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Respiration > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Describe the global distribution of TB

A

Global disease burden is falling
- Incidence rate falling at 2% per year
- TB deaths have fallen by 29% since 2000

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2
Q

Where in UK is TB most prevalent?

A

London
- Due to immigration from high incidence areas
- 39% all UK cases are London

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3
Q

How is TB transmitted?

A

Airborne
- Can stay in the air for many hours, more if poor circulation
- Usually require close prolonged contact (>8 hours)

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4
Q

Why is TB less transmissible outside?

A

Outside mycobacteria are eliminated by UV radiation and dilution

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5
Q

Describe the T-cell immune response to TB

A
  1. Activated macrophages -> epithelioid cells -> Langhan’s giant cells
  2. Accumulation of macrophages, epithelioid and langhan’s cells —»> GRANULOMA
  3. Central caseating necrosis
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6
Q

Describe primary TB

A

Small infection
Cleared/cured
Contained latent

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7
Q

What is the progression from primary TB to bronchopneumonia?

A

Primary focus continues to enlarge - cavitation
Enlarged hilar lymph node discharges into bronchi, lobar collapse
Enlarged lymph node discharges into bronchus
Poor prognosis

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8
Q

Explain Miliary TB

A

Hematogenous spread of bacteria to multiple organs
Fine mottling on X-ray, widespread granulomata
CNS TB in 10-30%

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9
Q

What are the possible progressions of TB from primary complex?

A

Progressive primary disease (1%)
Miliary, meningeal, pleural TB
Post primary disease
- Pulmonary, skeletal
Genitourinary, cutaneous TB

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10
Q

What mycobacteria can cause TB?

A

M.turberculosis
M.africanum
M.bovis

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11
Q

What type of bacteria casue TB?

A

Aerobic
Non motile bacillus, slow growing (disease is slow and treatment long)
Has a think fatty cell wall

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12
Q

What are the TB causing bacteria resistant to?

A

Acids, alkalis and detergents
Neutrophils and macrophage destruction

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13
Q

What is the common clinical presentation of TB?

A

Triad of symtpoms
- Prolonged cough (>1month)
- Night sweats
- Weight loss

And fever

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14
Q

What would you expect to see on a chest X-ray?

A

Classical signs
- Apices are soft/fluffy/nodular upper zones
- Cavitation in 20-30%

Lymphadenopathy is rare
CXR is normal in 13% definitive TB patients

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15
Q

When do you consider a CT scan?

A

Normal CXR but clinical suspicion
Miliary TB
Cavitation and other differential
Lymphadenopathy, alternative diagnosis
Targets for BAL

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16
Q

How do you confirm a diagnosis?

A

Sputum sample
Bronchoscopy with BAL
Endobronchial ultrasound (EBUS) with biopsy
Urine in urogenital TB
Lumbar puncture in CNS TB
Aspirate/biopsy from tissue (lymph-node, bone, joint, brain, abscess …)
Mantoux or IGRA are not routinely used in diagnosis of active TB

17
Q

What are the 4 standard drugs used to treat TB?

A

Isoniazid
Pyrazinamide
Rifampicin
Ethambutol

18
Q

What are the side effects of isoniazid?

A

Hepatitis
Peripheral neuropathy

19
Q

What are the side effects of pyrazinamide?

A

Hepatitis
Gout

20
Q

What are the side effects of rifampicin?

A

Orange (irn bru) urine/tears/lenses
Induces live enzymes, prednisolone, anticonvulsants
All hormonal contraceptive methods are ineffective
Hepatis

21
Q

What are the side effects of ethambutol?

A

Optic neuropathy
(must check visual activity)

22
Q

What is the treatment process for TB?

A

4 drugs for 6 moths
Multidrug is essential - single agent treatment leads to drug resistant organisms within 14 days
Legal requirement to notify all cases and trace contacts
Test for Hepatitis B&C and HIV

23
Q

What other drugs must you take alongside treatment?

A

Pyridoxine (vit B) with isoniazid to reduce risk of neuropathy
Steroids (CNS, miliary and pericardial)
Vitamin D substitution

24
Q

Who gets TB screening?

A

Contacts of people with active pulmonary or laryngeal TB aged <65
New entrants from high endemic areas
Pre-biologics
Outbreaks

25
Q

What is a LTBI diagnosis?

A

Asymptomatic
Normal CXR
Normal examination
Positive Mantoux skin test or IGRA test

26
Q

How do you treat LTBI?

A

Rifampicin and isoniazid for 3 months OR
- Isoniazid only for 6 moths
- Rifampicin only for 6 moths
- Rifampicin and Isoniazid once weekly for 12 weeks

Respiration (27 decks)

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