Acid-fast bacilli (AFB) (shown in red) are tubercle bacilli Mycobacterium tuberculosis.
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Tuberculosis

Tuberculosis (commonly shortened to TB) is an infection caused by the bacterium Mycobacterium tuberculosis, which most commonly affects the lungs (pulmonary TB) but can also affect the central nervous system (meningitis), lymphatic system, circulatory system (Miliary tuberculosis), genitourinary system, bones and joints. more...

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Tuberculosis is the most common major infectious disease today, infecting two billion people or one-third of the world's population, with nine million new cases of active disease annually, resulting in two million deaths, mostly in developing countries.

Most of those infected (90 percent) have asymptomatic latent TB infection (LTBI). There is a 10 percent lifetime chance that LTBI will progress to active TB disease which, if left untreated, will kill more than 50 percent of its victims. TB is one of the top three infectious killing diseases in the world: HIV/AIDS kills 3 million people each year, TB kills 2 million, and malaria kills 1 million.

The neglect of TB control programs, HIV/AIDS, and immigration has caused a resurgence of tuberculosis. Multiple drug resistant strains of TB (MDR-TB) are emerging. The World Health Organization declared TB a global health emergency in 1993.

Other names for the disease

  • TB (short for tuberculosis and also for Tubercle Bacillus)
  • Consumption (TB seemed to consume people from within with its symptoms of bloody cough, fever, pallor, and long relentless wasting)
  • Wasting disease
  • White plague (TB sufferers appear markedly pale)
  • Phthisis (Greek for consumption) and phthisis pulmonalis
  • Scrofula (swollen neck glands)
  • King's evil (so called because it was believed that a king's touch would heal scrofula)
  • Pott's disease of the spine
  • Miliary TB (x-ray lesions look like millet seeds)
  • Tabes mesenterica (TB of the abdomen)
  • Lupus vulgaris (the common wolf - TB of the skin)
  • Prosector's wart, also a kind of TB of the skin, transmitted by contact with contaminated cadavers to anatomists, pathologists, veterinarians, surgeons, butchers, etc.

The bacterium

The cause of tuberculosis, Mycobacterium tuberculosis (MTB), is a slow-growing aerobic bacterium that divides every 16 to 20 hours. This is extremely slow compared to other bacteria, which tend to have division times measured in minutes (among the fastest growing bacteria is a strain of E. coli that can divide roughly every 20 minutes). It is not classified as either Gram-positive or Gram-negative because it does not have the chemical characteristics of either, although it contains peptidoglycan in their cell wall. If a Gram stain is performed, it stains very weakly Gram-positive or not at all. It is a small rod-like bacillus which can withstand weak disinfectants and can survive in a dry state for weeks but, spontaneously, can only grow within a host organism (in vitro culture of M. tuberculosis took a long time to be achieved, but is nowadays a normal laboratory procedure).

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Pulmonary and pleural tuberculosis in extreme elderly
From CHEST, 10/1/05 by Eun A. Eum

PURPOSE: Several publications about tuberculosis in elderly patients have suggested that their clinical presentation and clinical course might be atypical from those in elderly. This tendency may be more strengthened with advancing years in age. The aim of this study was to compare clinical features of pulmonary and pleural tuberculosis in extreme elderly (>80 years old) with those in elderly (between 60 and 79).

METHODS: Thirty-seven extreme elderly with pulmonary and pleural tuberculosis from Ulsan University hospital between January 2000 and December 2004 were compared with randomly selected fifty-six elderly patients.

RESULTS: General weakness was the only symptom that was observed more frequently in extreme elderly than in elderly (p=0.016). Other symptoms such as cough, sputum, fever, weight loss, anorexia and chest pain were not different between two groups. Dyspnea tends to be more frequent, and hemoptysis tends to be less common in extreme elderly although they were not statistically significant (p=0.056, 0.053 respectively). Evolution time before diagnosis and laboratory findings at presentation were not different between two groups. The incidence of comorbid conditions such as chronic obstructive pulmonary disease, diabetes, gastrectomy and malignancies were not different between two groups. Anorexia was more frequently observed in extreme elderly than elderly after initiation of antituberculous drugs. The incidences of hepatotoxicity, skin rash, optic neuritis and peripheral neuropathy were not different. Moreover, the mortality from tuberculosis was not different between two groups. Three cases died from tuberculosis in extreme elderly. The cause of death for those three cases was mainly discontinuation of antituberculous drug.

CONCLUSION: The clinical features and prognosis of pulmonary and pleural tuberculosis in extreme elderly were not significantly different from those in elderly.

CLINICAL IMPLICATIONS: Tuberculosis even in extreme elderly should be treated with standard regimens because adverse effects of antituberculous drugs and prognosis were not different from elderly patients.

DISCLOSURE: Eun A Eum, None.

Eun A Eum MD * Yangjin Jegal MD Moo Cheol Shin MD Kwang Won Seo MD Woon-Jung Kwon MD Jong-Joon Ahn MD Department of Pulmonology and Critical Care Medicine, Ulsan University Hospital, Ulsan, Korea

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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