TB-revealed - I understand that there is a lot of confusion...

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I understand that there is a lot of confusion and therefore anxiety about numerous issues of tuberculosis. Most of this is because it is an extremely complicated organism and disease process – one of the most complicated that we will teach in this class. However, you hopefully appreciate that it is one of the most important bacterial diseases worldwide and that it will definitely impact your medical practice – it's not an esoteric topic. There are three areas of confusion/controversy so far – site of initial infection, location of the Ghon complex and secondary reactivation; reading a PPD; and treatment. I will summarize my understanding of these things. But more than anything else, please note that I, as the person who writes most the exams and ultimately approves them, am aware of these issues! 1. Location, location, location! Where is the site of primary infection? Ask yourself, how do people encounter Mtb and where do the bacteria enter the body. Answer – direct inhalation into the lungs, as opposed to initial colonization of the upper respiratory tract (no matter how you define it) followed by aspiration or extension. Therefore, THE INITIAL SITE OF INFECTION IS ANYWHERE INHALED PARTICLES SMALL ENOUGH TO AVOID THE MUCOCILIARY ESCALATOR WILL END UP. This will be alveoli and is clearly not restricted to the apices of the lung. At these sites, the organisms will be engulfed by resident macrophages which will be unable to completely kill the organisms. However, there will be an immune response to wall off the infection,
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This note was uploaded on 07/30/2011 for the course MMC 6500 taught by Professor Gulig during the Spring '11 term at University of Florida.

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TB-revealed - I understand that there is a lot of confusion...

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