“TOWARDS ERADICATING

TUBERCULOSIS”
-AETIOPATHOGENESIS OF
TUBERCULOSIS-
Dr. A. O. Oluwasola
MBBS FWACP(lab. Med.) Msc. Epid.
Snr. Lecturer/Consultant Pathologist
WHY THE NEED TO PURSUE TB
ERADICATION?
 The eradication of smallpox from the world in 1977 proved
the feasibility of infectious disease eradication
 About a third of world popn. is infected with TB

 Yet the global epidemic is growing and becoming more

dangerous
 The breakdown in health services, the spread of HIV/AIDS
and the emergence of multidrug-resistant TB are
contributing to the worsening impact of this disease.

 In 1993, the World Health Organization (WHO) declared

tuberculosis a global emergency!!!
 WHAT IS TUBERCULOSIS?
 'Tuberculosis' is a chronic infectious disease……
 Usually caused by the bacterium
Mycobacterium tuberculosis,
 Most commonly affects the lungs (pulmonary TB)
 Up to a third affect other organs: CNS, UGS,………
 ‘Tubercu……..losis’

 ‘Tubercle…….’ …………knob-like(L)

 ‘…………losis’ ………condition(GK)
 OTHER NAMES FOR THE
DISEASE ARE:
 'TB'
 Koch`s disease
 'Consumption'
 'Wasting disease'
 'White plague'
 'Phthisis' (Gk word for consumption) and 'phthisis pulmonalis'
 ' Scrofula' (swollen neck glands)
 'King's evil'
 ' Pott's disease' of the spine
 'Tabes mesenterica' (TB of the abdomen)
 ' Lupus vulgaris' (the common wolf - TB of the skin)
 ' Prosector's wart', also a kind of TB of the skin, transmitted by contact
with contaminated cadavers to anatomists, pathologists, veterinarians,
surgeons, butchers, etc.
 AETIOLOGY
 Tuberculosis, is caused by bacteria belonging to
the Mycobacterium tuberculosis complex.
 Belong the family Mycobacteriaceae and the order
Actinomycetales.
 The most frequent and important agent of human
disease is M. tuberculosis.
 The classical Myc. tb. complex also includes:
• M. bovis,
• M. africanum &
• M. microtii.
 CHARACTERISTICS OF
MYCOBACTERIA
 M. tuberculosis is a rod-shaped, non-spore-forming, thin
aerobic bacterium measuring about 0.5 um by 3 um.
 Acid-fast bacilli (AFB). -ZN stain; due to cell wall lipids
 Lipids (e.g., mycolic acids) are linked to underlying
arabinogalactan and peptidoglycan. –antbt. ineff.
 Lipoarabinomannan(LAM), -pathogen-host interaction &
facilitates the survival of M. tuberculosis within
macrophages.
 The complete genome sequence comprises about 4000
genes -antigenic variations\point mutations /MDR
 EPID EMIOL OGY
 1.7 billion individuals worldwide, 90% -developing
countries
 8 to 10 million new cases and 1.7 million deaths annually.
 2nd leading infectious cause of death in the world.
 Infection with HIV makes people susceptible to rapidly
progressive tuberculosis;
 Over 50 million people are infected with both HIV and M.
tuberculosis.
 Without greater control efforts, the annual incident
cases of tuberculosis globally may increase by 40%
between now and 2020.
TB CASE NOTIFICATION RATE
 EPIDEM IO LOG Y CTD
 Tuberculosis flourishes wherever there is
poverty, crowding, and chronic debilitating
illness.
 In the United States, tuberculosis is mainly
a disease of the elderly, the urban poor,
and people with AIDS.
 Certain medical conditions increase risk that
TB infection will progress to TB disease
Conditions That Increase the Risk of
Progression to TB Disease
•HIV infection
•Substance abuse
•Recent infection
•Chest radiograph findings suggestive of
previous TB
•Diabetes mellitus
•Silicosis
•Prolonged corticosteriod therapy
•Other immunosuppressive therapy
 Conditions That Increase the Risk of
Progression to TB Disease (cont.)
•Cancer of the head and neck

•Hematologic and reticuloendothelial diseases

•End-stage renal disease

•Intestinal bypass or gastrectomy

•Chronic malabsorption syndromes

•Low body weight (10% or more below the ideal

 FRO M EXPOSU RE TO
INF ECTIO N –
 Epidemiologic concept of infection/disease
 The chain of infection-
 RESERVOIR of infection is humans with active
tuberculosis.
 TRANSMISSION – mainly by droplet nuclei, which
are aerosolized by coughing, sneezing, or speaking.
 Other routes:- skin & placenta, are uncommon.
 SUSCEPTIBLE HOST: - Acquired & genetic factors.
IMPORTANT DETERMINANTS OF
TRANSMISSION:-
Mainly exogenous:
 The probability of contact with a case of
tuberculosis,
 The intimacy and duration of that
contact,
 The degree of infectiousness of the
case,
 The shared environment of the contact
SPREAD BY DROPLET NUCLEI
FROM I NF ECTION T O
DIS EASE
 Mainly endogenous
 Balance between bactericidal
activity/virulence
 The individual's innate susceptibility to
disease
• age,
• sex,
• genetic factors- #2q35
• Level of function of cell-mediated immunity-
acquired or congenital immunodeficiency
 PATH OG ENES IS
 Following inhalation ~10% → alveoli
 Virulence genes:- katG, rpov, erp

 Number of invading bacilli

 Resistance/susceptibility genes:-
NRAMP1polymorphism
 DTH
SEQUENCE OF EVENTS IN FIRST 3
WEEKS AFTER INFECTION
EVENTS OCCURRING AFTER 3
WEEKS OF EXPOSURE
Thin section transmission electron
micrograph of Mycobacterium
tuberculosis
MYCOBACTERIA DEMONSTRABLE
WITH ACID-FAST STAINS
A TUBERCULOUS GRANULOMA
HYPERSENSITIVITY REACTION
THE NATURAL HISTORY AND
SPECTRUM OF TUBERCULOSIS
GHON COMPLEX
SECONDARY PULMONARY
TUBERCULOSIS
MILIARY TUBERCULOSIS OF
THE SPLEEN
 COMPLICATIONS OF
TUBERCULOSIS
 PRIMARY TB  POSTPRIMARY TB
2. Reactive pleural effusion 2. Reactive pleural effusion
3. Tuberculous pleurisy 3. Pleural tuberculosis
4. Bronchial occlusion 4. Cavitation- hmge; tb brpn;
5. Bronchopneumonia pnthorax; aspergilloma
6. Pericarditis 5. Bronchiectasis
7. Laryngitis 6. Progressive pulm. fibrosis
8. Pulmonary collapse 7. Destroyed lung synd.
9. Body wasting 8. Percarditis
10. Localised TB in another 9. Miliary TB
organ 10. Amyloidosis
11. Miliary tuberculosis 11. ARDS
PROSPECTS FOR ERADICATION
1. PREPATHOGENESIS
 ?Ignorance
 ?Poverty
 ?Specific protection

3. PERIOD OF PATHOGENESIS
 ?Predisposing diseases
 ?Cytokines/immunotherapy/host immunity
 ?Genes/genotherapy
4. ?OTHER LEVELS/FACTORS
 THANK YOU FOR YOUR ATTENTION