PRIMARY PULMONARY TUBERCULOSIS

1. Presented by :Arif Khan
5th Year
4th Group

2.  Primary tuberculosis is the initial infection of the
host, usually being mild and asymptomatic. A
healthy person recently infected with the
mycobacterium may exhibit flu-like symptoms and
has no reason to suspect tuberculosis. Left
untreated, the bacilli infect and multiply within
pulmonary alveolar macrophages, migrating to the
hilar lymph nodes. An immune response is
exhibited by the T-helper cells, and inflammation
develops at multiple sites.
 Primary pulmonary tuberculosis is seen in
patients not previously exposed to M. tuberculosis.
It is most common in infants and children and has
the highest prevalence in children under 5 years of
age .

3.  A person may test positive in the tuberculin
skin test at this point, and a chest x-ray may
shows opacities in the lungs. Tuberculosis gets
its name from the small granulomas called
tubercles, consisting of epitheliod cells, giant
cells, and lymphocytes, where the bacteria
are contained. In normal patients, the lesions
in the lung tissue become fibrotic and heal,
but are visible in x-rays for the patient's
lifetime. During latency, a person cannot
transmit tuberculosis to others.

4.  parenchymal disease: usually manifests as
dense, homogeneous parenchymal
consolidation in any lobe; however,
predominance in the lower and middle lobes
(subpleural sites) is suggestive of the disease,
especially in adults 1
 lymphadenopathy
 miliary opacities
 pleural effusion

5.  The primary infection is usually
asymptomatic (majority of cases), although a
small number go on to have symptomatic
haematological dissemination which may
result in miliary tuberculosis. Only in 5% of
patients, usually those with impaired
immunity, go on to have progressive primary
tuberculosis.

7. Primary tuberculosis is always result of
exogenous infection.
The infection penetrates into organism
by:
- aerogenic (the most often way of
penetration)
- alimentary;
- contact way.

8.  Primary TB infection may be asymptomatic,cause
fevers and pleuritic pain or, rarely, progress to life
threatening disease. Dur ing the primary pulmonary
infection, symptoms may occur as the burden of
bacilli increases and the host mounts a systemic
immune response. Fever is the most common
symptom.
 On examination, a patient with primary pulmonary TB
may have erythema nodosum, bluish red tender
subcutaneous nodules several millimetres to several
centimetres in diameter appearing on the legs, and
phlyctenular conjunctivitis, hard raised red 1 to 3 mm
nodules accompanied by a zone of hyperaemia
located near the limbus on the bulbar conjunctiva of
the eye.

9.  dullness over lung component with a big
size.
 Weakend breathing with streached
exhale.
Hemogram: Leucocytosis 10-13 T/l, insignificant
shift to the left, lymphopenia, monocytosis, ESR
20-25 mm/h

10. Phases: 1) infiltrative or pneumonic;
2) resorbtion(suction,bipolarities);
3) scarring
4) calcification.

15.  In primary pulmonary tuberculosis, the initial
focus of infection can be located anywhere
within the lung and has non-specific
appearances ranging from too small to be
detectable, to patchy areas or consolidation
or even lobar consolidation.
 Radiographic evidence of parenchymal
infection is seen in 70% of children and 90%
of adults .

16.  In most cases, the infection becomes localised
and a caseating granuloma forms (tuberculoma)
which usually eventually calcifies and is then
known as a Ghon lesion/Ghon complex/ primary
complex.
 Consists of 3 components:
 Pulmonary component (Ghon’s Focus)
 Lymphatic component
 Lymph node component – Hilar & Tracheo-
bronchial

17.  Pulmonary component:
 lesion in the lung (Ghon focus or primary focus)
 1-2cm solitary area located peripherally in the
subpleural focus in the lower part of upper lobe or
upper part of lower lobe
 Micro: the lung lesion show tuberculous granuloma with
caseous necrosis
 Lymphatic component:
 lymphatics draining lung lesion containing phagocytes
with M tuberculosis bacilli
 Lymph node component:
 Enlarged hilar and tracheo-bronchial lymph node
 Gross: the affected lymph nodes are matted and
may show caseation necrosis
 Micro: tuberculous granulomas, caseation necrosis
and fibrosis.
 Nodal lesions are the potential source of
reinfection later.

19.  Complications connected with regional
lymphadenitis:
 - hematogenic dissemination
 - lymphogenic dissemination
 - pleuritis
 - extending of specific process from lymphatic
node
 It’s results:
 a) formation of fistula
 b) dispersion of caseous masses,
bronchogenic dessemination, bronchi
tuberculosis
 c) disorder of bronchial permeability,
atelectasis

20.  The doctor or nurse will perform a physical exam. This may show:
 Clubbing of the fingers or toes (in people with advanced disease)
 Swollen or tender lymph nodes in the neck or other areas
 Fluid around a lung (pleural effusion)
 Unusual breath sounds (crackles)
 Tests may include:
 Biopsy of the affected tissue (rare)
 Bronchoscopy
 Chest CT scan
 Chest x-ray
 Interferon-gamma release blood test such as the QFT-Gold test to
test for TB infection
 Sputum examination and cultures
 Thoracentesis
 Tuberculin skin test (also called a PPD test)

21. The treatment of tuberculosis (TB) must satisfy
the following basic therapeutic principles:
 Any regimen must use multiple drugs to
which Mycobacterium tuberculosis is susceptible
 The medications must be taken regularly
 The therapy must continue for a period sufficient to
resolve the illness
 New cases are initially treated with four drugs: isoniazid,
rifampin, pyrazinamide, and either ethambutol or
streptomycin. After 2 months, they are then treated with
a continuation phase of 4 months with isoniazid and
rifampin. Patients requiring retreatment should initially
receive at least 5 drugs, including isoniazid, rifampin,
pyrazinamide, and at least 2 (preferably 3) new drugs to
which the patient has not been exposed.