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T3 resp system > 6.2 Tuberculosis > Flashcards

6.2 Tuberculosis Flashcards

1
Q

What does TB result from ?

A
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2
Q

Patients with …1.. are more contagious

A
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3
Q

Patients with ..1.. are particulary contagious due to …2..

A
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4
Q

For how long can droplet nuclei be suspended in room air for ?

A
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5
Q

When does contagiousnes decrease rapidly ?

A
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6
Q

Pathophysiology of TB ? [infection slide has more info !]

A
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7
Q

What results in the following from exposure to M. tb ?
1. no TB
2. latent TB
3. Active TB

A
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8
Q

primary progressive TB is known as what ?

A

macrophages can not contain the bacteria ? i don’t get this !

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9
Q

….1.. significantly facilitates reactivation of TB
e.g. ..2…

A
  1. impaired cellular immunity
  2. HIV infection , immunosuppression , organ transplantation , corticosteroids, TNF-inhibitors
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10
Q

why does impaired cellular immunity significantly facilitate reactivation ?

A

Reaction to TB is a type 4 (delayed hypersensitivity) reaction which is mediated by T cells

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11
Q

TB typical histological appearance includes what ? [alter!!]

A

granulomatous necrosis with a caseous histological appearance

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12
Q

define granuloma

A

inflammatory mononuclear cell infiltrate

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13
Q

define tubercule

A

round nodule that contains caseous necrosis feature of a granuloma

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14
Q

define ghon focus

A

small area of granulomatous inflammation primary site of infection by M. tb

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15
Q

define ghon complex

A

ghon focus with lymph node involvement (hilar lymphadenopathy)

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16
Q

define ranke complex

A

calcified ghon complex - can see radiologically

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17
Q

difference between primary and secondary TB ?

A
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18
Q

progression of TB ?

A
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19
Q

Where is primary complex TB usually seen ?

A

lower / mid lobes

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20
Q

where in lungs is secondary TB pathology often seen ?

A

upper regions

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21
Q

M. tuberculosis:
1. full name
2. what it is ?
3. growth speed ?

A
  1. mycobacterium tuberculosis
  2. a bacteria - aerobic , acid fast
  3. very slow growing - culture can take up to 6 weeks
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22
Q

Confirmation of active TB infection usually done by what ?

A
  • acid fast smear (e.g. Ziehl Neelsen)
  • sputum culture
  • NAAT such as PCR
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23
Q

Differences between latent and active TB regarding the following

  1. progression to / progression from
  2. symptoms
  3. cellular immune system sufficiently does / does not contain the bacteria
  4. number of M. tb
  5. tests
A

Latent :
1. can turn into A TB
2. asymptomatic
3. does
4. lower
5. tuberculin skin test, IGRA

Active :
1. Either previously from L TB , or from progression of primary infection
2. symptomatic
3. does not
4. higher
5. CXR, sputum acid fast smear, culture , NAAT

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24
Q

Tuberculosis testing Active TB

A
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25
Q

Possibility of TB should be considered in any person with risk factors fro TB exposure who has suggestive symptoms or chest x-ray abnormalities

List these suggestive symptoms

A
  • fever
  • malaise
  • pleuritic chest pain
  • cough longer than 2-3 weeks
  • night sweats
  • weight loss
  • haemoptysis
  • psychological symptoms
  • clubbing
  • erythema nodosum
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26
Q

what is erythema nodosum?

A

painful patches of skin that look red or darker than the surrounding skin

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27
Q

Although the presence of upper lobe infiltrates is characteristic of the disease, atypical chest x-ray presentation is common among who ?

A
  • children
  • people who are immunocompromised
  • have HIV infection
  • have diabetes
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28
Q

Chest x-ray features for someone with TB ? [change !]

A
  • opacities in lobe
  • multifocal patchy opacities
  • ranke complex
  • bilateral consolidation in lower zones
  • very widespread randomly distributed innumerable tiny nodules in both lungs
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29
Q

Ranke complex is seen in …1. primary pulmonary tuberculosis and is a later manifestation of the …2.. complex.

It consists of two components:
* a Ghon lesion that has undergone ..3…
* an ..4.. node.

A
  1. ‘healed’
  2. Ghon
  3. calcification
  4. ipsilateral calcified mediastinal
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30
Q

Miliary TB represents what spread of TB infection ?

A

haematogenous spread of uncontrolled TB infection

31
Q

What is Miliary TB ? …. [slide 21/67]

A
32
Q

symptoms of miliary TB include what ?

A
  • fever
  • chills
  • weakness
  • malaise
  • often progressive dyspnea
33
Q

With miliary TB intermittent dissemination of tubercle bacilli may lead to what ?

A

a prolonged fever of unknown origin (FUO)

34
Q

regarding miliary tuberculosis bone marrow involvement may cause what ?

A
  • anemia
  • thrombocytopenia
  • leukemoid reaction
35
Q

miliary TB on CXR …

A
36
Q

Symptomatic patient/ suspected active TB investigations after chest x-ray , 3x sputum samples are taken what for?

A
  • acid fast stain
  • culture
  • PCR (gene Xpert)
37
Q

sputum acid fast bacilli smear for active TB ……

A
38
Q

sputum culture for active TB …….

A
39
Q

NAAT for active TB …

A
40
Q

Do we always see abnormal chest-X-ray in TB ?

A

not always , so the 3x sputum samples should still be done !

41
Q

extrapulmonary TB includes what ?

A
  • Genitourinary TB
  • TB meningitis
  • TB peritonitis
  • Pericardial tuberculosis
  • Tuberculosis lymphadenitis
  • Cutaneous tuberculosis
  • Pott disease
  • GI tuberculosis * Liver TB
42
Q

Other investigations apart to consider with extrapulmonary TB ? [SPLIT THE Q depending on which TB !!]

A
  • Ultrasound, CT, MRI or imaging (Central nervous system involvement, disseminated/ miliary TB)
  • Echocardiogram (pericardial TB)
  • Biopsy of omentum, bowel, liver or ascitic fluid (GI TB)
  • Aspiration of joint fluid or biopsy of joint (Bone TB)
  • CSF culture, cytology, microscopy (Miliary/ CNS TB)
  • HIV/ Hepatitis B and C testing
43
Q

If there are clinical signs and symptoms consistent with a diagnosis of TB when should treatment started ?

A

Immediately started without waitign for cultures

& patient should be referred to a clinican with training in specialised care of people with TB

44
Q

for people with active TB without central nervous system involvement what is offered for 2 months … [slide 29 alter !]

A
45
Q

It isn’t feasible or cost-effective to screen an entire population

For latent TB NICE recommends screening for specific high-risk groups in the UK , who do these groups include ?

A
  • close contacts of patient with TB
  • healthcare workers
  • immunosuppressed patients (e.g. those with HIV)
  • migrants from countries where TB is common
46
Q
  1. Mantoux tuberculin skin test (TST) is performed how ?
  2. when should the skin test reaction be read after administration ?
A
  1. by injecting 0.1 mL of tuberculin purified protein derivative into the inner surface of the forearm
  2. between 48 to 82 hours
47
Q

Complete the following :

  • If the Mantoux is positive ( > 5mm), assess for ..1..
  • If Mantoux is positive, but active TB is excluded, consider ..2…
  • If interferon gamma release assay also positive, offer treatment for …3…
A
  1. active TB
  2. interferon gamma release assay (IGFA)
  3. latent TB infection
48
Q

For those with risk factors, it may be appropriate to treat for latent TB infection after only one positive result (either Mantoux or IGFA) ????

A
49
Q

BCG vaccine full form ?

A

Bacillus Calmette–Guérin (BCG)

50
Q

What can BCG vaccination cause ?

A

false-positive Mantoux test

51
Q

BCG has greates effect in preventing which TB ?

A

miliary

52
Q

BCG vaccination efficacy ?

A

variable- some protective effect against progression to active TB and primary infection

53
Q

BCG vaccination leaves what ?

A

a characteristic raised scar which may be proof of previous immunisation

54
Q

A reactive TST is a contraindication to BCG due to what ?

A

risk of severe local inflammation and swelling

55
Q

Before a person receives the BCG vaccine what should they be tested for ?

A

latent TB infection using the TST

56
Q

Relationship between doing a TST and giving BCG vaccine ?

A
  • If a patient has a positive TST- refer to TB specialist and do not give BCG
  • If the patient is negative they can receive the BCG vaccine
57
Q

BCG vaccination is recommended for all babies and children <16 who:

A
  • are born in areas of the UK where the rates of TB are high
  • have a parent or grandparent who was born in a country where there’s a high rate of TB
  • live with, or are close contacts of, someone with infectious TB
  • Will travel for more than 3 months in an area with high rates of TB
58
Q

BCG vaccination is not usually offered to people over the age of 16 because why ?

A

there is limited evidence of how well the vaccine works in adults

59
Q

Who is the BCG vaccination not suitable for?

A

people with HIV, chemotherapy patients, pregnancy, SCID, immunosuppressed or those with malignancy, or infants born to a mother taking immunosuppressants during pregnancy

60
Q

Which certain groups of patients with latent TB are at increased risk of developing active TB ?

A

HIV, excessive alcohol, IV drug users, transplant, malignancy, diabetes, immunosuppression.

61
Q

For people, including those with HIV, aged younger than 65 years with evidence of latent TB offer either which drug treatments ?

A
  • 3 months of isoniazid (with pyridoxine) and rifampicin or * 6 months of isoniazid (with pyridoxine).
62
Q

contact tracing relation to TB ? [change Q!]

A

1) Offer screening to close contacts
2) Assess symptomatic close contacts for active TB
3) Consider BCG vaccination for close contacts

63
Q

Adherence, treatment completion and follow up ….

A
64
Q

Multidrug-resistant TB (MDR TB) refers to a strain of TB that is resistant to 2 first-line drugs which are what ?

A

isoniazid and rifampin

65
Q

When can drug-resistant TB occur ?

A

when the drugs used to treat TB are misused or mismanaged

66
Q

examples of misuse or mismangement of drugs include what ?

A
  • Not completing a full course of TB treatment
  • Poor quality drugs
  • Drugs for treatment not available
  • Wrong dose or length of time
67
Q

Which people are particularly at risk to drug resistant TB ?

A

People using homeless hostels, shelters, and day centres, and people living in prison or detention centres,

68
Q

slide 43..

A
69
Q

Imaging is non-specific and often other conditions can have similar appearance on CXR. Examples include:

A
  • URTI (upper respiratory tract infection )
  • asthma
  • COPD
  • lung fibrosis (e.g. sarcoidosis, silicosis)
  • lung cancer
70
Q

slide 45 - don’t need to know but some you’ve probably head of so just to know…

A
71
Q

What is leading cuase of death amongst those living with HIV ?

A

TB

72
Q

TB screening should be offered to all people with what ?

A

HIV at diagnosis and HIV testing should be routinely offered to all patients with TB

73
Q

Approximately …. % of TB cases know their HIV status ?

A

61

T3 resp system (12 decks)

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