Station 1.8: Old tuberculosis

Question 1

Clinical signs

What are the clinical signs of old tuberculosis?

Old tuberculosis

Please examine this man’s respiratory system

Answer 1

*  Chest deformity and absent ribs; thoracoplasty scar
*  Tracheal deviation towards the side of the fibrosis (traction)
*  Reduced expansion
*  Dull percussion but present tactile vocal fremitus
*  Crackles and bronchial breathing

Question 2

Discussion

What are the historical techniques to treat old tuberculosis?

Old tuberculosis

Please examine this man’s respiratory system

Answer 2

*  Plombage:insertion of polystyrene balls into the thoracic cavity
*  Phrenic nerve crush: diaphragm paralysis
*  Thoracoplasty: rib removal; lung not resected
*  Apical lobectomy
*  Recurrent medical pneumothoraces
*  Streptomycin was introduced in the 1950s. It was the first drug shown to be beneficial
in a randomized controlled trial

Question 3

Discussion

What are the serious side effects of TB drugs?

Old tuberculosis

Please examine this man’s respiratory system

Answer 3

*  Isoniazid Peripheral neuropathy (Rx Pyridoxine) and hepatitis
*  Rifampicin Hepatitis and increased contraceptive pill metabolism
*  Ethambutol Retro‐bulbar neuritis and hepatitis
*  Pyrazinamide Hepatitis

Question 4

Discussion

Prior to treating TB, check baseline liver function tests and visual acuity. Tell the patient
the following:

Old tuberculosis

Please examine this man’s respiratory system

Answer 4

1. Look at the whites of your eyes every morning. If yellow, stop the tablets and ring the
   TB nurse that morning.
2. Notice colours – if red becomes less bright than you expect ring the TB nurse that day.
3. You may develop tingling in your toes – continue with the tablets but tell the doctor at
   your next clinic visit.
4. Your secretions will turn orange/red. This is because of a dye in one of the tablets.
   If you wear contact lenses they will become permanently stained and should not be
   worn.
5. If you are on the OCP, it may fail. Use barrier contraception.

Question 5

Discussion

What are the serious side effects of TB drugs?

Old tuberculosis

Please examine this man’s respiratory system

Answer 5

*  Isoniazid Peripheral neuropathy (Rx Pyridoxine) and hepatitis
*  Rifampicin Hepatitis and increased contraceptive pill metabolism
*  Ethambutol Retro‐bulbar neuritis and hepatitis
*  Pyrazinamide Hepatitis