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Respiratory > Pulmonary Tuberculosis > Flashcards

Pulmonary Tuberculosis Flashcards

1
Q

What is TB?

A

Respiratory infection caused by Myobacterium Tuberculosis

  • Pulmonary TB is the only type of TB that is infectious
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2
Q

What are the two main forms of active tuberculosis

A
  • Pulmonary Tuberculosis

- Non-pulmonary Tuberculosis (Extra-pulmonary)

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3
Q

What are the different types of non-pulmonary tuberculosis?

A
  • TB Meningitis
  • TB Gastro
  • TB Genitourinary
  • TB Skeletal (reactive arthritis)
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4
Q

What are the risk factors of pulmonary tuberculosis?

A
  • HIV
  • Immunosuppression
  • Exposure to infection
  • Birth in an endemic country
  • Smoking
  • Age (under 5 or elderly)
  • Alcohol
  • Diabetes
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5
Q

What are the clinical features of pulmonary tuberculosis?

A
  • Unexplained weight loss
  • Drenching night sweats
  • Lymphadenopathy
  • Fever
  • Coughs
  • Haemoptysis
  • Pleuritic chest pain
  • Crackles on auscultation
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6
Q

What are the clinical features of TB Meningitis?

A
  • Headache
  • Fever
  • Mental State Changes
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7
Q

What are the clinical features of TB Skeletal?

A
  • Back pain and stiffness
  • Bone pain
  • Arthritis
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8
Q

What are the clinical features of TB Genitourinary?

A
  • Dysuria
  • Haematuria
  • Frequent infection
  • Flank Pain
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9
Q

What are the clinical features of TB Gastro?

A
  • Difficulty swallowing
  • Non healing ulcers
  • Abdo pain
  • Hepatomegaly
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10
Q

What is the differential diagnosis of pulmonary TB?

A
  • Pulmonary oedema
  • Lung cancer
  • Sarcoidosis
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11
Q

What are the two main types of tuberculosis?

A

=> Active infection:
- Can arise from primary infection or by reactivation of latent infection

=> Latent TB:
- Evidence of infection but the patient is asymptomatic

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12
Q

What is the pathophysiology of pulmonary tuberculosis?

A
  • Macrophages migrate to lymph nodes, lung lesion and affected lymph nodes is referred to as a Ghon complex
  • This leads to the formation of a granuloma which is a collection of epithelioid histiocytes
  • Presence o necrosis in centre
  • Inflammatory response is mediated by a Type 4 hypersensitivity reaction

=> In healthy individuals the disease may be contained, in immunocompromised military TB develops

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13
Q

What are the investigations in suspected Active Pulmonary TB?

A

PATIENT MUST BE ISOLATED IN SUSPECTED CASES

=> Ziehl-Neelson Staining - first line

=> NAAT:
- Rapid diagnosis in less than 8 hours

=> Sputum culture:
- More sensitive than smear but takes 4-8 weeks

=> Sputum smear

=> CXR:

  • Ghon complexes
  • Miliary TB
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14
Q

What is the affect of HIV on TB infection?

A

HIV infection leads to depletion of myobacterium tuberculosis specific CD4 lymphocytes, promoting activation of latent TB

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15
Q

What is the screening of latent TB?

A

=> Mantoux testing:
< 5 mm - Negative
6-15 mm - Positive
> 15 mm - Strongly positive for latent TB

=> Interferon-gamma releases assays:
- Diagnosing latent TB by measuring the release of interferon-gamma from T cells

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16
Q

What is the treatment regime for active TB?

A

R - Rifampicin (inhibits RNA polymerase)
I - Isoniazid (inhibits mycolic acid synthesis)
P - Pyrazinamide (inhibits fatty acid synthase)
E - Ethambutol (inhibits enzyme which polymerises arobinose to arabinan)

First 2 months (initial phase)- Rifampicin, Isoniazid and Pyrazinamide and Ethambutol
Next 4 months (continuation phase) - Isoniazid and Rifampicin

If there is central venous involvement, the continuation phase is extended to 10 months making a 12 month treatment programme

Meds are taken all together on an empty stomach one hour before breakfast

17
Q

What is direct observed therapy?

A
  • HCP, DOT observer or family member ensures patient adheres to treatment
  • Incentives include free meals and cash rewards
18
Q

Who is made available to the BCG vaccine in the UK?

A
  • All infants living in areas of the UK where annual TB incidence is > 40/100,000
  • All infants who have at least 1 parent or grandparent born in a country where the annual TB incidence > 40/100,000
  • Previously unvaccinated tubercullin-negative contacts of cases of respiratory TB
  • Previously unvaccinated tubercullin-negative < 16 year old who were born or of have lived for longer than 3 months in a country with an annual TB incidence > 40/100,000
  • Healthcare workers
  • Prison staff
  • Staff or care home for the elderly
  • Those who work with homeless people

=> Contraindications for the BCG vaccine:

  • Previous BCG vaccination
  • Past history of TB
  • Pregnancy
  • Positive tubercullin test
19
Q

What stain is typically used in the diagnosis of tuberculosis?

A

Ziehl-Neelson

20
Q

What are the most common side effects of the drugs in the treatment regimine of tuberculosis?

A

=> Rifampicin:

  • Orange body fluids
  • Rash
  • Hepatotoxicity
  • Drug interactions

=> Isoniazid:

  • Peripheral neuropathy
  • Psychosis
  • Hepatotoxicity

=> Pyranzinamde:

  • Arthralgia
  • Gout
  • Hepatotoxicity
  • Nausea

=> Ethambutol:

  • Optic neuritis
  • Rash
21
Q

How does Military TB spread through the lung parrenchyma?

A

Pulmonary venous system

22
Q

What set of investigations are most appropriate to check whether starting treatment for tuberculosis does not cause problems?

A

LFTS
U&ES
FBC
Vision testing

23
Q

What is the treatment regime for latent TB?

A

3 months of Isoniazid with Pyridoxine and Rifampicin for those < 35 where hepatotoxicity is a concern

OR

6 months of Isoniazid with Pyridoxine where Rifampicin toxicity is a concern

Respiratory (10 decks)

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