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TUBERCULOSIS - Coggle Diagram

- - - - access to healthcare
        
        mean age of the population
        
        lifestyle
        
        population density
        
        migration flows
    - - malnutrition and BMI
        
        diabetes
        
        tobacco smoke
        
        alcoholism
        
        silicosis
- - - - T cells in the periphery
  - - - aspirates
        
        BAL
        
        transbronchial biopsy
- - - - "dormient"
        
        persistent viral silent mycobacteria
      - miliary
        
        main DD: tumors
        
        blood dissemination
        
        young adults
        
        fever and CNS involvement
      - secondary
      - resolution
        
        reabsorption of primary lesion
        
        no symptoms
        
        scar
    - - no previous contact with mycobacteria
    - - index of previous contact with MT
      - exogenous entry
        
        airways (human type)
        
        intestinal (human and bovis types)
    - - 0-3 weeks = MT infection
        
        after 24h MT are in macrophages and they block the formation of phagolysosomes
        
        coagulative necrosis
        
        MT proliferation
      - 3 weeks =
        TH1 lymphocyte reaction
        
        macrophage activation + epithelioid transformation by TNF activation
        
        giant cell formation
        
        caseous necrosis and granuloma
        
        fibroblasts & lymphocytes in the periphery
        
        microscopic lesion
        
        fusion of granulomas leads to macroscopic lesions
        
        3 more items...
      - asymptomatic or flu-like
    - - virulence
        
        congenital resistance
        
        susceptibility
        
        delayed hypersensitivity
        
        these factors influence the exudative or productive evolution of lesions
        
        immunocompetence
        
        good in productive-caseous lesions, self-limiting
        
        poor in exudative-colliquative lesions, progressive
        
        mycobacterial load
        
        high in exudative-colliquative lesions
        
        low in productive-caseous lesions
    - - LUNG
        
        primary focus (Ghon)
        
        subpleural nodule 10-15 mm in middle portion of lobes with exudative alveolitis (gelatinous)
        
        macrophages containing MT, rare granulocytes, edema, few granulomas
        
        after 14 days caseous evolution
        
        after further 10 days, exudate reabsorption or calcification (Ranke complex)
        
        lymphatic spread
        
        from primary complex to hylar lymph nodes
        
        hylar lymph nodes involvement
        
        up to 6-7 cm
        
        persistent for years
        
        exudative or productive features and caseous evolution
        
        atypical form
        
        multiple nodules
        
        tracheo-bronchial lympho-adenopathy
        
        giant cells
        
        evolution of primary complex
        
        from 1 month to 1 year
        
        depending on MT virulence, bacterial lead, host immunocompetence (malnutrition, co-infections, alcohol, pregnancy, immunodeficiency)
        
        enlargement
        
        central necrosis
        
        cavitation
        
        local dissemination
        
        multiple lung lesions
      - LATERAL CERVICAL LYMPH NODES
        
        caseous exudation
        
        skin ulceration
        
        more frequent in children
        
        from oro-pharyngeal foci
        
        atypical mycobacteria
      - INTESTINE
        
        rapid caseous evolution in addominal lymph nodes
        
        calcification
        
        chronic persistence for years
  - - - tuberculin +
    - - reactivation
        
        from a primary complex
      - exogenous re-infection
        
        from the airways
      - endogenous re-infection
        
        from new lympho-hematogenous foci from a vital primary complex
    - - formation of granulomas (NO CAVITATIONS)
      - self-limiting
    - - scarce lymph node involvement + lesions in upper lobes
      - SIMON FOCUS
        
        children
        
        upper lobes with caseous matrix and fibrosis
        
        from latent primary focus
      - NODULAR SCLEROSIS of the apex
        
        lung and pleural thickening
      - ASCHOFF'S LESION
        
        broncho-alveolar exudative lesions in the apex
        
        self-limiting
      - ASSMANN REDEKER INFILTRATIVE FOCUS
        
        upper lobes
        
        not in the apex!!!
        
        hylar lymph nodes
        
        diffuse exudation
      - histopathology
        
        gelatinous pneumonia
        
        monocytes, no granuocytes, edema
        
        rare epithelioid cells
        
        aboundant caseosis
        
        colliquation with damage of bronchial wall
        
        evolution I
        
        2 more items...
        
        evolution II
        
        2 more items...
    - - bronchial
        
        cavitation and diffusion in the bronchial tree
        
        exudative lesions in the lower lobes
        
        laryngeal involvement
        
        intestinal lesions
      - lymphatic
        
        to the hylar lymph nodes
      - hematogenous
        
        miliary dissemination
        
        more common in 2ndary than in 1ary TBC
        
        lungs (but also other organs)
        
        bones in children
        
        joints, epididymis and salpynx in young adults
        
        CNS, adrenal glands, kidneys
- - - - only after >24h from fixation, the bacterium is inactivated (no more a biological hazard)
- - - - sex, site of infection, different immunocompetence
        
        familial (especially in age <15 yrs), school, public transportation, workplaces, hospitals, mines (silica), prisons
    - - different phenotypes, virulence and resistance to therapy
- - - - alcohol acid resistant
      - the only thing able to survive the staining is the bacterium envelope
      - highly specific, not so sensitive
      - if the staining is positive, the pt has tuberculosis; if the staining is negative, TBC cannot be excluded