Tuberculosis, MTB, or TB (short for tubercle bacillus) is a common, and in many cases lethal, infectious disease caused by various

strains of mycobacteria, usually Mycobacterium tuberculosis.[1] Tuberculosis typically attacks the lungs but can also affect other parts of the body. It is spread through the air when people who have an active TB infection cough, sneeze, or otherwise transmit their saliva through the air.[2] Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of those so infected. The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss (the last giving rise to the formerly prevalent term "consumption"). Infection of other organs causes a wide range of symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, and blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Social contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multiple drugresistant tuberculosis. Prevention relies on screening programs and vaccination with the bacillus Calmette-Gurin vaccine. One-third of the world's population is thought to have been infected with M. tuberculosis,[3] and new infections occur at a rate of about one per second.[3] In 2007, there were an estimated 13.7 million chronic active cases,[4] and in 2010, there where 8.8 million new cases, and 1.5 million deaths, mostly in developing countries.[5] The absolute number of tuberculosis cases has been decreasing since 2006, and new cases have decreased since 2002.[5] The distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 510% of the United States population test positive.[1] More people in the developing world contract tuberculosis because of compromised immunity due to high rates of AIDS.[6]

Signs and symptoms

The main symptoms of variants and stages of tuberculosis are given,[7] with many symptoms overlapping with other variants, while others are more (but not entirely) specific for certain variants. Multiple variants may be present simultaneously. Only about 5-10% of those without HIV, infected with tuberculosis, develop active disease during their lifetimes.[8] In contrast, 30% of those coinfected with HIV develop active disease.[8] Tuberculosis may infect any part of the body, but most commonly occurs in the lungs (known as pulmonary

tuberculosis).[9] Extrapulmonary TB is when tuberculosis occurs outside of the lungs and may coexist with pulmonary TB.[9] General symptoms such as: fever, chills, night sweats, appetite loss, weight loss, fatigue,[9] and finger clubbing may also occur.[8] Pulmonary If tuberculosis does become active, it most commonly involves infection in the lungs. Symptoms may include chest pain and a productive, prolonged cough. About a quarter of people, however, may not have any symptoms.[6] Occasionally, people may cough up blood in small amounts and in very rare cases the infection may erode into the pulmonary artery, resulting in massive bleeding known as Rasmussen's aneurysm. Spitting up stones known as lithoptysis has been described due to bronchial lymph nodes communicated with the airways.Tuberculosis may become chronic, with scarring usually in the upper lobes of the lungs. The upper lungs are believed to be more frequently affected due to their poor lymph supply rather than more air flow.[9] Extrapulmonary

Risk factors Main article: Risk factors for tuberculosis A a number factors make people more susceptible to TB infections. Worldwide, the most important of these is HIV, with coinfection present in about 13% of cases.[5] This is a particular problem in subSaharan Africa, where rates of HIV are high.[26][27] Tuberculosis is closely linked to both overcrowding and malnutrition, making it one of the principal diseases of poverty.[6] Chronic lung disease is a risk factor, with smoking more than 20 cigarettes a day increasing the risk by two to four times[28] and silicosis increasing the risk about 30-fold.[29] Other disease states can increase the risk of developing tuberculosis, including alcoholism[6] and diabetes mellitus (threefold increase).[30] Certain medications, such as corticosteroids and infliximab (an anti-TNF monoclonal antibody) are becoming increasingly important risk factors, especially in the developed world.[6] There is also a genetic susceptibility[31] for which overall importance is still undefined.[6] Mechanism

Transmission When people with active pulmonary TB cough, sneeze, speak, sing, or spit, they expel infectious aerosol droplets 0.5 to 5 m in diameter. A single sneeze can release up to 40,000 droplets.[32] Each one of these droplets may transmit the disease, since the infectious dose of tuberculosis is very low, and inhaling fewer than 10 bacteria may cause an infection.[33]

People with prolonged, frequent, or close contact are at particularly high risk of becoming infected, with an estimated 22% infection rate.[34] A person with active but untreated tuberculosis can infect 1015 other people per year.[3] Others at risk include people in areas where TB is common, people who inject illicit drugs, inhabitants and employees of locales where vulnerable people gather (eg. prisons, homeless shelters), medically underprivileged and resource-poor populations, high-risk racial or ethnic minorities, children in close contact with high-risk category patients, those who are immunocompromised by conditions such as HIV infection, people who take immunosuppressant drugs, and health care providers serving these clients.[35] Transmission can only occur from people with activenot latentTB.[1] The probability of transmission from one person to another depends upon the number of infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of exposure, and the virulence of the M. tuberculosis strain.[36] The cascade of person-to-person spread can be circumvented by effective segregation of those with active (overt) TB, and putting them on recommended anti-TB drug regimens. After about two weeks of such treatment, subjects with nonresistant active infections generally do not remain as potential sources of infection for contacts.[34] If someone does become infected, then it will take three to four weeks before the newly infected person can transmit the disease to others.[37]

Spinal tuberculosis

Pott's disease is a presentation of extrapulmonary tuberculosis that affects the spine, a kind of tuberculous arthritis of the intervertebral joints. It is named after Percivall Pott (17141788), a London surgeon who trained at St Bartholomew's Hospital, London. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Scientifically, it is called tuberculous spondylitis and it is most commonly localized in the thoracic portion of the spine. Potts disease results from haematogenous spread of tuberculosis from other sites, often pulmonary. The infection then spreads from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot receive nutrients and collapses. The disc tissue dies and is broken down by caseation, leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry soft tissue mass often forms and superinfection is rare. Prevention

Controlling the spread of tuberculosis infection can prevent tuberculous spondylitis and arthritis. Patients who have a positive PPD test (but not active tuberculosis) may decrease their risk by properly taking medicines to prevent tuberculosis. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.