Radiological Features of Mycobacterium tuberculosis TUBERCULE BACILLUS TUBERCULE BACILLUS DIAGNOSIS. Guy Richards. PATHOGENESIS of TUBERCULOSIS

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1 Radiological Features of Guy Richards Department of critical care Charlotte Maxeke Johannesburg Academic Hospital University of the Witwatersrand, Johannesburg, South Africa TUBERCULE BACILLUS Discovery of Robert Koch, German bacteriologist ( ) in the year 1882 Tuberculosis phthisis consumption A condition of little knobs and swellings King s evil White plague TUBERCULE BACILLUS Famous people who had Tuberculosis Frederick Chopin Franz Kafka John Keats Bronte family PATHOGENESIS of TUBERCULOSIS Expelled Swallowed Lymph nodes DIAGNOSIS Inhaled organisms To alveoli Distant spread Primary complex Distant spread Healing Progress Intestine Calcified lesion Stable Enlargement & Local spread Perhaps years later Reactivation demonstrate AFB positive culture skin test serology PCR Distant spread 1

2 Primary tuberculosis lymphadenopathy (big) parenchymal disease (small) pleural effusion atelectasis miliary disease normal radiograph in ~15% Primary tuberculosis Areas of greatest lung ventilation Middle lobe Lower lobes Anterior segment of upper lobes Primary tuberculosis hilar and mediastinal lymphadenopathy (>2 cm), which present with a hypodense centre (caseation) and rim enhancement obstructive atelectasis may occur cavitation is uncommon Harisinghani M G et al. Radiographics 2000;20: by Radiological Society of North America Harisinghani M G et al. Radiographics 2000;20: by Radiological Society of North America 2

3 Burrill J et al. Radiographics 2007;27: Harisinghani M G et al. Radiographics 2000;20: by Radiological Society of North America 3

4 Post-primary (reactivation) reactivation of previous TB lesion parenchymal disease with cavitation is common pleural involvement airway involvement other Post-primary (reactivation) apical or posterior segment of upper lobe superior segment of lower lobes usually two or more segments or bilateral CAVITATORY TB early if impaired immunity usually reactivated TB especially upper lobe moderate illness often sputum positive bronchoscopy if negative high communicability 4

5 Burrill J et al. Radiographics 2007;27: Burrill J et al. Radiographics 2007;27:

6 TB BRONCHPNEUMONIA Burrill J et al. Radiographics 2007;27: inhalation controlled unchecked progressive primary pneumonia or post-primary TB middle / lower lobe ± adenopathy, cavitation in children often fairly ill sputum usually positive high communicability Burrill J et al. Radiographics 2007;27: Pleural tuberculosis can be complication of primary TB or occur as part of postprimary TB pathogenesis different more common in adolescents and young adults commonly unilateral 6

7 Burrill J et al. Radiographics 2007;27: ACUTE PNEUMONIA IN ICU HIV ASSOCIATED TB Feldman et al, cases of pneumonia 21 cases due to TB Dalmash et al, patients 8% due to TB Rello et al, patients 11.4% due to TB Niederman et al, 1993 ATS guidelines presentation unusual the new TB extrathoracic disease common pulmonary lesions - non cavitatory associated adenopathy invasive procedures for diagnosis 7

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9 COMMON COMPLICATIONS OF TUBERCULOSIS Early Late Pneumonia Empyema Haemoptysis Laryngitis Pneumothorax Bronchiectasis Mycetomas in cavities Colonization if fibrotic lung with non-tuberculosis mycobacterium Non-respiratory disease (genitourinary, bone tuberculosis 9

10 Arthur M Walker ( ) I would like to remind those responsible for the treatment of TB, that Keats wrote his best poems while dying of this disease. In my opinion he would never have done so under the influence of modern chemotherapy. 10