TB and Pleural Infection Flashcards
What would white on a lung CXR indicate?
Mass, fluid, lung
How could you tell the difference between TB and lobar pneumonia on a CXR?
lobar pneumonia doesn’t go to the top?
Which lung problems go to top of lungs?
Airborne diseases eg. TB
What are TB granuloma walls like?
Thickened
When does TB cause pulmonary disease?
if the granuloma bursts
how many people infected with TB have primary tuberculosis?
5%
What are the clinical features of TB?
weight loss malaise night sweats cough heamoptysis breathlessness upper zone crackles
what symptoms are linked to meningeal TB?
Headache. drowsy, fits
what are symptoms of GI TB?
Pain
bowel obstruction
perforation
perironitis
what are symptoms of spinal TB?
Pain
deformity
paraplegia
what are signs of pericardial TB?
tamponade
what are symptoms of renal TB?
renal failure
What are some 20th century TB tests?
ZN stain, AAFB
auramine
What test can show if a person has an inactive and active TB?
PCR
Why is PCR useful for diagnosing TB?
Can tell if it’s resistant to drugs- rifampracin
What is the histology of TB like?
Multinucleate giant cell granulomas
caseating necrosis
visible mycobacteria
what are key characteristics of TB in radiology?
Upper lobe predominance cavity formation tissue destruction scarring and shrinkage heals with calcification
what is miliary TB?
when myobacteria gets into the bloodstream?
also worry about renal cancer
How do you treat TB?
Two months of: Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
Then four months of: Rifampicin, Isoniazid
Who can a person TB affect?
Everyone around them!!
what are side effects of rifampicin?
Colours urine
Has many interactions with other drugs- eg. some contraceptive pills
What are side effects of Ethambutol?
Can cause optic neuritis
What are side effects of Isoniazid?
B-6 neuropathy
When would you expect to see a sudden fall in actively replicating bacilli?
2 weeks after treatment
What are types of TB drug resistance?
Single agent- Isoniazid
MDR- Rifmapicin & Isoniazid
XDR- MDR and quinolone and injectable
If a person had HIV and TB which would you likely treat first?
HIV
What is latent TB?
symptom free
culture negative
Balance between your organism and your immune system
(between a quarter and third of worlds population have this)
What is IGRA test?
blood test, dectecys previous exposure to TB
What is Mantoux test?
skin test, detecects previous exposure to TB and BCG
Which test would be used for mass contact tracing?
IGRA
how do you manage latent TB?
Treat or leave alone
anti-TNF drugs:
6 months isoniazid or 3 months rifampicin and isoniazid
What increases risk of latent TB reactivation?
rheumatoid arthritis
TNFi
steroids/ immunosuppressant drugs
How to stop spread of TB?
Contact tracing screening of high risk groups isolation of infectious causes BCG immunisation social measures
What test should all TB patients be offered?
HIV
What should all patients with HIV be offered?
Chest X-ray
What does ‘smear positive’ indicate?
active TB
what is a d-shape on CXR associated with?
empyema
who is at risk of pleural infection?
Diabetes immunosuppression gastro-oesophageal reflux alcohol missuse IV drug abuse
what are different types of pleural infection?
Simple parapneumponic effusion
complicated parapneumonic effusion
empyema
what Pleural infection is pussy?
Empyema
How do you manage pleural infection?
Antibiotics Drain effusion as needed early discussion with surgeons if persistent sepsis nutrition (albumin levels) VTE prophylaxis
which antibiotic is good for reaching the pleural space?
Vancamicin
