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CR3 > TB and Sarcoidosis > Flashcards

TB and Sarcoidosis Flashcards

1
Q

Define TB

A

A communicable infectious disease transmitted almost exclusively by cough aerosol
- caused by Mycobacterium tuberculosis complex

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2
Q

What is the pathological characteristic of TB?

A

necrotising granulomatous inflammation

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3
Q

Causes of TB?

A 
M. tuberculosis
M bovis
M africanum
M canettii
M microti
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4
Q

Difference between primary and post-primary TB

A

Primary when no pre-existing immunity vs. post-primary when have pre-existing immunity

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5
Q

Features of primary TB

A
  • non infectious
  • high mortality
  • often outside lung
  • children and elderly
  • HIV co-infection
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6
Q

Features of post-primary TB

A
  • infectious
  • cavities with TB biofilm
  • well tolerated
  • young adults
  • immunocompetent as CD4 and 8 response
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7
Q

Highest risk TB group in London

A

HIV

Then homeless

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8
Q

Factors leading to decline of TB in UK?

A
  • less virulent
  • BCG
  • antibiotic treatment
  • pasteurisation of milk
  • improved general health
  • genetic selection
  • improved housing
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9
Q

Factors leading to increase in TB in London?

A
  • immigration
  • UK citizen travel to endemic
  • HIV
  • more poor and homeless
  • mini-epidemics
  • prison health overcrowding
  • substance abuse
  • spitting in public places
  • stopping BCG
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10
Q

Common TB symptoms

A
  • cough
  • sputum
  • fever
  • malaise
  • loss of appetite
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11
Q

Uncommon TB symptoms

A
  • haemoptysis
  • night sweats
  • weight loss
  • lymphadenopathy
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12
Q

Questions to ask about haemoptysis?

A
  • when did it start
  • what time of day?
  • how much
  • bright or dark red
  • streak or blob
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13
Q

Differentials of haemoptysis

A
  • nose bleed
  • PE = dark
  • lung cancer = streaky
  • bronchiectasis = maybe no fever, no chest pain
  • aspergilloma = lots, no fever or chest pain
  • foreign body = no chest pain, little amount
  • anticoagulation = no sputum, fever or chest pain
  • Wegners, goodpastures
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14
Q

How to diagnose TB

A
  • sputum sample -> then PCR, strain typing/genome sequencing, culture and drug sensitivity testing
  • CXR
  • inflammatory markers (CRP>5)
  • histology
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15
Q

Why do you PCR the sputum sample?

A
  • check for drug resistance

- confirm M. TB presence

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16
Q

TB Combination Tablet Treatment

A

Rifater
4 drug combo
So don’t stop taking 1 one them
6 tablets if > 70kg of 150mg

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17
Q

What happens if patient begins to become resistant to drugs?

A

Drop ethambutol for 2m

Final 4m with just rifampicin and isoniazid = rifinah = 2 tablets if >70kg

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18
Q

4 drugs to treat TB

A
  • isoniazid
  • rifampicin
  • pyrazinamide
  • ethambutol
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19
Q

Action of isoniazid

A

bactericidal

site = cell wall

20
Q

Action of rifampicin

A

Bacteriostatic

site = ribosome

21
Q

Action of pyrazinamide

A

Bacteriostatic

site = FASII

22
Q

Action of ethambutol

A

Bacteriostatic

site = cell wall

23
Q

Isoniazid side effects

A
  • liver damage ALT increase
  • peripheral neuropathy
  • nausea
  • tiredness
24
Q

Rifampicin side effects

A

Liver damage (bilirubin)
Flu like syndrome
Low platelets

25
Q

Pyrazinamide side effects

A

Flushing
Arthritis
Liver damage

26
Q

Ethambutol side effects

A

Optic neuritis

27
Q

What happens if patient non-adhere to drugs?

A
  • resistance
  • 2 months = interrupted treatment
  • due to common side effects and long regimen
28
Q

Legal restraint when and how?

A

If don’t take TB drugs and infectious

- Public Health Act 1984

29
Q

When is contact tracing done?

A

When someone is diagnosed with pulmonary TB

See transmission

30
Q

How many people will each index case infect?

A

10-15 people

31
Q

Requirements to be smear positive on sputum sample

A

See 10,000 organisms/ml of sputum

32
Q

When to do Mantoux or CXR?

A

Mantoux if <65

CXR if >65

33
Q

Mantoux test

A
  1. 1ml of PPD (purified protein derivative) which is collection of TB antigens is injected intradermally
    - measurements read at 46-72 hours
34
Q

QuantiFERON ELISA test

A

Blood is taken
Lymphocytes stimulated with TB antigens
Look for reaction with ELISA
Determines if quantiferon is positive or negative

35
Q

ELISPOT assay

A 
Excites T cells with antigens
See how many spots in wells
Looks at only 2 TB antigens
More specific to check for TB
Not positive if had BCG
Don't need to get people to come back to look at skin test
36
Q

BCG

A

Attenuvated form of M bovis
Cell mediated immunity against mycobacteria
Forms memory cells
Some protection against active disease
Children protective against military TB, TB and TB meningitis
Not clear how much in adults

37
Q

What is sarcoidosis?

A

Unknown exaggerated immune response
Not sure what is being walled off
Genetic link makes some people more vulnerable

38
Q

Sarcoidosis who?

A
  • 20th incidence of TB
  • 25-45 years
  • 2nd peak in women 50-70
  • West Africa
  • Afro-Carribbean
  • North eastern Europe
  • Japan
  • South Asia
39
Q

Symptoms of sarcoidosis

A
  • asymptomatic&raquo_space;>
  • dry cough
  • breathlessness
  • red eyes
  • skin lesions
  • thirst, polyuria with hypercalcemia
  • arthritis = sausage fingers
  • neurological
  • skin sarcoid = yellow
  • uveitis = red eye
40
Q

How to distinguish sarcoidosis from lymphoma and TB

A
  • eye skin affected
  • normal FBC
  • hypercalcemia
  • CXR mid zones bilateral affected
41
Q

How to diagnosis sarcoid?

A
  • via exclusion
  • Lofgrens = bilateral hilar lymphadenopathy, fever, arthritis
  • Heerfordt = parotid, uvetisi, fever
  • if none of these then biopsy (bronchial US)
  • exclude other granuloma causes
  • > 1 organ involved
  • exclude other multisystem granulomatous disease
42
Q

Gallium scan

A
  • panda sign
  • lacrimal and parotid glands glowing
  • bilateral hilar lymphadenopathy
43
Q

treatment of sarcoid

A
  • goes away by itself = European pops and if don’t have lung fibrosis
  • monitor lung function and serum ACE
  • steroids
44
Q

Indications for steroid treatment

A
  • pulmonary fibrosis
  • hypercalcemia
  • eye disease
  • neurological disease
  • worsening lung function
45
Q

Other treatments for sarcoid

A
  • steroid sparing = azathioprine, methotrexate, mycophenolate, leflunomide
  • hydroxycholoroquine (if skin and eye disease)
  • granulomas = antiTNF, rituxmimab
  • antibiotics = levofloxacin, ethambutol, azithromycin, rifampicin
46
Q

Prognosis of sarcoid

A

80% no problem
20% lung, eyes problems = need steroids
2% brain, lung transplant

CR3 (30 decks)

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