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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
Pyrazinamide side effects
Flushing Arthritis Liver damage
26
Ethambutol side effects
Optic neuritis
27
What happens if patient non-adhere to drugs?
- resistance - 2 months = interrupted treatment - due to common side effects and long regimen
28
Legal restraint when and how?
If don't take TB drugs and infectious | - Public Health Act 1984
29
When is contact tracing done?
When someone is diagnosed with pulmonary TB | See transmission
30
How many people will each index case infect?
10-15 people
31
Requirements to be smear positive on sputum sample
See 10,000 organisms/ml of sputum
32
When to do Mantoux or CXR?
Mantoux if <65 | CXR if >65
33
Mantoux test
0. 1ml of PPD (purified protein derivative) which is collection of TB antigens is injected intradermally - measurements read at 46-72 hours
34
QuantiFERON ELISA test
Blood is taken Lymphocytes stimulated with TB antigens Look for reaction with ELISA Determines if quantiferon is positive or negative
35
ELISPOT assay
``` 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
BCG
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
What is sarcoidosis?
Unknown exaggerated immune response Not sure what is being walled off Genetic link makes some people more vulnerable
38
Sarcoidosis who?
- 20th incidence of TB - 25-45 years - 2nd peak in women 50-70 - West Africa - Afro-Carribbean - North eastern Europe - Japan - South Asia
39
Symptoms of sarcoidosis
- asymptomatic >>> - dry cough - breathlessness - red eyes - skin lesions - thirst, polyuria with hypercalcemia - arthritis = sausage fingers - neurological - skin sarcoid = yellow - uveitis = red eye
40
How to distinguish sarcoidosis from lymphoma and TB
- eye skin affected - normal FBC - hypercalcemia - CXR mid zones bilateral affected
41
How to diagnosis sarcoid?
- 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
Gallium scan
- panda sign - lacrimal and parotid glands glowing - bilateral hilar lymphadenopathy
43
treatment of sarcoid
- goes away by itself = European pops and if don't have lung fibrosis - monitor lung function and serum ACE - steroids
44
Indications for steroid treatment
- pulmonary fibrosis - hypercalcemia - eye disease - neurological disease - worsening lung function
45
Other treatments for sarcoid
- steroid sparing = azathioprine, methotrexate, mycophenolate, leflunomide - hydroxycholoroquine (if skin and eye disease) - granulomas = antiTNF, rituxmimab - antibiotics = levofloxacin, ethambutol, azithromycin, rifampicin
46
Prognosis of sarcoid
80% no problem 20% lung, eyes problems = need steroids 2% brain, lung transplant

CR3 (30 decks)

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