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TUBERCULOSIS

Tuberculosis (TB) is a chronic bacterial infection caused by Mycobacterium tuberculosis. It usually infects the lungs, although other organs are sometimes involved. Many people infected with M. tuberculosis harbor the bacterium without developing symptoms, however, 1 in ten people that harbor the bacterium will develop active tuberculosis at some point in their life. Currently, it is estimated that 10-15 million people in the United States are carriers of M. tuberculosis.

People at higher risk for developing TB are those who are HIV positive, foreign-born nationals coming from countries with high TB rates, homeless people, those that abuse drugs, residents in long-term care facilities, and minority populations.

TB is spread from person to person primarily through the air in tiny microscopic droplets. This happens when a person infected with TB coughs, sneezes, speaks, sings, or laughs. Only people with active disease are contagious. Casual contact with a person who has TB does not usually cause infection. It usually takes lengthy contact with someone with active TB before a person can become infected. People with TB who have been treated with the recommended medications for 2 weeks are not contagious and cannot spread the germ to others.

When a person is infected with M. tuberculosis, within approximately 2-8 weeks, a person's immune system responds to the TB germ by forming a wall around the infected cells. This keeps the infection from growing. Many people recover from this initial infection, the bacteria die, and the only evidence of the infection may be a positive TB skin test and old scars seen on chest x-rays.

People infected with M. tuberculosis have the greatest chance of developing active TB during the first year after becoming infected, but active disease may not develop until many years after the initial infection. Early symptoms of TB may include weight loss, fever, night sweats and loss of appetite. Many times these symptoms are vague and not recognized by the infected person. If untreated, the disease progresses to include symptoms of debilitating cough, chest pain, and bloody sputum. Symptoms of TB in other areas of the body will vary depending on the organ affected.

Diagnosis of TB involves several tests. A skin test will be done. This test is read 48 to 72 hours after it is given. It will be read as "positive" if a person has been exposed to the bacterium M. tuberculosis. A positive skin test does not mean a person has active tuberculosis, only that they have been infected with the bacterium. Chest x-rays and CT scans will assist with locating abnormal areas of the lung. A sputum sample will be collected to check for the bacterium. A bronchoscopy may be performed to obtain an adequate sputum specimen. The specimen is looked at under a microscope to check for visible bacteria, and sent to a microbiology lab for a culture. M. tuberculosis is a slow-growing organism, and final results of the sputum culture may not be available for up to 8 weeks.

Treatment for TB involves a combination of medications taken for six to twelve months. It is very important to take all medications for the full length of treatment. When a person is diagnosed with TB, the physician must report it to the county health department. Many times, the health department will provide the medications necessary for treatment. Blood tests may be ordered to periodically check liver function. Close cooperation between the patient, physician, and local health department is very important to insure proper treatment and recovery.

For more information about TB, check the following web sites: http://www.niaid.nih.gov/factsheets, http://familydoctor.org , or http://www.cdc.gov

HEMOPTYSIS

Hemoptysis is the medical term used to describe bloody sputum coughed up from the lungs. Hemoptysis is usually a symptom of another medical problem. A person that has hemoptysis may have a small or large amount of blood present in their sputum. The severity may range from blood-tinged sputum to having large amounts of bright red blood coughed from the lungs. Some of the things that can cause Hemoptysis are bronchial infections, tuberculosis, lung cancer, or erosion of a blood vessel. There may be no pain associated with hemoptysis. You should contact your health care provider immediately if you experience hemoptysis for further diagnostic evaluation.

PRIMARY PULMONARY HYPERTENSION

Primary pulmonary hypertension (PPH) is a rare lung disorder in which the blood pressure in the pulmonary arteries is much higher than normal, for no identifiable reason. Normally, oxygen-poor blood from the body is returned to the right side of the heart. It is pumped to the lungs through the pulmonary arteries. Oxygen is picked up in the lungs, and the blood circulates back to the left side of the heart where it is pumped to the rest of the body.

In primary pulmonary hypertension, changes occur in the small blood vessels in the lungs, which make it harder for the blood to flow through those vessels. This causes increased pressure in the main blood vessels sending blood from the right side of the heart to the lungs. Because of this increased pressure, strain is put on the right side of the heart, which must work harder to pump against this extra resistance. Over time, scarring of the arteries takes place, and the blood vessels become stiff as well as thickened. Some vessels may become blocked. This makes it more difficult for the oxygen in the lungs to get into the bloodstream. The combination of increased workload and less oxygen in the bloodstream eventually causes the right side of the heart to become enlarged and weakened. Eventually, the right side of the heart may fail.

Early symptoms for PPH are shortness of breath, dizziness, and even fainting spells. Swelling of the legs and ankles, chest pain, and a bluish color to the lips and fingernails may also be present. Generally, the more severe the symptoms, the more advanced the disease.

PPH is diagnosed only after no other reasons for pulmonary hypertension can be determined. Tests that may be performed are chest x-ray, CT scan, ECG, pulmonary function tests, echocaridiogram, and blood tests. A cardiac catheterization may be ordered.

A new medication called Tracleer has become available recently. This medicine does not cure PPH, but does stop the progression of the disease. Other medications may be prescribed to help with symptoms, and may decrease the blood pressure in the lungs, but will not cure the disease. Single-lung transplant is a consideration for patients with severe PPH.

For more information about Primary pulmonary hypertension, check the following websites: http://www.nhlbi.nih.gov or www.phassociation.org

PLEURAL EFFUSION

A pleural effusion is the buildup of excess fluid in the space between the lungs and the ribcage. The fluid may be thin and clear, bloody-looking, or thick, like pus. The space between the lungs and the ribcage is the pleural space. Normally there is a small amount of fluid in this space that acts as a lubricant and allows the lungs to expand smoothly during breathing. When excess fluid collects in this space, the lungs are prevented from fully expanding.

A pleural effusion is usually related to some other illness or medical procedure, and generally cannot be prevented. Pleural effusions can occur with congestive heart failure, tumors, bacterial pneumonia, lung cancer, breast cancer, or cancer in the lymph system, tuberculosis or rheumatic diseases. It can also occur after childbirth or open heart surgery.

Symptoms of a pleural effusion are shortness of breath, chest pain, and possibly fever. An x-ray will assist the physician with diagnosis. A thoracentesis is performed to obtain a sample of the fluid for testing. Testing of the fluid may help determine the cause of the effusion. Thoracentesis is also done to drain the fluid from the pleural space. This procedure may be done in the physicians office or in the hospital. It involves numbing the skin, inserting a needle or small tube between the ribs, and draining the fluid.

For more information about pleural effusion, check the following web site:

http://www.nhlbi.nih.gov