Pulmonary Tuberculosis: A Detailed Overview
Diagnosis of Pulmonary Tuberculosis
Medical History and Physical Examination: A thorough medical history, including symptoms (such as persistent cough, weight loss, night sweats, and fever) and exposure to TB, is taken. A physical examination is conducted to assess overall health.
Tuberculin Skin Test (TST): Also known as the Mantoux test, this involves the intradermal injection of a small amount of purified protein derivative (PPD) and assessing the reaction after 48-72 hours. A positive reaction indicates exposure to the TB bacteria, but further testing is needed to confirm active disease.
Interferon Gamma Release Assays (IGRAs): Blood tests that measure the immune response to specific TB proteins can also be used to diagnose latent or active TB.
Chest X-ray: Imaging studies help to identify abnormalities in the lungs associated with TB, such as infiltrates or cavitations.
Sputum Tests: Patients may provide sputum samples, which are examined under a microscope for the presence of Mycobacterium tuberculosis and cultured to confirm the diagnosis. Sputum tests can also determine drug susceptibility.
Treatment of Pulmonary Tuberculosis
The treatment for pulmonary tuberculosis typically involves a combination of antibiotics over an extended period. The standard treatment regimen includes:
First-Line Antitubercular Drugs:
Isoniazid (INH): Inhibits the synthesis of mycolic acids in the bacterial cell wall.
Rifampicin (RIF): Inhibits RNA synthesis by binding to the bacterial RNA polymerase.
Pyrazinamide (PZA): Disrupts mycobacterial cell metabolism.
Ethambutol (EMB): Inhibits cell wall synthesis.
Standard Treatment Regimen:
Initial Phase: A combination of the above four drugs is usually given for the first two months.
Continuation Phase: After the initial phase, typically isoniazid and rifampicin are continued for an additional four to six months, depending on the patient's response and drug susceptibility.\
Directly Observed Therapy (DOT): In many cases, treatment is administered under the supervision of healthcare providers to ensure adherence and completion of therapy, which is crucial for preventing drug resistance and ensuring successful treatment.
Drug-Resistant TB: If drug-resistant TB is suspected or confirmed, treatment regimens may involve second-line medications and require more extended therapy, often lasting 18-24 months or longer.
Supportive Care: Patients may require supportive measures such as nutritional support, management of symptoms, and psychological support.
Successful treatment of pulmonary tuberculosis requires prompt diagnosis, adherence to prescribed regimens, and regular follow-up to monitor progress and prevent complications.