Reactivation Disease

® About 10% of infected patients develop reactivation TB, with half occurring in the first 2 years after infection.2'6'12 Upper lobe pulmonary disease is the most common (85% of cases).2 Caseating granulomas result from the vigorous immune response, and liquefaction leads to local spread. Eventually, a pulmonary cavity results, and this provides a portal to the outside that allows for person-to-person spread. Bacterial counts in the cavities can be as high as 1011/L of cavitary fluid (108/mL)2,18 Prior to the chemotherapy era, pulmonary TB usually was associated with hypoxia, respiratory acidosis, and eventually death.

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