Pulmonary tuberculosis

ICD-9: 011.xx



Pulmonary tuberculosis (TB) is a slowly developing bacterial lung infection characterized by progressive necrosis of lung tissue. An inflammatory response begins with phagocytosis. Growths of inflamed, granular-appearing tissue (granulomas) form and, when they calcify, leave lesions that may be visible on an x-ray. The lymph and blood generally are affected.

Pulmonary TB is a common cause of death in the world. The arrival of nearly 400,000 immigrants and over 50,000 refugees per year from overseas contributes to the rise of TB in the United States. The incidence of TB also is increasing due to homelessness, substance abuse, and HIV infection – all related to individuals who are less likely to receive adequate medical attention. In general, TB is more common among elderly persons, the urban poor, and members of minority groups.

READ:   Lung cancer


Pulmonary TB is caused by Mycobacterium tuberculosis. The infected individual’s immune system usually is able to wall the bacteria into a tubercle or tiny nodule. The bacteria can lie dormant for years and then reactivate and spread when conditions are favorable. The disease is transmitted in aerosol droplets exhaled by infected individuals. Note: Although the lungs are the organs most commonly infected, the bacteria can infect other parts of the body as well.

Signs and Symptoms

Pulmonary TB may be asymptomatic. The onset generally is insidious. When symptoms are present, they are often vague and may include cough, lassitude, malaise, fatigability, night sweats, anorexia, afternoon fever, weight loss, pleuritic chest pain, hemoptysis, and wheezing.

READ:   Pleurisy (Pleuritis)

Diagnostic Procedures

Anteroposterior x-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis

FIGURE. Anteroposterior x-ray of a patient diagnosed with advanced bilateral pulmonary tuberculosis. (Centers for Disease Control and Prevention, 1972.)

A thorough physical examination, chest x-ray or CT scan, bronchoscopy, and positive tuberculin test often confirm the diagnosis. The tuberculin test of choice is the Mantoux test, which consists of an intradermal injection of a purified protein derivative (PPD) of the tuberculin bacillus. The TB skin test cannot determine if the disease is active. This determination requires sputum analysis (smear and culture) in the laboratory. The sensitive PCR (polymerase chain reaction) test can detect the genetic material of the bacteria, usually within a few days. The bacteria may be identified in the sputum, urine, body fluids, or tissues of the client. Pulmonary and pleural biopsies may be ordered.

READ:   Infectious mononucleosis


Drug therapy is indicated in every case of pulmonary TB. There are many TB drugs, however, and these can be used in a number of different ways. To prevent the development of resistance, TB drugs are administered in combinations of two or more (usually four) in most instances. Prolonged use of about 6 months is essential. Bed rest and isolation are indicated until the person is strong enough to resume activities.

Complementary Therapy

A whole-foods and nutritious diet combined with vitamin supplements can be helpful. Enhancing the body’s immune response with fresh air, rest, light exercise, and relaxation will prove beneficial.


READ:   Sleep apnea

Teach clients to cough and sneeze into tissues and to properly dispose of all secretions. Remind them of the importance of taking all their medications. Teach family members about the infectious nature of the disease and proper medication regimen. Individuals exposed to someone with pulmonary TB disease should contact their primary care provider or local health department about getting a TB skin test.


The prognosis for an individual with active pulmonary TB is good if the disease is detected early and if the client follows the prescribed regimen of drug therapy. However, if strains of bacteria are resistant to two or more of the major antituberculosis agents, mortality rates increase.



Preventive measures include proper infection control, tuberculin testing of persons known to have been in close contact with infected persons, and treatment of individuals reacting to the tuberculin testing. Generally, a person with a positive tuberculin reaction is put on 1 year of isoniazid prophylactically. Use of the bacille Calmette-Guerin (bCG) vaccination should be considered only for very select persons who meet specific criteria and in consultation with a TB expert.

Pneumoconiosis ICD-9: 505 Pneumoconiosis is a disease of the respiratory tract caused by inhaling inorganic or organic dust particles or chemical irritants over a prolonged period. It is an occupational disorder associated with mining and stonecutting. Four of the most frequently seen varieties of pneumoconiosis are silicosis (most common), asbestosis, berylliosis, and anthracosis.
Lung abscess ICD-9: 513.0 Description A lung abscess is an area of necrotized lung tissue containing purulent material. Abscesses are more frequent in the lower dependent portions of the lungs and in the right lung, which has a more vertical bronchus. Etiology Lung abscesses caused by infectious organisms may be a complication of pneumonia. Aspiration of infectious material is the most frequent etiology; however, aspiration due to dysphagia or compromised consciousness (e.g., seizure, cerebrovascular accident, head trauma, alcoholism) appears to be a predisposing factor. Poor oral hygiene, dental infections, and gingivitis are also common indicators. Antibiotic therapy has greatly decreased the number of deaths caused by lung abscess. However, the increased use of corticosteroids, immunosuppressive drugs, and chemotherapeutic agents in the past couple of decades has changed the natural environment of the oropharyngeal cavity and contributed to increased frequency of opportunistic lung abs...
SINUSITIS ICD-9: 473.9 Description Sinusitis is inflammation of the paranasal sinus. The condition may be acute, subacute, chronic, allergic, or hyperplastic. Acute sinusitis generally is caused by the common cold and lingers in the subacute form in about 10% of the cases. Chronic sinusitis follows a viral or bacterial infection. Allergic sinusitis often accompanies allergic rhinitis. Hyperplastic sinusitis is a combination of purulent acute sinusitis and allergic sinusitis. Etiology Sinusitis is usually caused by pneumococcal, streptococcal, or Haemophilus influenzae bacterial infections. The infection may spread to the sinuses when an individual has a cold, usually because of excessive nose blowing. Sinusitis also can result from swimming or diving, dental abscess or tooth extractions, or nasal allergies. Chronic sinusitis may be caused by the same etiologic factors as acute sinusitis but more frequently is caused by staphylococcal and gram-negative bacteria. These bacteria may be se...
Pulmonary edema ICD-9: 514 Description Pulmonary edema is a diffuse extravascular accumulation of fluid in the pulmonary tissues and air spaces. Most commonly, it represents the projection of cardiac disease processes, such as atherosclerosis, hypertension, or valvular disease. The condition is usually a direct consequence of left ventricular failure. Pulmonary edema can occur as a chronic condition, or it can develop quickly. Pulmonary edema is considered a medical emergency. Etiology When the alveoli fill with fluid instead of air, preventing oxygen from being absorbed into the bloodstream, more blood is added to the pulmonary circulation than can be adequately removed. In addition to the cardiac problems already mentioned, pulmonary edema may also be the result of lung infections, living at high altitudes, smoking, certain toxin exposure, pneumonia, and acute respiratory diseases. Signs and Symptoms The onset of pulmonary edema frequently occurs at night, after the person has been l...
Understanding ARDS Acute respiratory distress syndrome (ARDS) is sudden, life-threatening lung failure. ARDS occurs when the alveoli become inflamed and filled with liquid, causing their collapse. Gas exchange ceases, and the body is starved for oxygen. ARDS is a syndrome rather than a disease. It most often occurs within 24 to 48 hours of injury or illness, and the intensity and duration varies from one person to another. The mortality rate ranges from 35% to 50%, in most cases as a result of underlying disease or mechanical ventilation complications.