TB Flashcards

1
Q

What pathogen is responsible for TB?

A

Mycobacterium tuberculosis (can be dormant beforehand)

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2
Q

How is TB transmitted?

A

Droplet-droplet/direct contamination

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3
Q

What is the aetiology of TB?

A
  1. Begins in terminal air spaces, bacteria engulfed by alveolar macrophages (not destroyed).
  2. Proliferate inside macrophage (cell death, bacteria released).
  3. Spreads via blood (usually asymptomatic).
  4. Macrophages activate CD4+ Th cells via MHC II, interferon gamma activates more macrophages.
  5. Aggregate around mycobacterium, granuloma forms.
  6. Caseous necrosis in centre of lesion to kill mycobacterium.
  7. Eventually sealed off by fibrous scar which can calcify, some bacteria can survive in dormant form and reactivate.
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4
Q

What are the risk factors for the reactivation of TB?

A

Children <5yrs, elderly, new TB infection, HIV, organ transplant, immunosuppression, IVDU, malnutrition, homeless, prison, poor.

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5
Q

What is unique about mycobacterium compared to other pathogens?

A
  1. Slow cell division (20hrs)
  2. Thick cell wall
  3. Resists decolourisation by acid (acid-fast)
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6
Q

What are the types of staining for acid-fast organisms?

A
  1. Ziehl-Neelsen

2. Auramine staining

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7
Q

What is this a presentation of?
Immigrant, HIV, immunosuppressed, elderly. 2-3 weeks cough (dry then productive), low grade fever, anorexia, weight loss, malaise, night sweats, sometimes haemoptysis.

A

TB

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8
Q

What are the investigations for suspected TB?

A
  1. CXR - upper lobe infiltrates and opacity, cavitation, calcification, effusion, lymphadenopathy, miliary TB (1-3mm nodules).
  2. Sputum acid-fast bacilli smear - 3 specimens including early morning sample.
  3. Sputum culture - precise identification and drug susceptibility.
  4. Nucleic acid amplification test - PCR, rapid diagnosis, detects drug resistance
  5. Diagnosis may be made on clinical findings and radiography.
  6. HIV test within 2 months
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9
Q

What is the management for active TB?

A
  1. Notify PHE
  2. 2 months intensive RIPE - rifampicin, isoniazid, pyrazinamide, ethambutol
  3. 4 months continuation - rifampicin, isoniazid
  4. Infectious until 3 AFB results negative, 2 weeks treatment, clinical improvement.
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10
Q

What is the management for contacts of latent TB?

A
  1. Testing for close contacts in last 2 years. BCG vaccine for Mantoux -ve contacts.
  2. Mantoux test - delayed type IV hypersensitivity, if +ve assess for active TB.
  3. Interferon gamma release assays (IGRA) - if had the BCG vaccine
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11
Q

What is the management for latent TB?

A
  1. If 35-65yrs with no hepatotoxicity, long term steroids, chemo, anti-TNFa.
  2. 3 months - rifampicin, isoniazid, pyridoxine
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12
Q

What are the side effects of rifampicin?

A

Body secretion coloured orange-red, hepatitis, rash, GI upset.

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13
Q

What are the side effects of isoniazid?

A

Peripheral neuropathy, hepatitis (give vitamin B6), rash.

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14
Q

What are the side effects of pyrazinamide?

A

Hyperuricaemia, hepatitis, rash, N&V, arthralgia, facial flushing.

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15
Q

What are the side effects of ethambutol?

A

Decrease in visual acuity, red green colour blindness (monthly vision checks if on for >2 months)

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16
Q

Who is screened for TB?

A
  1. New NHS employees
  2. Substance misuse services and prisons (and Hep B, C, HIV)
  3. Close staff/pupils/airline employees/passengers in close proximity
  4. Detainees and immigration removal centres
17
Q

What does BCG vaccinate against and what type of vaccine is it?

A
  1. TB (including more serious forms)

2. Live, attenuated vaccine, not for immunocompromised.

18
Q

What are the non-pulmonary forms of TB?

A
  1. Lymphatic - lymphadenopathy
  2. GI - ileocecal, colicky abdo pain + vomiting, bowel obstruction
  3. Spinal - pain, slow progression, late presentation
  4. Miliary - granulomatous tissue in lungs
  5. CNS - meningitis, headaches, focal neurology
  6. GU - dysuria, frequency, loin pain, haematuria
  7. Cardiac - pericarditis, pericardial effusion/fibrosis
19
Q

How is suspected non-pulmonary TB investigated?

A

CXR, sputum smear & culture, Mantoux test, lymph node FNA, pleural fluid analysis, ascitic fluid analysis, CSF analysis, urinalysis.