A patient has pleural effusion with empyema. The following are clinical manifestations except:

A. It does not remain dormant but some host defenses can kill the bacteria: While the immune system can kill some of the Mycobacterium tuberculosis bacilli, in many cases, the bacteria evade complete eradication and persist in a dormant state within the lungs. This does not mean the infection is fully eliminated, as it can reactivate later.

B. Virulence factors in the bacilli weaken over time, leading to apoptosis: Mycobacterium tuberculosis does not naturally lose its virulence over time. Instead, it can persist in a latent state due to immune containment, not because of a reduction in its ability to cause disease.

C. The bacilli can become isolated within tubercles in the lungs, possibly encapsulated: In latent tuberculosis, the immune system walls off the bacilli within granulomas (tubercles), preventing active disease. These granulomas may be encapsulated with fibrous tissue, restricting bacterial growth and spread. The bacteria remain dormant but can reactivate if the immune system weakens.

D. Macrophages attack and phagocytize new areas of infection: While macrophages do play a role in the immune response to tuberculosis, they are often unable to completely eradicate the bacilli. Instead, the bacteria can survive within macrophages and trigger the formation of granulomas, which help contain but not eliminate the infection.

A. Obstructive: Obstructive pulmonary disease is characterized by increased resistance in the airways, making it more difficult to expire air. Conditions such as asthma and chronic obstructive pulmonary disease (COPD) lead to airflow limitation, requiring greater force to expel air from the lungs.

B. Communicable: Communicable pulmonary diseases refer to infections that can be transmitted from person to person, such as tuberculosis or influenza. This classification does not directly relate to the mechanics of airflow and does not specifically require more force to expire air.

C. Acute: Acute pulmonary disease describes a sudden onset of symptoms, which can be caused by various conditions (e.g., pneumonia or pulmonary embolism). The term "acute" does not inherently indicate a need for increased expiratory force and can encompass both obstructive and restrictive patterns.

D. Restrictive: Restrictive pulmonary disease involves reduced lung volume and compliance, making it difficult to expand the lungs fully during inspiration. While patients may struggle to inhale adequately, they typically do not require increased force to expire air, as expiratory airflow is usually not obstructed in the same manner as in obstructive diseases.