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Tuberculosis
by Anson Strejcek

Tuberculosis is a bacterium-caused ailment, primarily affecting the lungs. The bacteria that most commonly causes tuberculosis is Mycobacterium tuberculosis, and rarely, M. bovis or M. africanum. M. tuberculosis is a non-motile rod, and is acid fast, that is, colorizing for diagnosis is permanent because of their fatty walls prevent acid solutions from [staining, therefor] destroying the integrity of the colorizing procedure. Tuberculosis is often abbreviated TB, and used to be referred to as consumption. It was discovered by the german doctor Robert Koch, in 1882.

The mycobacterium are usually inhaled in small droplets that are airborne. The mycobacterium is small enough  to bypass many of the defenses of the pulmonary system, such as the hairs of the air passageways and the mucous secretions. Active tuberculosis rarely results unless the immune system of the patient is depressed, as in AIDS. Macrophages, failing to destroy the bacteria, may carry it to other parts of the body. The actual disease tends to occur long after infection. Reactivating of tubercles in the lungs triggers it, and the process leading to this is unclear.

Pulmonary tuberculosis is the most common form of tuberculosis. There is both a childhood and adult variety of tuberculosis, and though the symptoms may vary slightly, the treatment is almost identical. Extrapulmonary tuberculosis occurs when the infection spreads to other tissues, usually by contiguous tissue or intracanalicular spread. Central nervous system [tuberculosis], also called tuberculous meningitis, may develop as [tuberculosis] advances into the subarachnoid space, or [the] space directly below the serous membrane surrounding the brain. This type of [tuberculosis] occurs most often in young children. There are also forms of tuberculosis that affect the pericardium (tuberculosis pericarditis), pelvic and interstitial area (genitourinary tuberculosis), the adrenal glands, and bones and joints.

Pulmonary [tuberculosis] has no symptoms in the beginning stages. Early symptoms may be confused with that of the common cold. Fever and weight loss may be noticed once the lesions in the lungs are large enough to detect by x-ray. Coughing, first only in the mourning from secretions accumulated overnight. Chest pain is also common. Tubercular meningitis is signaled by headaches and behavioral changes, with changes in consciousness ranging from drowsiness to coma. Bloody coughing and bloody sputum are signs as well.

Diagnostic measures that most commonly implicate [tuberculosis] are chest x-rays to detect lesions, along with microidentification af acid-fast rods in saliva. For definitive diagnosis, a cultural identification of the strain, varieties hominis or bovis, must be taken from tissue or body fluids. Results of the culture may take as long as six weeks. Skin tests can determine whether a patient has been infected before.

Some common complications of pulmonary [tuberculosis] are respiratory failure or pulmonary hypertension. Death from [tuberculosis] is usually slow and lingering.

INH (isoniazid) is the most common drug treatment of [tuberculosis]. INH is even helpful if the mycobacteria have developed a resistance to it because resistant strains tend not to be as invasive. For more extreme cases, chest surgery is used. Treatment varies between active and suppressive, to prevent a relapse. Suppressive therapy is usually INH, sometimes indefiately. Active treatment requires an entire drug regimen. Lax adherence to such regimens has created more and more drug resistant strains. Some regimens that may be used are INH and streptmycin or INH and ethambutol. Triple therapy is sometimes used, with all three of the aforementioned drugs. In case of treatment failure, rifampin is used. Other specific antimicrobial drugs may be administered in addition to INH. Hepatitis-like symptoms, such as jaundice and other toxic reactions, necessitate stopping antimicrobial treatment. Aminosalicylic acid is the most toxic of drugs used. Historically, patients were treated by placement in a sanitarium.


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