TB Effusion vs Pulmonary TB – Understanding the Difference, Symptoms, and Care

Tuberculosis (TB) is the infectious disease that is caused by Mycobacterium tuberculosis, one of the oldest infectious diseases in the world. Even though TB may attack other body organs, most people only consider lung infections. Tuberculous Pleural Effusion (TB Effusion) and Pulmonary TB are the two common types of tuberculosis which may confuse a person.

Although they are all caused by the same bacteria, they are widely differentiated with respect to their sites of infections, their symptoms, diagnosis and treatment.

An extensive and detailed two column comparison that clarifies such variances in details to the advantage of the patient is given below.

TB Effusion (Tuberculous Pleural Effusion)

Definition
A tuberculous pleural effusion is a condition that arises when Mycobacterium tuberculosis infiltrates into the thin, fluid filled space that exists between the chest wall and the lungs, and it is called the pleural space. The inflammation caused by the infection causes so-called effusion or the excessive accumulation of fluid. This accumulation makes breathing a hard task as it constrains expansion of the lungs.

Cause
In cases where TB infection leaves one lung tissue and enters the pleura, then this often leads to TB diffusion. It may also be caused by an over reaction of immune system to TB antigens in the pleural membrane.

Pathophysiology
A intense inflammatory response of the immune system occurs when the TB bacteria or antigens penetrate the pleura. This results in the leakage of proteins and immune cells in the pleural cavity to form fluid. There can be little or no effusions.

bacteria, which makes confirmation in the lab difficult.

 

Common Symptoms
• Sharp sudden chest pain that is worse during inspiration.

• A chronic dry cough.

• Fluid pressure-induced breathlessness.

Physical Findings
• Fewer breath sounds on the affected side.
• Percussion dullness.
• Decreased chest expansion.

Contagiousness
Because bacteria are scarce in pleural fluid, TB Effusion is not contagious. So instead of being active bacterial shedding, it’s an immune response that is confined.

Diagnosis:
• The testing of pleural fluid that has been removed to a small volume through thoracentesis.

• Pleural fluid analysis: high ADA (adenosine deaminase), high protein, and lymphocyte dominance.

• Thoracoscopic pleural biopsy if the diagnosis remains unclear.

Radiological Appearance

• The opacification of one side of the chest is homogenous.

• Mild pulmonary collapse or mediastinal deviation may occasionally occur.

Laboratory Findings
• The pleural fluid has a straw color, high protein (>3 g/dL) and mainly lymphocytes.

• The cause of TB is confirmed by ADA levels of more than 40 U/L.

• In most cases, bacteria cannot be seen on the smears.

Treatment
• The same six-month course of anti-TB therapy as in pulmonary TB: isoniazid, rifampicin, pyrazinamide, and ethambutol.

• In severe cases, prolonged therapy (nine to twelve months).

• Drainage of pleural effusion when there is a large effusion, causing distress to the patient.

• Corticosteroids may be used to reduce inflammation and hasten healing.

Complications
• Prolonged dyspnea due to fibrosis and thickening of the pleurae.

• Chronic empyema (pus collection) and recurrence.

Prognosis
With early diagnosis and adequate treatment, the prognosis is excellent. Mild restrictive defects, however, may persist.

Prevention
• Quicker diagnosis of and complete treatment of TB. Sufficient food and immune helping; no alcohol or tobacco.

 

Dietary Advice
• Fresh fruits, vegetables and grains.

• Proteins e.g., milk, eggs, fish, pulses.

• Drink much water to help your lungs work.

Follow-up
• after the treatment, chest pictures are to be arranged. • If symptoms persist lung function tests.

vs

Pulmonary TB (Tuberculosis of the Lungs)

Definition
Pulmonary TB is the most common and classical form of this condition that directly interferes with the lung tissue. The bacteria develop further inside the lungs leading to inflammation, formation of granuloma and structural damage of the lungs.

Cause
Pulmonary tuberculosis can be caused by inhaling airborne droplets of Mycobacterium tuberculosis of an infected individual after he or she coughs, sneezes, or talks. The bacteria begin growing once in the lungs.

Pathophysiology

When the bacteria enter the lungs, the immune system forms granulomas to prevent their entry. These granulomas break up when the immune system is compromised and this leaves live bacteria that spread and destroys lung. tissue. The openings that are a result of this process appear on X-rays.

 

Common Symptoms
• Coughing that lasts more than three weeks.

• Cough up blood or bloody flem.

• Gripping pains and chest aches.

• Weight loss and decreased appetite.

Physical Findings
• Auscultation shows crackles or rales.

• Lung consolidation symptoms.

• Cavitary images are present.

Contagiousness
Tuberculosis in the lung is very contagious since when the sick person coughs or sneezes, active bacteria are released into the air.

Diagnosis
• The application of sputum smear microscopy to detect acid-fast bacilli (AFB).

The presence of bacterial DNA is confirmed by GeneXpert or PCR test.

• A chest X-ray shows the existence of cavities, nodules, or infiltrates.

• The IgG test for interferon-gamma or the tuberculin skin test (TST).

Radiological Appearance
•  Localised nodular sclerosis may be seen in upper lung, mostly occurring peripherally. 

• Risk factors for such large and infectious TB lesions include chronic cavitary fibroses in the upper lung.

Laboratory Findings
Blood tests will show the ESR is higher and there could be tinge of anemia- but also the sputum dyes containing Mycobacterium tuberculosis.

Treatment
• Conventional anti-TB treatment for 6 months, consisting of 2 months of intensive treatment and 4 months of continuation therapy. Adherence to treatment is guaranteed by DOTS (Directly Observed Treatment Short-Course).

• In cases of extensive pulmonary damage, oxygen treatment.

• Prolonged treatment for MDR-TB, or multidrug-resistant tuberculosis.

Complications
• Bronchiectasis or permanent lung scarring.

• Proliferate to other organs (TB meningitis, military TB).

• If therapy is not completed, then multi-drug resistance may develop.

Prognosis
Curable with adequate care. Incomplete or delayed therapy may cause long term damage or dissemination to other people.

Prevention
• Childhood B.C.G. vaccine.

• Avoid contact with infectious

• Use of masks and adequate ventilation in crowded places.

 

Dietary Advice
• The same diet is applicable.

• Avoid cigarettes and prepared foods.

• Get enough sleep and take water enough.

Follow-up
• Examine sputum to test for recovery regularly.

• Continued observation for relapse.

Key Comparison Summary

Site of Infection: Pulmonary TB occurs in tissue of the lungs whereas TB diffusion occurs in the pleural space.

  • Transmission: Pulmonary TB is contagious but TB diffusion is not.
  • Major Symptom: TB Effusion presents as dyspnea and chest pain, whereas the pulmonary TB presents as a persistent cough and sputum.

Diagnosis Sputum testing is required in pulmonary TB, and pleural fluid testing is required in TB diffusion.

Treatment: Supportive management, however, is the same but they all need the basic anti-TB medicines.

Conclusion - Two Faces of the same disease

Despite the fact that TB Effusion and Pulmonary TB are caused by Mycobacterium tuberculosis, the physiological effects of the two are hugely different. Although TB is an active infection in the lungs, which may be transmitted to other individuals, the diffusion of TB is due to an infection or immune response in the pleural cavity.

In spite of their differences, both types can be treated properly and on time. Taking prescriptions, eating well and avoiding alcohol and tobacco.

a vital role in recovery.

It is also very paramount to protect others, in regards to pulmonary tuberculosis; patients should wear a mask, observe good hygiene and follow the instructions of their doctors keenly.

Seek medical attention immediately in case of persistent cough, chest pains, and unexplainable fever. TB is treatable; early medical care, adherence to treatment and good awareness of the public health is essential.

 

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