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Pulmonary tuberculosis - PubMed Health

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A.D.A.M.MedicalEncyclopedia.Atlanta(GA):A.D.A.M.;2011.

Pulmonarytuberculosis
TB;Tuberculosispulmonary
Lastreviewed:December6,2011.

Pulmonarytuberculosis(TB)isacontagiousbacterialinfectionthatinvolvesthelungs,butmayspreadtoother organs.

Causes,incidence,andriskfactors
Pulmonarytuberculosis(TB)iscausedbythebacteriaMycobacteriumtuberculosis(M.tuberculosis).Youcan getTBbybreathinginairdropletsfromacoughorsneezeofaninfectedperson.ThisiscalledprimaryTB. IntheUnitedStates,mostpeoplewillrecoverfromprimaryTBinfectionwithoutfurtherevidenceofthedisease. Theinfectionmaystayinactive(dormant)foryears.However,insomepeopleitcanreactivate. MostpeoplewhodevelopsymptomsofaTBinfectionfirstbecameinfectedinthepast.However,insomecases, thediseasemaybecomeactivewithinweeksaftertheprimaryinfection. ThefollowingpeopleareathigherriskforactiveTB: Elderly Infants Peoplewithweakenedimmunesystems,forexampleduetoAIDS,chemotherapy,diabetes,orcertain medications YourriskofcontractingTBincreasesifyou: AreinfrequentcontactwithpeoplewhohaveTB Havepoornutrition Liveincrowdedorunsanitarylivingconditions ThefollowingfactorsmayincreasetherateofTBinfectioninapopulation: IncreaseinHIVinfections Increaseinnumberofhomelesspeople(poorenvironmentandnutrition) TheappearanceofdrugresistantstrainsofTB IntheUnitedStates,thereareapproximately10casesofTBper100,000people.However,ratesvary dramaticallybyareaofresidenceandsocioeconomicstatus. Seealso:Disseminatedtuberculosis

Symptoms
TheprimarystageofTBusuallydoesn'tcausesymptoms.WhensymptomsofpulmonaryTBoccur,theymay include: Cough(usuallycoughupmucus) Coughingupblood Excessivesweating,especiallyatnight Fatigue Fever Unintentionalweightloss Othersymptomsthatmayoccurwiththisdisease: Breathingdifficulty Chestpain Wheezing

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Pulmonary tuberculosis - PubMed Health

Signsandtests
Thedoctorornursewillperformaphysicalexam.Thismayshow: Clubbingofthefingersortoes(inpeoplewithadvanceddisease) Swollenortenderlymphnodesintheneckorotherareas Fluidaroundalung(pleuraleffusion) Unusualbreathsounds(crackles) Testsmayinclude: Biopsyoftheaffectedtissue(rare) Bronchoscopy ChestCTscan Chestxray InterferongammabloodtestsuchastheQFTGoldtesttotestforTBinfection Sputumexaminationandcultures Thoracentesis Tuberculinskintest(alsocalledaPPDtest)

Treatment
ThegoaloftreatmentistocuretheinfectionwithdrugsthatfighttheTBbacteria.Treatmentofactive pulmonaryTBwillalwaysinvolveacombinationofmanydrugs(usuallyfourdrugs).Allofthedrugsare continueduntillabtestsshowwhichmedicinesworkbest. Themostcommonlyuseddrugsinclude: Isoniazid Rifampin Pyrazinamide Ethambutol OtherdrugsthatmaybeusedtotreatTBinclude: Amikacin Ethionamide Moxifloxacin Paraaminosalicylicacid Streptomycin Youmayneedtotakemanydifferentpillsatdifferenttimesofthedayfor6monthsorlonger.Itisveryimportant thatyoutakethepillsthewayyourhealthcareproviderinstructed. WhenpeopledonottaketheirTBmedicationsasrecommended,theinfectionmaybecomemuchmoredifficult totreat.TheTBbacteriamaybecomeresistanttotreatment,andsometimes,thedrugsnolongerhelptreatthe infection. Whenthereisaconcernthatapatientmaynottakeallthemedicationasdirected,ahealthcareprovidermay needtowatchthepersontaketheprescribeddrugs.Thisiscalleddirectlyobservedtherapy.Inthiscase,drugs maybegiven2or3timesperweek,asprescribedbyadoctor. Youmayneedtostayathomeorbeadmittedtoahospitalfor24weekstoavoidspreadingthediseasetoothers untilyouarenolongercontagious. YourdoctorornurseisrequiredbylawtoreportyourTBillnesstothelocalhealthdepartment.Yourhealthcare teamwillbesurethatyoureceivethebestcareforyourTB.

SupportGroups
Youcaneasethestressofillnessbyjoiningasupportgroupwherememberssharecommonexperiencesand problems. See:Lungdiseasesupportgroup

Expectations(prognosis)

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Pulmonary tuberculosis - PubMed Health

Symptomsoftenimprovein23weeks.Achestxraywillnotshowthisimprovementuntilweeksormonths later.TheoutlookisexcellentifpulmonaryTBisdiagnosedearlyandtreatmentisbegunquickly.

Complications
PulmonaryTBcancausepermanentlungdamageifnottreatedearly. MedicinesusedtotreatTBmaycausesideeffects,includingliverproblems.Othersideeffectsinclude: Changesinvision Orangeorbrowncoloredtearsandurine Rash Avisiontestmaybedonebeforetreatmentsoyourdoctorcanmonitoranychangesinyoureyes'healthover time.

Callingyourhealthcareprovider
Callyourhealthcareproviderif: YouhavebeenexposedtoTB YoudevelopsymptomsofTB Yoursymptomscontinuedespitetreatment Newsymptomsdevelop

Prevention
TBisapreventabledisease,eveninthosewhohavebeenexposedtoaninfectedperson.Skintesting(PPD)for TBisusedinhighriskpopulationsorinpeoplewhomayhavebeenexposedtoTB,suchashealthcareworkers. PeoplewhohavebeenexposedtoTBshouldbeskintestedimmediatelyandhaveafollowuptestatalaterdate, ifthefirsttestisnegative. ApositiveskintestmeansyouhavecomeintocontactwiththeTBbacteria.Talktoyourdoctorabouthowto preventgettingtuberculosis. PrompttreatmentisextremelyimportantincontrollingthespreadofTBfromthosewhohaveactiveTBdisease tothosewhohaveneverbeeninfectedwithTB. SomecountrieswithahighincidenceofTBgivepeopleaBCGvaccinationtopreventTB.However,the effectivenessofthisvaccineislimitedanditisnotroutinelyusedintheUnitedStates. PeoplewhohavehadBCGmaystillbeskintestedforTB.Discussthetestresults(ifpositive)withyourdoctor.

References
1. EllnerJJ.Tuberculosis.In:GoldmanL,SchaferAI,eds.CecilMedicine.24thed.Philadelphia,PA: SaundersElsevier;2011:chap332. 2. FitzgeraldDW,SterlingTR,HaasDW.Mycobacteriumtuberculosis.In:MandellGL,BennettJE,Dolan R,eds.Mandell,Douglas,andBennettsPrinciplesandPracticeofInfectiousDiseases.7thed. Orlando,FL:SaundersElsevier;2009:chap250.
ReviewDate:12/6/2011. Reviewedby:DavidC.Dugdale,III,MD,ProfessorofMedicine,DivisionofGeneralMedicine,DepartmentofMedicine,University ofWashingtonSchoolofMedicine;JatinM.Vyas,MD,PhD,AssistantProfessorinMedicine,HarvardMedicalSchool,Assistantin Medicine,DivisionofInfectiousDisease,DepartmentofMedicine,MassachusettsGeneralHospital.AlsoreviewedbyDavidZieve, MD,MHA,MedicalDirector,A.D.A.M.,Inc.

A.D.A.M.,Disclaimer Copyright2012,A.D.A.M.,Inc.

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