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Bloc G - Infection > May2 M3-Tuberculosis > Flashcards

May2 M3-Tuberculosis Flashcards

1
Q

(imp) most important consideration in diagnosing TB

A

think of the epidemiologic probability

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2
Q

TB infection definition

A

-carrier state
-infected, healthy and not contagious
(sometimes called latent)
-CXR and culture negative
-PPD positive

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3
Q

tuberculosis definition

A
  • disease state
  • contagious
  • culture positive
  • CXR positive
  • PPD negative
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4
Q

mycobacterium def

A

genus of the mycobacteria. most mycobacteria are harmless (NTM = non tuberculous mycobacteria)

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5
Q

pathogen of tuberculous infection and tuberculosis disease

A

mycobacterium tuberculosis

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6
Q

definitive host of mycobacterium tuberculosis

A

humans (only)

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7
Q

how tuberculosis risk varies on a graph after exposure to M. TB pathogen

A

increases as years after exposure increase

there is NO bimodal distribution and no clear cut between primary and latent TB

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8
Q

why TB is said to be a symbiont

A
  • symbiosis = divergent organisms (humans and M. TB) live together in a fine balance
  • TB does enough pathology to transmit but not enough to kill the host (the reservoir)
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9
Q

example of lung pathology in someone with tuberculosis

A

localized, chronic pathology, one cavity and rest of the lung is fine.

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10
Q

vaccine of TB and benefits vs problems

A

BCG

  • medical impact (stops children from being infected. protects 80% of children from pediatric TB)
  • NO public health impact (adults are still contagious)
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11
Q

events that made TB rates go up

A

when life conditions get worse basically

  • WWI and WW2
  • famines
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12
Q

(imp?) what is the risk of tuberculosis after tuberculosis infection

A

10% lifetime risk

  • 5% in first 2 years after infection (1 in 40 chance per year)
  • 5% for the rest of your life (1 in 1000 chance per year per year)
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13
Q

when do you get the most benefit out of treating latent TB

A

treat TB infection as early as possible is the best

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14
Q

1st step of pathogenesis in TB infection

A
  • aerosol travers to lung and encounters ALVEOLAR MACROPHAGE FIRST
  • macrophage eats it (done, no infection) or delivers it to DENDRITIC cell that brings it to lymph node
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15
Q

what happens if TB brought to lymph node and its replication is permitted

A
  • replication of TB in the lung, if permitted by alveolar macrophages, = get Ghon focus
  • bc brought to lymph nodes, get adaptive immunity and granuloma forms
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16
Q

clinical significance of M. TB being brought to the lymph node

A

because get adaptive immunity, the PPD test will be positive (cell-mediated immunity = type IV HS rx)

17
Q

what can happen after M. TB brought to lymph nodes and granuloma forms

A

can get:

  • chronic localized lymphadenitis (containment)
  • spread through lymphatics in lungs or outside the lungs and in blood possibly (dissemination)
18
Q

possible complication of M.TB going to lymph nodes

A

infected lymph nodes (NOT reative) can compress bronchi and lead to bronchial pneumonia or post obstructive bronchial pneumonia

19
Q

content of granuloma

A

middle = M.TB
around = lymphocytes and macrophages (some of the macrophages are infected)
around that = fibrous ring

20
Q

pathology of when tuberculosis infection becomes tuberculosis

A
  • M. TB breaks from granuloma and spills in airways
  • sputum and breathing = become contagious (but may not be sick initially)
  • become sick as pathogen progresses
  • if get disseminated, extrapulmonary TB = lethal to host and pathogen, TB meningitis possible
21
Q

species where TB can be and definitive host

A
  • can be in humans, animals, cattle

- definitive host = humans

22
Q

% of world population infected with TB and nbr of people with tuberculosis

A
  • quarter of world population has TB

- 10-15M walking around with tuberculosis (contagious)

23
Q

number 1 cause of infectious mortality in the world

A

tuberculosis (1.7M deaths per year)

  • 1.3M deaths per year (TB)
  • 0.4M deaths per year (HIV or AIDS + TB)
24
Q

how HIV and TB interact

A
  • TB accelerates HIV progression to AIDS

- HIV accelerates progression of TB infection to tuberculosis disease

25
Q

symptoms of TB

A
  • cough with sputum, maybe blood
  • fever
  • sweats
  • weight loss
  • consumption
26
Q

what’s miliary TB

A

TB everywhere and there is no containment

27
Q

most important consideration in doing a TB dx

A

epidemiologic probability

28
Q

physical exam and investigations of TB

A
  • lung auscultation
  • CXR (FOR TB DISEASE)
  • PPD test FOR LATENT (TB infection)
  • path lab for granulomas, acid-fast staining, PCR=gold std
29
Q

why M. TB culture is essential in a sick patient even when you already have a dx

A

to test for drug susceptibility

30
Q

why treat TB (Abx)

A

reduce mortality, morbidity and spread

31
Q

considerations in TB tx

A
  • same for immunocompetent and deficient
  • MDR TB exists and can spread, XDR (extensively drug resistant is worse)
  • several weeks to get susceptibility data
32
Q

4 drugs you start with in TB (to make sure at least 2 are active)

A
  • isoniazid
  • rifampin
  • ethambutol
  • pyrazinamide
33
Q

duration of the short course tx of TB

A

24 weeks

34
Q

2 types of testing for TB infection

A
  • tuberculin skin test (TST): give Ags to the patient

- IFN-g release assays: bring patient’s lymphocytes to the Ags

35
Q

treatment of drug-sensitive TB INFECTION

A
  • isoniazid for 9 months

- rifampin for 4 months

36
Q

treatment of drug-resistant TB INFECTION

A

monitor clinically

37
Q

what can you predict when you see TB rates increasing in a population

A

drop in life expectancy in years to come

38
Q

what would be a good TB vaccine

A

vaccine that prevents contagion: only way TB can be fought

Bloc G - Infection (39 decks)

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