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IMED3001 > Tubercolosis > Flashcards

Tubercolosis Flashcards

1
Q

What commonly happens when TB appears in emergency departments?

A

People around the patient often are infected as well due to contagious nature of the illness.

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2
Q

What was the first antibiotic used to kill TB?

A

Streptomycin (still used but it isn’t pleasant)

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3
Q

What caused TB resurgence?

A

Contributing factors include:

Inadequate funding for TB control programs

HIV epidemic

Increased immigration from countries where TB is common

Spread in homeless shelters and correctional facilities

Increase and spread of multi-drug resistant TB

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4
Q

What increases the chances of TB being transmitted?

A

Infectiousness of person with TB disease

Environment in which exposure occured

Length of exposure

Virulence of the tubercle bacilli

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5
Q

What is the best way to stop transmission of TB?

A

Isolate infectious people

Provide effective treatment asap

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6
Q

How does TB find a new host and cause disease in new host?

A

Droplets containing tubercle bacilli inhaled

Tubercle bacilli multiply in alveoli where infection begins.

Macrophages in alveoli engulf mycobacteria and bacteria divide in endosome.

Bacteria is carried to lymph nodes and T cells get involved.

Lymphocytes surround bacteria and lead to granuloma formation.

At this stage the bacteria is either cleared or becomes latent.

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7
Q

What is a ghon focus?

A

A Ghon focus is a primary lesion usually subpleural, often in the mid to lower zones,

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8
Q

How does immune system keep tubercolosis under control?

A

Within 2 to 8 weeks macrophages surround the tubercle bacilli and these cells form a barrier shell that keeps bacilli contained.

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9
Q

What happens if immune system can’t keep tubercle bacilli under control?

A

Bacilli begin to multiply rapidly and cause TB disease.

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10
Q

What is the difference between latent and non-latent TB infection?

A

Latent TB: Inactive, normal chest ray, sputum smears and cultures negative, no symptoms, not infectious.

Normal TB shows opposite symptoms and is infectious before treatment.

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11
Q

When is risk highest for developing TB disease?

A

The first 2 years after infection.

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12
Q

How can people with LTBI be prevented from developing TB?

A

Early detection and treatment.

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13
Q

What factors increase the risk of developing TB from LTBI?

A

Infection with HIV

Substance abuse

Recent TB infection

Prolonged corticosteroid therapy.

Organ transplant

Silicosis

Diabetes mellitus

Severe kidney disaease

Cancer

Certain intestinal conditions

Low body weight

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14
Q

How can tuberculin be used to detect latent TB?

A

Tuberculin is injected and a reaction on the skin is positive indication of latent TB

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15
Q

How can tuberculin be used to detect latent TB?

A

Tuberculin is injected and a reaction on the skin is positive indication of latent TB

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16
Q

What tests can be used to test for latent TB infection?

A

TST or QFT-G test

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17
Q

How is latent TB diagnosed?

A

Positive mantoux (tuberculin skin test)

Positive quantiferon (remains positive even when the disease has cleared)

18
Q

How can latent TB be treated?

A

In adults: Isoniazid

In children: Isonaizid and rifampicin for 3 months

19
Q

What common sites does TB commonly affect?

A

Brain

Bone

Kidney

Larynx

Lung

Lymph nodes

Pleura

Spine

20
Q

What are the symptoms of normal TB?

A

Fevers

Chills

Night sweats

General feeling of unwellness and malaise

21
Q

What is the most common site of TB?

A

The lungs

22
Q

Who are the less common TB locations seen in?

A

HIV-infected or other immunosuppressed people

Young children

23
Q

What is the most devastating TB?

A

Miliary TB which affects all parts of the body due to carriage by the bloodstream

24
Q

What are the most common clinical symptoms of TB?

A

Cough

Hemptysis

Fever + Sweats

Weight loss

Pneumonia or pleural effusion

25
Q

How is TB diagnosed?

A

Sputum (ZN stain, Culture (Lowenstein-Jensen) PCR can give quick result, children may need gastric aspirates)

26
Q

What is a ZN stain?

A

Ziehl–Neelsen stain

27
Q

How long does it take to culture TB?

A

6 weeks

28
Q

What is IGRA?

A

Quantiferon ot T-spot test

29
Q

What antibiotics do we use for tuberculosis?

A

Rifampicin

Pyrazinamide

Isoniazid

Ethambutol

Easy way to remember (IRPE) for the first 8 weeks and IR for the next 18 weeks.

This treatment has lots of side effects

30
Q

How are the antibiotics taken for TB?

A

8 weeks of normal cycle. Then 18 weeks of Isoniazid+rifampin

31
Q

What are the side effects of isoniazid?

A

Tingling sensation in hands and feet.

GI intolerance

Hepatic toxicity

32
Q

What are the side effects of pyrazinamide?

A

GI intolerance (upset stomach, vomiting, and lack of appetite)

Joint aches

Gout

33
Q

What are the side effects of rifampicin?

A

GI intolerance

Rashes

Hepatic toxicity

34
Q

What are the side effects of streptomycin?

A

Balance problems

Hearing loss

Ringing in ears

Abnormal kidney function test results

35
Q

What are the side effects of ethambutol?

A

Visual colour impairment

36
Q

What are the classes of drug-resistant TB?

A

Mono-resistant

Poly-resistant (>2 but not both isoniazid and rifampin)

Multidrug resistant (Resistant to one of isoniazid and rifampin)

Extensively drug resistant (Resistant to both isoniazid and rifampicin + fluoroquinolone (any) + 1 of 3 injectable second line drugs)

37
Q

What is done when antibiotics of the first line do not work against TB?

A

Second line drugs are used

38
Q

Which country suffers extensively from XDR TB?

A

South Africa

39
Q

What are possible complications of TB?

A

TB meningitis (Causes basal meningitis and hydrocephalus in some cases)

Miliary TB (Widespread dissemination characterized by CXR findings)

40
Q

How can TB outbreaks be prevented?

A

Public health measures

Early diagnosis and treatment

Social improvements

BCG (most useful in infants not known to be effective in anyone else)

41
Q

What second line treatments are used for TB?

A

Streptomycin

Cycloserine

Capreomycin

Amikacin

IMED3001 (46 decks)

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