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:   Respiratory mycoses


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:   Atelectasis

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:   Pneumothorax (Collapsed lung)


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:   Pneumoconiosis

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.

READ:   Silicosis


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.

Berylliosis ICD-9: 503 Description Berylliosis is beryllium poisoning, usually of the lungs. The skin and other bodily organs also may be affected. The acute form of the disease is characterized by the onset of pneumonia-like symptoms and other respiratory tract disorders. The more common, chronic form is characterized by granuloma formation and diffuse interstitial pneumonitis. Etiology Those at risk of contracting berylliosis include workers in primary production, metal machining, and reclaiming scrap alloys. Other high-exposure occupations are in the nuclear power, aerospace, and electronics industries. The metal may be either inhaled or directly absorbed through the skin in the form of dusts, salts, or fumes. As with asbestosis, berylliosis can affect family members who are exposed to dust in the worker’s clothing. Signs and Symptoms After exposure, dry cough and nasal mucosal swelling with ulceration occur. As the condition worsens, substernal pain, tachycardia, dyspnea, weigh...
Atelectasis ICD-9: 518.0 Description Atelectasis is a collapsed or an airless condition of all or part of a lung that allows unoxygenated blood to pass unchanged through the area; this produces hypoxia. The condition may be acute or chronic. Etiology The condition may be caused by obstruction of the lung by foreign matter, mucus plugs, or excessive secretion. It is seen in many clients with COPD or cystic fibrosis and those who smoke heavily. Compression of the lung by tumors, aneurysms, enlarged lymph nodes, or pneumothorax also may cause lung collapse (see Pneumothorax). Atelectasis is sometimes a complication of abdominal surgery or a general consequence of postoperative immobilization. Signs and Symptoms Chronic atelectasis may be marked only by the gradual onset of dyspnea. Acute atelectasis typically includes marked dyspnea, cyanosis, fever, tachycardia, anxiety, and diaphoresis (profuse sweating). There may be a decrease in chest motion on the affected side. Chronic atelecta...
Chronic obstructive pulmonary disease: pulmonary emphysema and chronic bronchitis ICD-9: 491.21 Description Chronic obstructive pulmonary disease (COPD) is a functional diagnosis given to any pathological process that decreases the ability of the lungs and bronchi to perform their function of ventilation. It is an umbrella term that includes pulmonary emphysema and chronic bronchitis. COPD affects 12 million Americans, and it is estimated that 12 million more are undiagnosed. It is a common cause of death and disability in the United States. Pulmonary emphysema (ICD-9:492) is the permanent enlargement of the air spaces beyond the terminal bronchioles resulting from destruction of alveolar walls. As a consequence of this destruction, the lungs slowly lose their normal elasticity. Air reaches the alveoli in the lungs during inhalation but may not be able to escape during exhalation. Evidence suggests that some forms of the emphysema may be hereditary. In rare instances, emphysema is associated with a deficiency of a1-antitrypsin, a protein that plays a role in ...
PHARYNGITIS ICD-9: 462 Description Pharyngitis, inflammation of the pharynx, is the most common throat disorder and may be acute or chronic. On the average, children experience sore throats about five times a year, adults twice a year. Etiology Acute pharyngitis can be caused by any of a number of bacterial or viral infections, with viral infections being the most common. Streptococcus pyogenes (causing strep throat) is the most common of many possible bacterial pathogens; influenza virus and common cold viruses are the most common viral pathogens causing the condition. Acute pharyngitis also may arise secondary to systemic viral infections, such as measles or chickenpox. Noninfectious causes of the disease include trauma to the mucosa of the pharynx from heat, sharp objects, or chemical irritants. Chronic pharyngitis is more likely to have a noninfectious origin and is often associated with persistent cough or allergy. Signs and Symptoms The hallmark of acute pharyngitis is sore t...
Pleural effusion ICD-9: 511.9 Description Pleural effusion is an excess of fluid between the parietal and visceral pleural membranes enveloping each lung. The accumulating fluid may be characterized as transudate, which has little or no protein, or exudate, which is rich in protein. Etiology Pleural effusion may occur regardless of whether there is a pathological process affecting the pleurae themselves. Transudative pleural effusions frequently result from congestive heart failure, hepatic disease with ascites, and peritoneal dialysis. Exudative pleural effusions more often are seen with inflammation of the pleura, TB, rheumatoid arthritis, pancreatitis, respiratory neoplasms, and bacterial pneumonia. Signs and Symptoms The person may be asymptomatic. When signs and symptoms are manifested, they may include cough, dyspnea, and chest or pleuritic pain. The symptoms of pleural effusion will typically accompany those of any underlying condition. Diagnostic Procedures Auscultation of...