1. Pathophysiology Disease - Tuberculosis Anna Forynska Madeline Fung Maicakrise Garcia Jill Garrett Kyle Geving Jennifer Heuer

2. “Pathophysiology” Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis. Infection occurs when a person inhales droplet that reach the alveoli of the lungs, and it spread through the air from one person with TB to another by coughs, sneezes, speaking, · The bacteria usually attack the lungs, but can attack any part of the body using lymphatic channels or through the bloodstream to more distant tissues as the kidney, spine or brain. The bacteria can live in the body without making you sick, the body is able to fight it off and the person do not feel sick and do not have any symptoms · In people who become infected the bacteria is stop from growing - latent TB infection and when it becomes active – active TB when their immune system becomes weak for another reason. · Within 2 to 8 weeks, special immune cells called macrophages ingest and surround the TB bacteria that keeps the bacilli contained and under control. If the immune system cannot keep the TB bacteria under control it begin to multiply rapidly and becomes active TB disease.

3. Impacted Body Systems Respiratory System- lungs: coughing, loss in breath, and lethargy. Skeletal System- the pelvic girdle and below: hip pain, inflammation, and rapid deterioration. Central Nervous System- brain (meninges)/spinal cord: a "ring" like lesions, hydrocephalous, and inflammation. a

4. Concepts of TB Respiratory/ Pulmonary System Concept: Gas Exchange ●When the person inhaled the infected air, the bacteria go the lungs to through the bronchioles. ●At the bronchioles there is the sac called alveoli, this is where the blood takes oxygen from inhaled air and release carbon dioxide into the air exhaled. ●Tuberculosis bacilli infect the alveoli, where they invade and replicate within endosomes of alveolar macrophages. ●Then M. tuberculosis is gradually spread and makes the lungs inflamed, as a result it develops cavities or holes that can cause to tissue destruction Skeletal System Concept: Mobility ●most common on spine, knees, feet, elbows, wrist, and shoulders ●disease starts in the synovium and grows slowly over in the cartilage; it extends through the cartilage into the underlying bone, which decalcifies. ●there may be also a curving of affected bone or joint, that can cause to loss of movement in the affected bone or joint. Central Nervous System Concept: Inflammation ●It is common with children ●The disease begins in the development of small tuberculous foci in the brain, spinal cord and meninges ●It is the is a thick exudate most notably affecting the basal portions of the brain ●The location of these foci and the capacity to control them ultimately determine which form of CNS tuberculosis, and it manifests itself primarily as tuberculous meningitis.

5. Risk Factors Compromised immune system –HIV, diabetes, etc. Traveling or living in certain areas –Countries that have high rates of TB Poverty and substance abuse –Substance/Tobacco use Where you work or live –Hospital, shelter, etc.

6. Latent Tuberculosis ●Persons with latent tuberculosis have no signs or symptoms of the disease, do not feel sick, and are not infectious. ●Mycobacterium tuberculosis organisms can persist in the necrotic material for years or even a lifetime, and if the immune system later becomes compromised, the disease can be reactivated in severely ill patients.

7. Primary Progressive Tuberculosis ●When a patient progresses to active tuberculosis, early signs and symptoms often include progressive fatigue, weight loss, and a low-grade fever accompanied by chills and night sweats. ●A cough eventually develops in most patients, which usually advances to a productive cough of sputum or blood. ●Activated tuberculosis can progress into symptoms such as fever, chest pain, and dyspnea. Dyspnea is due to poor gas exchange in the areas of affected lung tissue. ● Pleural effusion: is a buildup of fluid between the layers of tissue that line the lungs and chest cavity.

8. Extrapulmonary Tuberculosis ●The risks for extrapulmonary disease increases within 20% of immunocompetent patients. ●Tubercular meningitis can lead to headaches and mental change but is fatal in most cases. ●Lymphatic tuberculosis is the most common extrapulmonary tuberculosis. Signs and symptoms include the appearance of a chronic, painless mass in the neck, which typically worsens with time.symptomsneck

9. Lab and Diagnostic Testing Tuberculin Skin Test (TST) aka Mantoux tuberculin skin test This is done by injecting a small amount of tuberculin under the skin. TB Blood Test aka interferon-gamma release assays (IGRAs) ● QuantiFERON® ● T-SPOT®

10. Reference Lee, P., Chang, F., (2012). Latent infection treatment TB transmission in school settings. Journal of the Formosan Medical Association, 111(10), 525-526. Center for Disease and Control Prevention. (2012). Basic TB Facts. Retrieved from : http://wwwhttp://www. cdc.gov/tb/topic/basic/default.htm Center for Disease and Control Prevention. (2012). Transmission and Pathogenesis Of Tuberculosis. Retrieved from: www.cdc.goc/tb/education/corecurr/pdf/chapter2.pdf TB Treatment. (2012, August 1). Retrieved January 25, 2015, from Center for Disease Control website: http://www.cdc.gov http://www.cdc.gov Testing and Diagnostics. (2013, April 12). Retrieved January 25, 2015, from Center for Disease Control website: http://www.cdc.gov/tb/topic/testing/ default.htm

11. ●Rock, B., Olin, M., Baker, C., Molitor, T., & Peterson, P. (2008). Central Nervous System Tuberculosis: Pathogenesis and Clinical Aspects. Clinical Microbiology Reviews, 21, 171-241. doi: 10.1128/CMR.00042-07 ●Giddens, J. (2012). Concepts for Nursing Practice. St. Louis, MO: Elsevier. ●Ahmad, S. (2011). Pathogenesis, Immunology, and Diagnosis of Latent Mycobaterium tuberculosis Infection. Journal of Immunology Research, 2011. http://www.hindawi.com/journals/jir/2011/814943/http://www.hindawi.com/journals/jir/2011/814943/ ●King, M., Bewes, P., Cairns, J., Thornton, J. (1999). http://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x10416.htmlhttp://www.meb.uni-bonn.de/dtc/primsurg/docbook/html/x10416.html