4 - TB Flashcards
Second leading cause of death from infection worldwide?
Invariably, its TB.
US cases of TB originate from:
Mexico Philippines Vietnam India China Haiti Guatemala
Reservoir for TB
Humans
Transmission of TB?
Airborne droplet nuclei
Inhaled
Macrophages ingest
Transported to regional lymph nodes (hence hilar lymphadenopathy)
Active TB pt’s - likely to also have:
HIV DM Substance abuse Recent TB infection Low body weight Silicosis Gastrectomy (loss of MALT)
Who gets extrapulmonary TB?
AIDS , elderly
Sxs of primary TB
Productive cough Fever Weight loss Hemoptysis Chest pain Anorexia Fatigue Night sweats
TB meningitis sxs
HA
AMS
Coma
Fever (not req’d)
Skeletal TB sxs
Back pain or stiffness
Paralysis
Arthritis
Genitiourinary TB sxs
Flank pain Dysuria Epididymitis Scrotal mass PID -> sterility
GI TB sxs
Ulcers
Malabsorption
Diarrhea
Hematochezia
Miliary TB sxs
Weakness Weight loss HA Fever Cough Generalized lymphadenopathy Hepatomegaly Splenomegaly Pancreatitis Multi-organ dysfunction
Testing for latent TB?
PPD
Definitive ID of TB?
Can only be made with a culture of NAA
Positive PPD warrants:
CXR
Primary TB CXR shows
Central apical portion - left-lower lobe infiltrate
Pleural effusion
Reactivation TB CXR shows
Cavitation
Noncalcified round infiltrates
Ranke complexes (Ghon lesion and calcified hilar nodes)
Calcified nodules on CXR typically means:
Old dz
Miliary TB
Millet seed
Whatever tf that means
Active TB txt
INH
Rifampin
Pyrazinamide
Ethambutol
If you know it’s fully susceptible, you can stop Ethambutol
After 2 mos, you can stop Pyrazinamide
After 4 more months, you’re done
If INH resistant, just do everything else for 6 mos
TB can lead to:
Aspergilloma
Carcinoma
Describe PPD
5 units intradermal
Read it 48-72hrs later
Measure induration, not erythema
ALL POS PPD GET CXR
POS PPD for 5mm or greater:
Close contact with newly Dx’d TB patient
HIV positive
Organ transplant patients
Long term steroid use
Fibrotic lesions on CXR
POS PPD for 10mm or greater
Pts with high-risk conditions (DM, CA, ESRD, malnutrition, silicosis, IVDU, etc)
Recent converter
Recent immigrants from high-prevalence country
Kids under 4yrs with adult TB exposure
Residents and employees of high risk facilities (prisons, military - same thing)
