Pulmonology
Tuberculosis
결핵
Chronic granulomatous infection by Mycobacterium tuberculosis
- How common
- Korea: highest incidence in OECD
- Typical age
- All ages
What is it?
M. tuberculosis is phagocytosed by alveolar macrophages but not killed, forming granulomas.
Commonly affected: Upper lobes, also LN/bone/kidney possible
How it develops
- Droplet inhalationInhale droplet nuclei <5 μm
- Macrophage infectionProliferates within alveolar macrophages
- Granuloma formationTh1/CD4-mediated (Ghon focus)
- Latency/reactivationReactivates with immune compromise
Symptoms
- Chronic coughPersists ≥3 weeks
- HemoptysisWith advanced or cavitary disease
- Night sweats/weight lossB symptoms
- Low-grade feverEvening low-grade fever
- Anorexia/weaknessChronic wasting pattern
How it is examined
- IGRAQuantiFERON or T-SPOT.TB
- Tuberculin skin testRead at 48–72 hrs (≥10 mm positive)
- Sputum AFB smear + culture3 sputum samples + NAAT
Imaging
Upper lobe infiltrate, cavitation, lymphadenopathy.
- Upper lobe cavity
- Lymphadenopathy
- Miliary pattern
Chest CT details cavities/nodules.
- Cavitary nodules
- Tree-in-bud pattern
Non-surgical care
- RIPE therapy (2-mo intensive phase)Rifampin, Isoniazid, Pyrazinamide, Ethambutol
- Continuation phase (4 mo)Rifampin + Isoniazid
- Directly observed therapy (DOT)Ensures adherence
- Vitamin B6 (pyridoxine)Prevents INH-induced neuropathy
- Contact tracing/LTBI treatmentIGRA-positive contacts treated for LTBI
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
MDR-TB, large cavities, uncontrolled hemoptysis
Procedures that may be discussed
- Lobectomy
- Bronchial artery embolization (hemoptysis)
- MDR-TB: bedaquiline + linezolid
Outlook
>95% cure with adherence; MDR/XDR-TB much worse.