Pulmonary Tuberculosis
Definition
Pulmonary tuberculosis is an infectious disease of the lungs produced by the bacillus Mycobacterium tuberculosis.
Causes / Etiology
The organism is inhaled in droplet nuclei from a person with active pulmonary disease; the droplets reach the alveoli and establish infection.
Types or Classification
Primary pulmonary TB – first infection in a person who has never been exposed; usually seen in children and produces a Ghon focus.
Post‑primary (secondary) TB – re‑activation of a latent focus or reinfection in a previously sensitised adult; characteristically produces cavitary lesions in the upper lobes.
Pathology (stepwise)
step 1 → inhalation of droplet nuclei containing bacilli →
step 2 → bacilli are taken up by alveolar macrophages →
step 3 → macrophages try to destroy the organisms but many survive and multiply →
step 4 → a local inflammatory response develops →
step 5 → formation of granulomas (tubercles) to wall‑off the infection →
step 6 → caseation necrosis occurs in the centre of the granuloma →
step 7 → if immunity is insufficient the caseous centre liquefies, ruptures into bronchi and the bacilli are coughed out in sputum.
Clinical Features
General – low‑grade fever, night sweats, loss of appetite, weight loss, fatigue, malaise.
Specific – chronic productive cough, haemoptysis (blood‑streaked sputum), pleuritic chest pain, breathlessness on exertion, occasional fever spikes.
Complications
Acute – massive haemoptysis, pneumothorax (collapsed lung), respiratory failure, tuberculous pleural effusion.
Chronic – pulmonary fibrosis with restrictive lung defect, bronchiectasis, cor pulmonale (right‑heart failure), secondary bacterial infection, disseminated (miliary) TB.
Diagnosis / Investigations
Routine – chest X‑ray (shows infiltrates, cavitations, Ghon focus), sputum smear for acid‑fast bacilli, complete blood count (often mild anaemia).
Special – sputum culture on Lowenstein‑Jensen medium (gold standard), nucleic‑acid amplification test (rapid detection), Mantoux tuberculin skin test (indicates exposure), interferon‑γ release assay (IGRA) for latent infection.
Management
General – strict bed rest, adequate nutrition, isolation of the patient until sputum becomes negative, smoking cessation, vaccination against influenza and pneumococcus.
Modern drug therapy – intensive phase 2 months of isoniazid + rifampicin + pyrazinamide + ethambutol, followed by continuation phase 4 months of isoniazid + rifampicin (total 6 months; extended to 9 months in cavitary disease). Directly observed therapy (DOT) is recommended.
Dietary advice – high‑calorie, high‑protein diet; plenty of fluids; vitamin C and zinc rich foods; avoid excessive tea/coffee which may impair iron absorption.
Homeopathic Therapeutics (key remedies, 6‑7 points each)
Phosphorus
- marked aversion to cold air, feels worse in cold weather
- dry, hacking cough with scanty sputum, sometimes blood‑streaked
- chest pain aggravated by coughing, relieved by warmth
- great weakness, trembling, desire for fresh air
- night sweats, fever that rises in the evening
- thirst for cold water, better after drinking
Lycopodium
- cough with difficult, painful expectoration, feels blocked in the right chest
- sensation of heaviness in the chest, worse after eating rich foods
- shortness of breath on slight exertion, anxiety about breathing
- great desire for warm drinks, especially tea with milk
- constipation with hard stools, relief after warm bath
- symptoms improve in the evening, worsen at night
Tuberculinum
- chronic cough with profuse, blood‑stained sputum, especially in the mornings
- severe emaciation, loss of appetite, great fatigue
- night sweats, chilliness, feeling of “coldness” throughout the body
- pain in the spine and joints, especially lumbar region
- tendency to develop tubercular lymphadenitis (scrofula)
- better from warm applications, worse from cold exposure
Carbo veg (Carbo vegetabilis)
- great debility, feels “as if about to die” when lying down
- cough with profuse, foul‑smelling sputum, often with a feeling of heaviness in the chest
- marked pallor, cold extremities, rapid weak pulse
- relief when lying on the left side, worse when lying on the right
- excessive flatulence, belching, feeling of fullness in the stomach
- improves with fresh air and gentle motion
Natrum muriaticum
- dry, hacking cough with scanty sputum, especially after emotional upset
- loss of appetite, craving for salty foods, aversion to sweets
- headaches, especially over the forehead, worse in the evening
- tendency to develop scar tissue in the lungs (fibrosis) after infection
- emotional sensitivity, tears without much reason
- symptoms improve with warm drinks and rest, worsen in hot weather