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Tuberculosis (TB) is a potentially fatal contagious
disease that can affect almost any part of the body
but is mainly an infection of the lungs.
TB is caused by a bacterium called Mycobacterium
tuberculosis.

 
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‘n 1994 tuberculosis bacilli were found in a 1000-
year-old mummy, in Chiribaya Alta, Peru.This mummy dated from before the
time of Colombus. This negated the opinion that Europeans had introduced
tuberculosis to that continent.

Œ
‘n 1997, DNA of M. tuberculosis was found in 3000 year old an Egyptian
mummy from Thebes. ‘t is possible that the bacterium originates from the
one causing bovine tuberculosis.
Some people claim that tuberculosis started to spread among humans after
the domestication of cattle.

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M.Tuberculosis is a pathogenic bacterial spp. in the genus Mycobacterium
causative agent of TB.
First discovered by Robert Koch in 1882, so called Koch·s bacillus or Tubercle
bacilli.(noble price)
M. Tuberculosis has a waxy coating of on the cell surface.
These organisms are very inactive compared with the organisms of typhoid
fever and diphtheria Means«?««««
The organisms are slow grower taking 3 to 6 weeks for colony growth to
appear. 
Morphological characteristics

è The organisms are slender and straight.

è Staining may produce a granular or a bedded
appearance.
è Often seen in ´palisadeµ or V shape or L shape.

è ‘t can·t tolerate heat, but ‘t can live in humid or

dry or cold surroundings.

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The chemical composition of M. tuberculosis is somewhat differ from other
organisms.

Much of its pathogenicity is related to its antigenic activity and this in turn
depends on its chemical composition. (No exotoxin or endotoxin)
‘t consists of Y
, Protein, and Carbohydrate.


6
 

Constitute approximately 50% of the organism.
Form a waxy coated around the bacillus or interspersed throughout its
substance.
‘t is responsible for the folowing special features :
(1) ‘t makes the organism more difficult to stain , so that heat and a mordant
are required and it is responsible for its © ©


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(2) ‘t provide the bacilli more resistant to therapeutic agents.
(3) ‘t protects them against digestion when taken up by phagocytes.
(4) ‘t is less irritating to the tissue than the surface of rapidly multiplying
bacteria , so that the type of cellular response is less acute.
(5) The lipid seems to be responsible for transforming the mononuclear and
macrophages of the exudate into the epithelioid type of cell and thus for
the formation of the tubercle which gives the disease its name.

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The protein fraction was origenally extracted by Koch , who name it

Tuberculin.
This protein is he active antigen responsible for producing the state of
hypersensitivity of the tissues .
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‘t is notable that tuberculin itself does not have this power when injected
into an animal.

   

 


The carbohydrate fraction , a polysaccharide , when injected it promotes the

speedy accmulation of polymorphonuclear Leukocytes at the site of
injection. Thus it may be noted that it is the first response of the tissues to
invasion by the Tubercle bacillus.

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Tuberculosis spreads by droplet infection. This type of transmission means
that when a TB patient exhales, coughs, or sneezes, tiny droplets of fluid
containing Tubercle bacilli are released into the air.

This mist or aerosol can be taken into the nasal passages and lungs of a
susceptible person nearby.

Tuberculosis is not, however, highly contagious compared to some other

infectious diseases. Only about one in three close contacts of a TB patient,
and fewer than 15% of more remote contacts, are likely to become infected.

As a rule, close, frequent, or prolonged contact is needed to spread the

disease. 
Transmission of TB. TB is spread from person to person through the air. The dots in the
air represent droplet nuclei containing Tubercle bacilli.

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Latent TB infection :
 To be infected with TB means that Tubercle bacilli are in the body but are
being kept in a dormant or latent state by the body·s immune system.
 The immune system does this by producing special immune cells that
surround the tubercle bacilli. The cells form a hard shell that keeps the
bacilli contained and under control.
 Because of the potential for the bacilli to become active, multiply, and lead
to TB disease, individuals infected with M. tuberculosis are said to have
latent TB infection (LTB‘).
 TB infection is detected by the tuberculin skin test. Most people with LTB‘
have a positive reaction to the tuberculin skin test.(chest x-ray)
 People who have LTB‘, but not TB disease are NOT infectious ² in other
words, they cannot spread the infection to others.
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Active TB disease :
Some people with LTB‘ develop TB disease. TB disease develops when the
immune system cannot keep the tubercle bacilli under control and the bacilli
begin to multiply rapidly.

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Droplet nuclei are inhaled and pass down the bronchial tree and implant in
a bronchiole OR alveolus.
The bacillus may multiply here without resistance from the host.
Macrophages may slowly engulf organisms that may remain viable and
multyply within the cell.

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Droplet nuclei containing tubercle

bacilli are inhaled, enter the lungs, and
travel to the alveoli.

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 Tubercle bacilli multiply in the alveoli.

A small number of tubercle bacilli enter

the bloodstream and spread throughout
the body.

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 ½ithin 2 to 10 weeks, the immune system
produces special immune cells that surround the
tubercle bacilli. The cells form a hard shell that
keeps the bacilli contained and under control
(LTB‘).

‘f the immune system cannot keep the

bacilli under control, the bacilli begin to
multiply rapidly (TB disease). This process
can occur in different places in the body
such as the lungs, kidneys, brain, or bone.

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 ‘n the center of the granuloma is a compact mass of giant cells.

Surrounding this mass are epithelioid cells, lymphocytes,
monocytes, and fibroblasts.

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 having a
fibrous outside and calcified inside. The organisms inside may die
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 Certain medical conditions increase the risk that LTB‘ will progress to TB
disease. The risk may be about 3 times higher (as with diabetes) to more
than 100 times higher (as with H‘V infection) .


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 H‘V infection,
 Chest x-ray findings consistent with prior TB (in a person
inadequately treated)
 Low body weight (10% or more below ideal)
 Recent infection (within the past 2 years)
 Silicosis
 Diabetes mellitus
 Chronic renal failure/hemodialysis
 Prolonged therapy with corticosteroids and other
immunosuppressive agents
 Solid organ transplant
 Certain intestinal conditions (e.g., gastrectomy, jejunoileal bypass)



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