Pulmonary Tuberculosis

Sarah M. Lyon; Milton D. Rossman

doi:10.1128/microbiolspec.TNMI7-0032-2016

Chapter 16 : Pulmonary Tuberculosis

Authors: Sarah M. Lyon¹, Milton D. Rossman²

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Affiliations: 1: Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104; 2: Pulmonary, Allergy and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104

Content Type: Monograph

Publication Year: 2017

Category: Bacterial Pathogenesis; Clinical Microbiology

Book DOI: 10.1128/9781555819866

Chapter DOI: 10.1128/microbiolspec.TNMI7-0032-2016

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Abstract:

The lung is the most commonly affected organ in tuberculosis infection in the immunocompetent host, with estimates of lung involvement in subjects with active tuberculosis of 79 to 87% ( 1 – 3 ). Estimates of lung involvement are similar in immunocompromised hosts, such as those with human immunodeficiency virus (HIV) infection, with studies from the 1980 to 1990s suggesting that the rates of pulmonary involvement were on the order of 70 to 92% ( 4 – 6 ). However, these individuals are also more likely to have extrapulmonary disease as well ( 7 ).

Citation: Lyon S, Rossman M. 2017. Pulmonary Tuberculosis, p 285-298. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Seventh Edition. ASM Press, Washington, DC. doi: 10.1128/microbiolspec.TNMI7-0032-2016

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Figures

Pulmonary Tuberculosis

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Figure 1

Primary tuberculosis in an adult. Shown is a right lower lobe infiltrate with bilateral hilar adenopathy.

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Figure 1

Primary tuberculosis in an adult. Shown is a right lower lobe infiltrate with bilateral hilar adenopathy.

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Figure 2

Left upper lobe tuberculosis. Shown is a typical fibronodular pattern of reactivation tuberculosis with linear densities extending to the left hilum.

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Figure 2

Left upper lobe tuberculosis. Shown is a typical fibronodular pattern of reactivation tuberculosis with linear densities extending to the left hilum.

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Figure 3

Late changes of upper lobe tuberculosis. (A) Posterior-anterior chest radiograph with volume loss of the right upper lobe indicated by the elevated minor fissure. Small cavities are not clearly visible, but there is endobronchial spread to the superior segment of the right lower lobe, suggesting cavitary formation. (B) A CT scan of the same patient that clearly demonstrates extensive bilateral cavitary disease.

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Figure 3

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Figure 4

Miliary tuberculosis. (A) Characteristic diffuse small nodules are seen in the posterior-anterior radiograph. (B) CT scan of the lung in the same subject demonstrates the diffuse small nodular disease.

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Figure 4

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Figure 5

Tuberculous empyema. Posterior-anterior (A) and lateral (B) chest radiographs demonstrate a left lower lobe effusion.

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Figure 5

Tuberculous empyema. Posterior-anterior (A) and lateral (B) chest radiographs demonstrate a left lower lobe effusion.

References

/content/book/10.1128/9781555819866.chap16

1. Farer LS,, Lowell AM,, Meador MP . 1979. Extrapulmonary tuberculosis in the United States. Am J Epidemiol 109 : 205– 217.[PubMed]

2. Arango L,, Brewin AW,, Murray JF . 1973. The spectrum of tuberculosis as currently seen in a metropolitan hospital. Am Rev Respir Dis 108 : 805– 812.[PubMed]

3. CDC . 2015. Reported Tuberculosis in the United States, 2014. Department of Health and Human Services, CDC, Atlanta, GA. https://www.cdc.gov/tb/statistics/reports/2014/.

4. Centers for Disease Control and Prevention . 2009. Updated guidelines for the use of nucleic acid amplification tests in the diagnosis of tuberculosis. MMWR Morb Mortal Wkly Rep 58 : 7– 10.[PubMed]

5. Shafer RW,, Kim DS,, Weiss JP,, Quale JM . 1991. Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine (Baltimore) 70 : 384– 397.

6. Perlman DC,, el-Sadr WM,, Nelson ET,, Matts JP,, Telzak EE,, Salomon N,, Chirgwin K,, Hafner R , The Terry Beirn Community Programs for Clinical Research on AIDS, The AIDS Clinical Trials Group . 1997. Variation of chest radiographic patterns in pulmonary tuberculosis by degree of human immunodeficiency virus-related immunosuppression. Clin Infect Dis 25 : 242– 246.[PubMed]

7. Shafer RW,, Edlin BR . 1996. Tuberculosis in patients infected with human immunodeficiency virus: perspective on the past decade. Clin Infect Dis 22 : 683– 704.[PubMed]

8. Small PM,, Schecter GF,, Goodman PC,, Sande MA,, Chaisson RE,, Hopewell PC . 1991. Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection. N Engl J Med 324 : 289– 294.[PubMed]

9. Glassroth J,, Robins AG,, Snider DE Jr . 1980. Tuberculosis in the 1980s. N Engl J Med 302 : 1441– 1450.[PubMed]

10. Mayock RL,, MacGregor RR . 1976. Diagnosis, prevention and early therapy of tuberculosis. Dis Mon 22 : 1– 60.[PubMed]

11. Farer LS,, Lowell AM,, Meador MP . 1979. Extrapulmonary tuberculosis in the United States. Am J Epidemiol 109 : 205– 217.[PubMed]

12. MacGregor RR . 1975. A year’s experience with tuberculosis in a private urban teaching hospital in the postsanatorium era. Am J Med 58 : 221– 228.[PubMed]

13. Garibaldi RA,, Drusin RE,, Ferebee SH,, Gregg MB . 1972. Isoniazid-associated hepatitis. Report of an outbreak. Am Rev Respir Dis 106 : 357– 365.[PubMed]

14. Holden M,, Dubin MR,, Diamond PH . 1971. Frequency of negative intermediate-strength tuberculin sensitivity in patients with active tuberculosis. N Engl J Med 285 : 1506– 1509.[PubMed]

15. Fraser RG,, Pare JAP . 1977. Diagnosis of diseases of the chest, p 731– 764. WB Saunders, Philadelphia, PA.

16. Weber AL,, Bird KT,, Janower ML . 1968. Primary tuberculosis in childhood with particular emphasis on changes affecting the tracheobronchial tree. Am J Roentgenol Radium Ther Nucl Med 103 : 123– 132.[PubMed]

17. Cardinale L,, Parlatano D,, Boccuzzi F,, Onoscuri M,, Volpicelli G,, Veltri A . 2015. The imaging spectrum of pulmonary tuberculosis. Acta Radiol 56 : 557– 564.[PubMed]

18. Lee KS,, Hwang JW,, Chung MP,, Kim H,, Kwon OJ . 1996. Utility of CT in the evaluation of pulmonary tuberculosis in patients without AIDS. Chest 110 : 977– 984.[PubMed]

19. Hatipoğlu ON,, Osma E,, Manisali M,, Uçan ES,, Balci P,, Akkoçlu A,, Akpinar O,, Karlikaya C,, Yüksel C . 1996. High resolution computed tomographic findings in pulmonary tuberculosis. Thorax 51 : 397– 402.[PubMed]

20. Wallace JM,, Deutsch AL,, Harrell JH,, Moser KM . 1981. Bronchoscopy and transbronchial biopsy in evaluation of patients with suspected active tuberculosis. Am J Med 70 : 1189– 1194.[PubMed]

21. Moore DF,, Guzman JA,, Mikhail LT . 2005. Reduction in turnaround time for laboratory diagnosis of pulmonary tuberculosis by routine use of a nucleic acid amplification test. Diagn Microbiol Infect Dis 52 : 247– 254.[PubMed]

22. Yan L,, Xiao H,, Zhang Q . 2016. Systematic review: comparison of Xpert MTB/RIF, LAMP and SAT methods for the diagnosis of pulmonary tuberculosis. Tuberculosis (Edinburgh) 96 : 75– 86.[PubMed]

23. CDC . 2004. Reported Tuberculosis in the United States, 2003. US Department of Heatlh and Human Services, CDC, Atlanta, GA. [PubMed]

24. Chaisson RE,, Schecter GF,, Theuer CP,, Rutherford GW,, Echenberg DF,, Hopewell PC . 1987. Tuberculosis in patients with the acquired immunodeficiency syndrome. Clinical features, response to therapy, and survival. Am Rev Respir Dis 136 : 570– 574.[PubMed]

25. Handwerger S,, Mildvan D,, Senie R,, McKinley FW . 1987. Tuberculosis and the acquired immunodeficiency syndrome at a New York City hospital: 1978–1985. Chest 91 : 176– 180.[PubMed]

26. Louie E,, Rice LB,, Holzman RS . 1986. Tuberculosis in non-Haitian patients with acquired immunodeficiency syndrome. Chest 90 : 542– 545.[PubMed]

27. Selwyn PA,, Hartel D,, Lewis VA,, Schoenbaum EE,, Vermund SH,, Klein RS,, Walker AT,, Friedland GH . 1989. A prospective study of the risk of tuberculosis among intravenous drug users with human immunodeficiency virus infection. N Engl J Med 320 : 545– 550.[PubMed]

28. Reid MJ,, Shah NS . 2009. Approaches to tuberculosis screening and diagnosis in people with HIV in resource-limited settings. Lancet Infect Dis 9 : 173– 184.[PubMed]

29. Stead WW,, Lofgren JP . 1983. Does the risk of tuberculosis increase in old age? J Infect Dis 147 : 951– 955.[PubMed]

30. Morris CDW . 1989. The radiography, haematology and biochemistry of pulmonary tuberculosis in the aged. Q J Med 71 : 529– 536.[PubMed]

31. Korzeniewska-Kosela M,, Krysl J,, Müller N,, Black W,, Allen E,, FitzGerald JM . 1994. Tuberculosis in young adults and the elderly. A prospective comparison study. Chest 106 : 28– 32.[PubMed]

32. Furst DE,, Breedveld FC,, Kalden JR,, Smolen JS,, Burmester GR,, Sieper J,, Emery P,, Keystone EC,, Schiff MH,, Mease P,, van Riel PL,, Fleischmann R,, Weisman MH,, Weinblatt ME . 2007. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2007. Ann Rheum Dis 66( Suppl 3) : iii2– iii22.[PubMed]

33. Frye MD,, Pozsik CJ,, Sahn SA . 1997. Tuberculous pleurisy is more common in AIDS than in non-AIDS patients with tuberculosis. Chest 112 : 393– 397.[PubMed]

34. Pérez-Guzmán C,, Vargas MH,, Torres-Cruz A,, Villarreal-Velarde H . 1999. Does aging modify pulmonary tuberculosis? A meta-analytical review. Chest 116 : 961– 967.[PubMed]

35. Light RW,, Macgregor MI,, Luchsinger PC,, Ball WC Jr . 1972. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med 77 : 507– 513.[PubMed]

36. van Keimpema AR,, Slaats EH,, Wagenaar JP . 1987. Adenosine deaminase activity, not diagnostic for tuberculous pleurisy. Eur J Respir Dis 71 : 15– 18.[PubMed]

37. Valdés L,, San José E,, Alvarez D,, Valle JM . 1996. Adenosine deaminase (ADA) isoenzyme analysis in pleural effusions: diagnostic role, and relevance to the origin of increased ADA in tuberculous pleurisy. Eur Respir J 9 : 747– 751.[PubMed]

38. Yam LT . 1972. Diagnostic significance of lymphocytes in pleural effusions. Am Rev Respir Dis 105 : 458– 460.

39. Trajman A,, da Silva Santos Kleiz de Oliveira EF,, Bastos ML,, Belo Neto E,, Silva EM,, da Silva Lourenço MC,, Kritski A,, Oliveira MM . 2014. Accuracy of polymerase chain reaction for the diagnosis of pleural tuberculosis. Respir Med 108 : 918– 923.[PubMed]

40. Denkinger CM,, Schumacher SG,, Boehme CC,, Dendukuri N,, Pai M,, Steingart KR . 2014. Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Respir J 44 : 435– 446.[PubMed]

41. Berger HW,, Mejia E . 1973. Tuberculous pleurisy. Chest 63 : 88– 92.[PubMed]

42. Gopi A,, Madhavan SM,, Sharma SK,, Sahn SA . 2007. Diagnosis and treatment of tuberculous pleural effusion in 2006. Chest 131 : 880– 889.[PubMed]

43. Scerbo J,, Keltz H,, Stone DJ . 1971. A prospective study of closed pleural biopsies. JAMA 218 : 377– 380.[PubMed]

44. Bock NN,, McGowan JE Jr,, Ahn J,, Tapia J,, Blumberg HM . 1996. Clinical predictors of tuberculosis as a guide for a respiratory isolation policy. Am J Respir Crit Care Med 154 : 1468– 1472.[PubMed]

45. Tattevin P,, Casalino E,, Fleury L,, Egmann G,, Ruel M,, Bouvet E . 1999. The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model. Chest 115 : 1248– 1253.[PubMed]

46. Wisnivesky JP,, Kaplan J,, Henschke C,, McGinn TG,, Crystal RG . 2000. Evaluation of clinical parameters to predict Mycobacterium tuberculosis in inpatients. Arch Intern Med 160 : 2471– 2476.[PubMed]

47. Wisnivesky JP,, Henschke C,, Balentine J,, Willner C,, Deloire AM,, McGinn TG . 2005. Prospective validation of a prediction model for isolating inpatients with suspected pulmonary tuberculosis. Arch Intern Med 165 : 453– 457.[PubMed]

48. Research Committee of the British Thoracic and Tuberculosis Association . 1970. Aspergilloma and residual tuberculous cavities—the results of a resurvey. Tubercle 51 : 227– 245.

49. Mayock RL,, Goldberg M . 1964. Metabolic Considerations in Disease of the Respiratory System. WB Saunders, Philadelphia, PA.

50. Chung DK,, Hubbard WW . 1969. Hyponatremia in untreated active pulmonary tuberculosis. Am Rev Respir Dis 99 : 595– 597.[PubMed]

51. Kethireddy S,, Light RB,, Mirzanejad Y,, Maki D,, Arabi Y,, Lapinsky S,, Simon D,, Kumar A,, Parrillo JE,, Kumar A , Cooperative Antimicrobial Therapy of Septic Shock (CATSS) Database Group . 2013. Mycobacterium tuberculosis septic shock. Chest 144 : 474– 482.[PubMed]

Tables

Pulmonary Tuberculosis

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Table 1

Increased susceptibility to tuberculosis

Table 1

Increased susceptibility to tuberculosis

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Table 2

Clinical symptoms of patients presenting with active tuberculosis

Table 2

Clinical symptoms of patients presenting with active tuberculosis

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Table 3

Criteria for activity in pulmonary tuberculosis

Table 3

Criteria for activity in pulmonary tuberculosis

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Table 4

Diagnostic difficulties

Table 4

Diagnostic difficulties

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Table 5

Predicting active pulmonary tuberculosis

Table 5

Predicting active pulmonary tuberculosis