Infection - TB Flashcards
What are some clinical features of TB?
Fever, drenching nocturnal sweats, weight loss (weeks- months), malaise
Resp TB: cough, purulent sputum, haemoptysis, pleural effusion
Non resp TB: erythema nodosum, lymphadenopath, bone/joint, abdo, CNS (meningitis), GU, military, cardiac (pericardial effusion)
DD of haemoptysis
Infection: pneumonia, TB, bronchiectasis/CF, cavitating lung lesion (fungal)
Malignancy: lung ca, mets
Haemorrhage: bronchial artery erosion, vasculitis, coagulopathy
PE
Risk factors of TB
Past history of TB Known TB contact Born in place with high incidence Foreign travel to place with high incidence Immunosuppressed
What is the initial management for TB?
ABCDE approach and culture
What should be considered when a TB patient is admitted to the ward?
Admit to side room and start infection control measures such as masks and negative pressure room
What should you do for a TB patient with a productive cough?
3 morning sputum samples for AAFB&TB culture
What should you consider in a TB patient without a productive cough?
Bronchoscopy
What bloods should be done for a TB patient?
Routine bloods including LFT
HIV test
Vitamin D
When would you consider a CT chest for a TB patient?
If TB suspected but clinical features or CXR isn’t typical
What must you do it military TB is suspected?
MRI brain/spine
Followed by LP
What should you do if the diagnosis between TB and pneumonia is unclear?
Start antibiotics for pneumonia while investigating TB
What should you do if there is a critically ill patient with suspected TB?
No time to wait for sputum results so start anti Tb therapy AFTER sputum samples are taken
How long does TB culture take? What is the relevance of this?
6-8 weeks
Treatment often started before diagnosis confirmed
What is the standard regimen for TB treatment?
4 antibiotics for 2 months (rifampicin, isoniazid, pyrazinamide, ethambutol)
then 4 months of rifampicin and isoniazid
What patient factor is important in TB treatment?
Patient weight
What baseline tests should be done before TB treatment?
LFT
Visual acuity before ethambutol
What is crucial in TB treatment and how can it be maintained?
Compliance can be maintained by Directly Observed Therapy (DOT)
Ensure patient knows side effects
What other medication is given while on isoniazid and why?
Pyridoxine as prophylaxis against peripheral neuropathy
What is the test of choice for CNS TB and why?
MRI brain
More likely to identify tubercles than CT
What are the major side effects of rifampicin?
Hepatitis, rashes, febrile reaction, orange/red secretions, drug interactions including warfarin and oral contraceptive pill
What are the major side effects of isoniazid?
Hepatitis, rashes, peripheral neuropathy, psychosis
What are the major side effects of pyrazinamide?
Hepatitis, rashes, vomiting, arthralgia
What are the major side effects of ethambutol?
Retrobulbar neuritis
