
Mycobacterium tuberculosis (Gladwin & Trattler, 2006)• Gram-positive thin rods
• Obligate aerobe
• Slooooow growing
• Posses a class of lipid called mycosides that give it, its virulence
Transmission (Nairn & Helbert, 2007)
· Droplet nuclei containing M. Tuberculosis is breathed into the lungs
· Once inside, the TB bacteria stimulates immune system reaction such as macrophages and neutrophils.
· Some TB bacteria multiplied and survive inside our macrophages while others are destroyed by them.
Formation of Granuloma (Nairn & Helbert, 2007)
• As the infection progress i.e. day 2, another type of immune cells known as T helper 1 cells, which has received signals from the macrophages of the infection, arrived to the infection site to help fight TB bacteria
• T helper 1 cells secretes potent inflammatory chemicals known as cytokines specially Interferon gamma (IFN-gamma) and tumor necrosis factor (TNF) aiming to kill and contain TB bacteria
• In the process of doing so, a granuloma made of calcium shell is formed around dead tissue that resulted from TNF destroying the host tissues along with the TB bacteria
Primary Tuberculosis Infection a.k.a first infection (Nairn & Helbert, 2007)
• 90% of those infected with TB do not have any symptoms
• Less than 10% develop TB disease or widespread infection.
• Even when infection is contained and controlled, many mycobacteria survive inside macrophages or other cells for several years. This is latent TB.
• On the other hand, if your immune system is “over zealous” and fights TB infection with excessive production of TNF, local tissue damage occurs and infectiousness develops
Secondary or Reactivation Tuberculosis (Nairn & Helbert, 2007)
• Occurs in about 10% of patients; usually happens when immune system is compromised or macrophage function is moderately impaired.
• Compromised immune system or moderately impaired macrophage function usually happen with treatment that requires high dose of corticosteroids, malnutrition, or immunosuppression due to HIV/AIDS or anti rejection drugs which are taken by organ transplant patients.
Tuberculosis “Rules of Fives” (Gladwin & Trattler, 2006)
• Droplet nuclei are 5 micrometers and contain 5 Mycobacterium tuberculosis bacilli
• Patients infected with Mycobacterium tuberculosis have a 5% risk of reactivation in the first 2 years and then a 5% lifetime risk
• Patients with “high five” HIV will have a 5 + 5% risk of reactivation per year!
The pathophysiology and disease process of Tuberculosis is highly immunologic. In order for me to understand the disease process thoroughly, there are still a lot to learn and study.
Gladwin, M., & Trattler, B. (2006). Clinical microbiology made ridiculously simple. MedMaster series. Miami: MedMaster.
*Nairn, R., & Helbert, M. (2007). Immunology for medical students. Philadelphia: Mosby.
www.nature.com/.../n7034/fig_tab/434709a_F1.html
*most comprehensive in the explanation of the pathophysiology of TB and its immunology.
posted by Nui at
9:53 AM
2 Comments:
Beautiful,
What a great write-up for TB. I also like the references. Please seperate them.
Thanks,
Joachim
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