TB and Pleural Infection Flashcards
When performing a bronchoscopy what seen, would indicate TB?
Tubercles and pus. Slide 4
Why is TB often seen at the top of the lungs?
A it is inhaled and infection through the spread of airborne mycobacterium tuberculosis. Slide 6
How long does it take to treat TB on average?
6 months. Slide 8
What are the general and respiratory clinical features of TB?
Weight loss, malaise and night sweats.
Cough, haemoptysis, breathlessness. Upper zone crackles. Slide 11
What other areas can you get TB in?
Meningeal - headache Gastrointestinal - pain Spinal - pain, paraplegia Lymphadenophathy Cold Abscess - no pain. Slide 12
What clinical conditions could have TB as an underlying disease?
Pericardial Tamponade
Renal Failure
Septic Arthritis
Hypoadrenalism. Slide 13
What tests can you perform to diagnose TB?
ZN staining sticks to mycobacteria, PCR which can also identify if it is rifampicin resistant. Slide 14-16
From histological samples what can be seen if TB was present?
Multinucleated giant cell granulomas
Caseating necrosis
Sometimes there is visible mycobacteria. Slide 17
Looking at a chest X-ray, if TB was present what would be seen?
Tissue destruction and cavity formation predominantly in the upper lobe. Slide 18
What is miliary TB?
When mycobacteria spreads through the bloodstream and can be seen on a CXR of the full chest covered. If untreated it would be fatal. Slide 22
What is the combination therapy of TB split into 2 months and 4 months of treatment?
2 months: Rifampicin, Isoniazid, Pyrazinamide and Ethambutol.
4 months: Rifampicin and Isoniazid. Slide 24
What are side effects of rifampicin?
Male urine pink/orange.
Rapid breakdown of hormonal contraceptions. Slide 25
What is a side effect of Ethambutol?
Optic neuritis. Slide 25
If there wasn’t a rapid fall in two weeks of actively replicating bacteria what could be a cause?
They’re not taking their medication
It is resistant to the medication. Slide 26
What are the 3 types of drug resistance and to what drugs?
Single - Isoniazid
MDR - Rifampicin and Isoniazid
XDR - MDR and quinolone. Slide 29
What clinical condition effects the treatment of TB?
HIV. Slide 30
What is Latent TB?
Symptom free and is dormant.
Balance between organism and immune system.
There is no evidence of active TB but evidence of previous TB infection. Slide 32-34
What tests can be performed to test for previous exposure?
IGRA (Interferon Gamma Release Assay) - Detects previous exposure to TB
Mantoux test -Detects previous exposure to TB AND BCG. Slide 35
If there is a possibility of latent TB in a rheumatoid Arthritis patient and they’re about to be treated with Anti-TNF what should happen?
The latent TB should be treated first cause the anti-TNF will cause the immune system to suppressed and so then the latent TB could reactivate and cause harm to the patient. Slide 40+41
If a patient has had TB what evidence can be seen?
Scarring
Calcification on x-ray. Slide 34
