• Primary TB
• Secondary TB
• Miliary TB – Diffuse dissemination by vascular system in immune suppressed

Etiology

• Mycobacterium tuberculosis
• Oral lesion secondary to pulmonary TB
• AIDS defining illness

Clinical

• Scrofula – lymphadenopathy on neck Picture
• Fever
• Night sweats
• Malaise
• Weight loss
• Cough
• Hemoptysis
• Intraoral lesion: Indurated chronic non healing ulcer and is painful

Diagnosis

• Mantoux test
• ZN staining for AFB (acid fast bacilli)
• HIV screening

NB: Immunocompromised patients have atypical mycobacteria infections eg. M. avium intracellulare

Histology

• Caseating necrosis/granuloma – cheesy appearance
• Langerhans giant cells
• Inflammatory response

Management

• Directly observed therapy (DOT) – multidrug therapy
• Isoniazid
• Rifampicin
• Ethambutol
• Pyrazinamide
• Streptomycin

Mnemonic: PRIESt

Clinical stages

• Non immune host exposed to TB (skin test positive)
• Primary TB of lung
• Arrested TB in immunocompetent individuals
• Progressive TB – hematogenous, lymphatic, direct spread
• Arrested TB reactivated – secondary TB – progressive TB

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Cervical TB:

• Most common in level 2 nodes
• Lymph nodes > 2cm
• With or without evidence of TB elsewhere
• Clinical: Night sweats, weight loss, fever
• Diagnosis: FNA, ZN staining with AFB, Mantoux test