Post-primary pulmonary tuberculosis is a chronic disease commonly caused by either endogenous reactivation of a latent infection or exogenous re-infection by Mycobacterium tuberculosis. It has other synonyms derived mostly from the route of transmission of the infection or from the age of the patient at the onset of the disease, including endogenous reactivation primary tuberculosis, exogenous re-infection pulmonary tuberculosis, or adult-onset pulmonary tuberculosis. The term being used here is ‘post-primary pulmonary tuberculosis’ to include both re-infection and reactivation forms. The clinical features of the disease are not specific, and the imaging features are suggestive but can simulate other diseases. The definitive diagnosis depends on the identification of M. tuberculosis bacilli, using conventional microbiological methods of sputum smear and culture or radiometric culture methods such as BACTEC or DNA probe PCR-based assays which can identify drug-resistant strains as well. Sputum smear and culture remain the most important investigative methods. Smear-negative sputum may delay the diagnosis for 4–8 weeks or longer if the culture is also negative. A presumptive diagnosis based on the clinical and radiographic features should be made with initiation of treatment after the exclusion of other possible causes of the radiographic findings.
KeywordsPulmonary Tuberculosis Sputum Smear Directly Observe Therapy Bronchopleural Fistula Massive Hemoptysis
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