Pathophysiology

A. In most individuals infected with mycobacterium tuberculosis (by respiratory aerosols), the primary pulmonary infection occurs early in life, and the organism is contained by host defenses. The primary infection usually resembles pneumonia or bronchitis, and the infection usually resolves without treatment.

B. After the immune system limits spread of the bacilli during the primary infection, patients are typically asymptomatic, although the organisms may remain viable and dormant for many years. In these individuals, the only indication of primary infection is conversion to a positive reaction to the purified protein derivative (PPD) skin test. Acid-fast bacilli are not present in the sputum.

C. Later in life, the organism may cause reactivation disease, usually pulmonary, but it may affect the genitourinary system, bones, joints, meninges, brain, peritoneum, and pericardium. Reactivation of tuberculosis is the most common form of clinically apparent disease. Immunocompetent individuals with tuberculosis infection have a 10% chance of developing reactivation disease during their lifetimes. In HIV positive patients, the risk of acquiring active TB is 10% per year.

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