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2. Respiratory diseases
Pulmonary tuberculosis
P ulm onary t2uberculosis is a bacterial infection d ue to Mycobacterium tuberculosis,
spread
by airborne route. A fter contam ination, M. tuberculosis m ultiplies slow ly in th e lung s:
th is represents th e prim ary infection.
In im m unocom petent patients, th e pulm onary lesion h eals in 9 0 % of cases, but in
10% ,
patients d ev elop activ e tuberculosis.
T uberculosis m ay also be extrapulm onary: tuberculous m ening itis, d issem inated
tuberculosis, lym ph nod e tuberculosis, spinal tuberculosis, etc.
P atients w ith H I V infection h av e an increased risk of d ev eloping activ e tuberculosis.
T uberculosis is th e opportunistic d isease th at m ost com m only rev eals A I D S. I n certain
countries, up to 7 0 % of patients w ith tuberculosis are co-infected w ith H IV .
Clinical features
P rolong ed coug h (> tw o w eeks), sputum prod uction, ch est pain, w eig h t loss,
anorexia,
fatig ue, m od erate fev er, and nig h t sw eats.
T h e m ost ch aracteristic sig n is h aem optysis (presence of blood in sputum ), h ow ev er it
is not alw ays present and h aem optysis is not alw ays d ue to tuberculosis. If sputum is
sm ear-neg ativ e, consid er pulm onary d istom atosis (pag e 1 4 9 ) , m elioid osis (South east
A sia), profound m ycosis or bronch ial carcinom a.
In an end em ic area, th e d iag nosis of tuberculosis is to be consid ered , in practice, for all
patients consulting for respiratory sym ptom s for ov er tw o w eeks w h o d o not respond
to non-specific antibacterial treatm ent.
Diagnosis
– Sputum sm ear m icroscopy; culture
– C h est X - rays are useful for th e d iag nosis of sm ear neg ativ e tuberculosis and
tuberculosis in ch ild ren.
Treatment
T h e treatm ent is a com bination of sev eral of th e follow ing antituberculous d rug s
[isoniazid (H ), rifam picin (R ), pyrazinam id e (Z ), eth am butol (E ), streptom ycin (S)]. T h e
reg im en is stand ard ised and org anized into 2 ph ases (initial ph ase and continuation
ph ase).
T h e treatm ent of d rug -sensitiv e tuberculosis lasts a m inim um of 6 m onth s.
I t takes sig nificant inv estm ent to cure a T B patient, both from th e patient and th e
m ed ical team . O nly uninterrupted treatm ent for sev eral m onth s m ay lead to cure and
prev ent th e d ev elopm ent of resistance, w h ich com plicates later treatm ent. I t is essential
th at th e patient und erstand s th e im portance of treatm ent ad h erence and th at h e h as
access to correct case m anag em ent until treatm ent is com pleted .
Pulmonary tuberculosis
P ulm onary t2uberculosis is a bacterial infection d ue to Mycobacterium tuberculosis,
spread
by airborne route. A fter contam ination, M. tuberculosis m ultiplies slow ly in th e lung s:
th is represents th e prim ary infection.
In im m unocom petent patients, th e pulm onary lesion h eals in 9 0 % of cases, but in
10% ,
patients d ev elop activ e tuberculosis.
T uberculosis m ay also be extrapulm onary: tuberculous m ening itis, d issem inated
tuberculosis, lym ph nod e tuberculosis, spinal tuberculosis, etc.
P atients w ith H I V infection h av e an increased risk of d ev eloping activ e tuberculosis.
T uberculosis is th e opportunistic d isease th at m ost com m only rev eals A I D S. I n certain
countries, up to 7 0 % of patients w ith tuberculosis are co-infected w ith H IV .
Clinical features
P rolong ed coug h (> tw o w eeks), sputum prod uction, ch est pain, w eig h t loss,
anorexia,
fatig ue, m od erate fev er, and nig h t sw eats.
T h e m ost ch aracteristic sig n is h aem optysis (presence of blood in sputum ), h ow ev er it
is not alw ays present and h aem optysis is not alw ays d ue to tuberculosis. If sputum is
sm ear-neg ativ e, consid er pulm onary d istom atosis (pag e 1 4 9 ) , m elioid osis (South east
A sia), profound m ycosis or bronch ial carcinom a.
In an end em ic area, th e d iag nosis of tuberculosis is to be consid ered , in practice, for all
patients consulting for respiratory sym ptom s for ov er tw o w eeks w h o d o not respond
to non-specific antibacterial treatm ent.
Diagnosis
– Sputum sm ear m icroscopy; culture
– C h est X - rays are useful for th e d iag nosis of sm ear neg ativ e tuberculosis and
tuberculosis in ch ild ren.
Treatment
T h e treatm ent is a com bination of sev eral of th e follow ing antituberculous d rug s
[isoniazid (H ), rifam picin (R ), pyrazinam id e (Z ), eth am butol (E ), streptom ycin (S)]. T h e
reg im en is stand ard ised and org anized into 2 ph ases (initial ph ase and continuation
ph ase).
T h e treatm ent of d rug -sensitiv e tuberculosis lasts a m inim um of 6 m onth s.
I t takes sig nificant inv estm ent to cure a T B patient, both from th e patient and th e
m ed ical team . O nly uninterrupted treatm ent for sev eral m onth s m ay lead to cure and
prev ent th e d ev elopm ent of resistance, w h ich com plicates later treatm ent. I t is essential
th at th e patient und erstand s th e im portance of treatm ent ad h erence and th at h e h as
access to correct case m anag em ent until treatm ent is com pleted .
