TB + UTI Flashcards
How is TB transmitted
Infective droplet nuclei
“Small size will remain suspended in air”
What are the risk factors for progression of latent TB to TB disease
- children <4y
- adolescence
- HIV
- immunocompromised
What do you expect to find in patients who are asymptomatic for TB infection
- positive Tuberculin skin test
- no clinical or radiographic mainfestations
How does primary pulmonary TB usually present?
Chronic cough & Hemoptysis
+ constitutional symptoms
What are the extra-pulmonary TB
- TB meningitis
- pleural effusion
- pericardial effusion
- ascites
- jaundice
- Tb adenitis (cervical)
- sterile pyuria & hematuria
- non-tender joint effusion
- back pain
- warty lesions - lupuus vulagris - erythema nodosum
- iritis\optic neuritis -
What is pott’s disease
Tb spine
What is miliary TB?
Lympho-hematogenous dissemination leading to embolization in organs
What are the organs commonly affected by miliary TB?
- liver
- spleen
- BM
- lungs
- meninges
What is the screening tests for TB?
Tuberculin skin test + IGRA (interferon gamma release assays)
What are the confirmatory tests for TB?
- Lab: acid fast smear - culture - Xpert MTB\RIF
- imaging: chest radiograph\CT
A positive TST may indicate
Latent or active TB
Does negative TST rule out TB infection
No
What is the difference between interferon gamma release assays test and TST?
It’s more specific
In childrern who are not able to provide a sputum sample for TB, how to optain sample for culture and stain?
Gastric aspirate
How long does culture takes to be positive for TB?
14 days in liquid media and 32 in solid media
What is the name of stain used to diagnose TB?
ZN or flourescent
What is the role of CT chest in TB diagnosis
Done when radiographs are equivocal, they show better visualization of cavitation, bronchiactsis, endobrachial involvement
How to treat patients with TB?
Isoniazed, ethambutol, rifampicin, pyrazinmide, and streptomycin
How to provide treatment regimen for TB patients? “Durations”
- in 1st 2 months: isoniazed, rifampicin, ethambutol, pyrazinimide
- 6-9 or 7-10: INH, rifampicin
What is the major complication of isoniazid?
Peripheral neuropathy
What is the major complication of Rifampicin?
Orange color secertion
What is the major complication of pyrazinmide?
Arthralgia
What is the major complication of ethambutol?
Visual disturbance
How to treat latent Tb who are isoniazid sensitive:
Isoniazed for 9 months
How to treat latent Tb who are isoniazid resistant:
Rifampicin 6 months
What is the prognosis of pulmonary TB?
Good
What is the prognosis of bone, joint, meningitis TB?
Depend on the time of adminstration of medications
How to prevent TB infection
- isolation of TB + in negative pressure room
- airborne isolation
- BCG vaccine
how long does small and large droplets pass
- 3 feet large
- 6 feet small
Incidence of TB in KSA
Declined
When to suspect UTI?
Temperature >38 and no other cause of infection is found
What are the RF for UTI in children?
- previous UTI
- poor urine flow\constipation
- spinal lesion
- renal abnormality
- abdominal mass
- high BP
What is the risk in females vs males for UTI?
If <1 year, boys more than girls
School age: 3x more in girls
Adolescence: far far more in girls
If urine dipstick is
- positive nitrate
- positive leukocyte
UTI
If urine dipstick is
- positive nitrate
- negative leukocyte
Start treatment if sample was fresh
If urine dipstick is
- negative nitrate
- positive leukocyte
Treatment not started
“Unless there’s good evidence of UTI”
If urine dipstick is
- negative nitrate
- negative leukocyte
Not UTI
If urine dipstick is
- positive pyuria
- positive bacteriuria
Definite UTI
If urine dipstick is
- negative pyuria
- positive bacteriuria
Regarded UTI
If urine dipstick is
- positive pyuria
- negative bacteriuria
if clinically UTI: start Ab
If urine dipstick is
- negative pyuria
- negatibe bacteriuria
No UTI
What is pyuria
WBC > or = 5 “centerfuged”
WBC > or = 10 “uncenterfuged”
What is the likelihood of having UTI infection if SPA showed gram negative bacili
Any number is UTI
What’s the titer that indicate UTI in
- clean catch
- transuretheral asymp
- transuretheral symp
- gram positve cocci
- 10^5
- 50.000
- 10^4
- 10^3
What are the indications for hospitilization of UTI patinets?
- less than 3m
- concern for bactermia\urosepsis
- immunocompromised
- can’t tolerate oral medics
- renal insufficency
when to refer children to secondary care
- <3 month
- >3 month w\pyelonephritis - upper UTI
What is the management of choice for infant <3month with possible UTI
Cefotaxim IV 7-10d
What is the management of choice for infant >3month with possible pyelonephritis or upper UTI
Ceftriaxone for 7-10d
What is the management of choice for infant >3month with possible UTI or cystitis
Trimethoprim - nitrofirtanotoin 5 days
What is the risk associated with recurrent UTI?
Developing vesicoureteric reflux which can cause renal scarring
What are the outcomes of renal scarring?
- HTN
- proteinuria
- renal failure progression
Most common type of tb
Pulmonary
How can one be infected with TB
One needs from 5-200 inhaled bacili to get infection
“1 droplet:1-10 bacilli”
What determines a person exposed to tb droplet to get the infection
Immmune system - age
How many people from latent to active tb disease
Only 10%
What is the most common extrapulmonary mainfestation of tb
Tb adenitis
When you inject the TST test, what is the level of injection?
Intradermal
Do not reach subcutaneous part
What are we measuring in tst
The raised reaction
If you vaccinate the child for TB, what screening test will show false positive results
The tuberculin skin test
