Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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Tuberculosis, often referred to as the “White Plague” due to the extreme pallor seen in patients during the pre-antibiotic era, remains one of the world’s most formidable infectious diseases. Despite being preventable and curable, it continues to claim over 1.5 million lives annually, ranking alongside HIV/AIDS as a leading cause of death from a single infectious agent. This ancient disease has co-evolved with humanity for millennia, leaving its mark on history, art, and society. The persistence of tuberculosis in the modern era is a testament to the remarkable adaptability of its causative agent and the complex social and biological factors that fuel its transmission.
At Liv Hospital, we recognize that tackling this disease requires a deep understanding of its definition, not merely as a lung infection, but as a systemic condition with profound immunological and public health implications. Our approach integrates cutting-edge diagnostics with patient-centered care to address the full spectrum of the disease, from latent infection to complex, drug-resistant cases.
To truly define tuberculosis, one must first understand the unique biology of the organism responsible for it.
The Mycobacterium Tuberculosis Complex
The disease is caused by members of the Mycobacterium tuberculosis complex, with Mycobacterium tuberculosis being the primary pathogen in humans. This bacterium is a rod-shaped, aerobic organism, meaning it requires oxygen to thrive, which explains its predilection for the oxygen-rich environment of the lung apices. What sets it apart from other bacteria is its cell wall.
The definition of tuberculosis is inextricably linked to the host’s immune response. It is a disease of granulomatous inflammation.
The Initial Invasion
When tuberculosis bacteria are inhaled, they travel to the alveoli (air sacs) of the lungs. Here, they are engulfed by alveolar macrophages, the first responders of the immune system. In a “successful” pathogen response, the macrophage would destroy the bacteria. However, TB bacteria have evolved mechanisms to survive and even multiply within macrophages, using them as a “Trojan horse” to establish infection.
Granuloma Formation: Containment vs. Disease
The body responds by recruiting more immune cells, T lymphocytes, B lymphocytes, and neutrophils to the site. These cells surround the infected macrophages, forming a tight, spherical structure called a granuloma.
While predominantly a pulmonary disease, tuberculosis can affect virtually any organ system.
Pulmonary Tuberculosis: This accounts for about 85% of cases. It involves the lung parenchyma and is the only form that is contagious via the airborne route. It typically affects the upper lobes of the lungs, where ventilation-perfusion ratios favor high oxygen tension.
Extrapulmonary Tuberculosis: This occurs when the bacteria spread through the lymphatic system or bloodstream to other sites. It is more common in children and HIV-positive individuals. Common forms include:
Miliary tuberculosis represents a catastrophic failure of the immune system to contain the infection.
The definition of tuberculosis in the 21st century must include the growing threat of drug resistance.
To understand the disease, one must appreciate its historical weight.
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Tuberculosis is a chronic, granulomatous infectious disease caused by the bacterium Mycobacterium tuberculosis, primarily affecting the lungs but capable of invading any organ of the body.
Medically, latent tuberculosis infection is a state of infection, not a disease; you harbor the bacteria, but there is no active illness, no symptoms, and no risk of contagion unless it reactivates.
Untreated active tuberculosis disease destroys lung tissue, leading to respiratory failure; it can also cause fatal bleeding (hemorrhage) or spread to vital organs like the brain, causing meningitis.
“Infection” means the bacteria are in your body (often dormant/latent), while “disease” means the bacteria are actively multiplying, damaging tissue, and making you sick.
It was called the White Plague because of the extreme paleness (pallor) seen in patients with advanced disease, in contrast to the “Black Death” (plague), which caused dark skin discolorations.
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