INTRODUCTION Pulmonary tuberculosis (TB) is a contagious bacterial infection that involves the lungs. It may spread to other organs.

Causes Pulmonary tuberculosis (TB) is caused by the bacteria Mycobacterium tuberculosis (M. tuberculosis). You can get TB by breathing in air droplets from a cough or sneeze of an infected person. The resulting lung infection is called primary TB. Most people recover from primary TB infection without further evidence of the disease. The infection may stay inactive (dormant) for years. However, in some people it can reactivate. Most people who develop symptoms of a TB infection first became infected in the past. In some cases, the disease becomes active within weeks after the primary infection. The following persons are at high risk of active TB:

Elderly Infants People with weakened immune systems, for example due to AIDS, chemotherapy, diabetes, or medicines that weaken the immune system

Your risk of catching TB increases if you:

Are around people who have TB Live in crowded or unclean living conditions Have poor nutrition

The following factors may increase the rate of TB infection in a population:

Increase in HIV infections Increase in number of homeless people (poor environment and nutrition)

The appearance of drug-resistant strains of TB

Symptoms The primary stage of TB does not cause symptoms. When symptoms of pulmonary TB occur, they can include:

Cough (usually with mucus) Coughing up blood Excessive sweating, especially at night Fatigue Fever Weight loss

Other symptoms that can occur:

Breathing difficulty Chest pain Wheezing

Exams and Tests The doctor or nurse will perform a physical exam. This may show:

Clubbing of the fingers or toes (in people with advanced disease) Swollen or tender lymph nodes in the neck or other areas Fluid around a lung (pleural effusion) Unusual breath sounds (crackles)

Tests may include:

Biopsy of the affected tissue (rare) Bronchoscopy Chest CT scan Chest x-ray

Interferon-gamma release blood test such as the QFT-Gold test to test for TB infection Sputum examination and cultures Thoracentesis Tuberculin skin test (also called a PPD test)

Treatment The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best. Commonly used drugs include:

Isoniazid Rifampin Pyrazinamide Ethambutol

You may need to take many different pills at different times of the day for 6 months or longer. It is very important that you take the pills the way your health care provider instructed. When people do not take their TB medications as instructed, the infection can become much more difficult to treat. The TB bacteria can become resistant to treatment. This means the drugs no longer work. When there is a concern that a patient may not take all the medication as directed, a health care provider may need to watch the person take the prescribed drugs. This approach is called directly observed therapy. In this case, drugs may be given 2 or 3 times per week, as prescribed by a doctor.

You may need to stay at home or be admitted to a hospital for 2 - 4 weeks to avoid spreading the disease to others until you are no longer contagious. Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care. Support Groups You can ease the stress of illness by joining a support group. Sharing with others who have common experiences and problems can help you feel more in control. Outlook (Prognosis) Symptoms often improve in 2 - 3 weeks after starting treatment. A chest x-ray will not show this improvement until weeks or months later. Outlook is excellent if pulmonary TB is diagnosed early and effective treatment is started quickly. Possible Complications Pulmonary TB can cause permanent lung damage if not treated early. Medicines used to treat TB may cause side effects, including liver problems. Other side effects include:

Changes in vision Orange- or brown-colored tears and urine Rash

A vision test may be done before treatment so your doctor can monitor any changes in the health of your eyes. Multidrug-resistant TB Standard anti-TB drugs have been used for decades, and resistance to the medicines is growing. Disease strains that are resistant to a single anti-TB drug have been documented in every country surveyed.

Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line (or standard) anti-TB drugs. The primary cause of MDR-TB is inappropriate treatment. Inappropriate or incorrect use of anti-TB drugs, or use of poor quality medicines, can all cause drug resistance. Disease caused by resistant bacteria fails to respond to conventional, first-line treatment. MDR-TB is treatable and curable by using second-line drugs. However second-line treatment options are limited and recommended medicines are not always available. The extensive chemotherapy required (up to two years of treatment) is more costly and can produce severe adverse drug reactions in patients. In some cases more severe drug resistance can develop. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines, including the most effective second-line anti-TB drugs. There were about 310 000 cases of MDR-TB among notified TB patients with pulmonary TB in the world in 2011. Almost 60% of these cases were in India, China and the Russian Federation. It is estimated that about 9% of MDR-TB cases had XDR-TB.

When to Contact a Medical Professional Call your health care provider if:

You have been exposed to TB You develop symptoms of TB Your symptoms continue despite treatment New symptoms develop

Prevention TB is preventable, even in those who have been exposed to an infected person. Skin testing for TB is used in high risk populations or in people who may have been exposed to TB, such as health care workers.

People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date, if the first test is negative. A positive skin test means you have come into contact with the TB bacteria. It does not mean that you have active disease of are contagious. Talk to your doctor about how to prevent getting tuberculosis. Prompt treatment is extremely important in preventing the spread of TB from those who have active TB disease to those who have never been infected with TB. Some countries with a high incidence of TB give people a BCG vaccination to prevent TB. However, the effectiveness of this vaccine is limited and it is not routinely used in the United States. People who have had BCG may still be skin tested for TB. Discuss the test results (if positive) with your doctor.

Global impact of TB TB occurs in every part of the world. In 2011, the largest number of new TB cases occurred in Asia, accounting for 60% of new cases globally. However, Sub-Saharan Africa carried the greatest proportion of new cases per population with over 260 cases per 100 000 population in 2011. In 2011, about 80% of reported TB cases occurred in 22 countries. Some countries are experiencing a major decline in cases, while cases are dropping very slowly in others. Brazil and China for example, are among the 22 countries that showed a sustained decline in TB cases over the past 20 years. In the last decade, the TB prevalence in Cambodia fell by almost 45%.