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Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Describe the epidemiology of tuberculosis?

A

The disease burden for TB is falling globally
Worldwide incidence rate is falling and TB deaths have fallen
TB is no.1 killer of communicable diseases

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2
Q

How many people are infected with TB worldwide?

A

2 billion people

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3
Q

Describe TB and association with top infectious killer

A

1.6 million TB deaths in 2017
TB is the leading killer of people with HIV and major cause of death due to antimicrobial resistance

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4
Q

Describe epidemiology of TB nationally?

A

Major problem in London is the immigration from high incidence areas
2/3 cases are born abroad and clusters in cities

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5
Q

What are the vulnerable groups in the UK?

A

Those in high prevalence countries
70% are non-UK born and most aged between 15-44
HIV positive, immunosuppressed
Elderly, neonates with parents from high prevalence areas and diabetics
Homeless, alcohol dependency, IVDU, Mental health and prisons

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6
Q

Describe mycobacteria

A

Non-motile bacillus, very slowly growing
Aerobic - predilection for apices of lungs
Uniquely has a very thick fatty cell wall so makes very difficult to treat
Not all AAFBs are TB

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7
Q

What are some species responsible for human disease?

A

Tuberculosis
Non-tuberculosis mycobacteria
NTM-infections
Leprosy

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8
Q

How does TB spread?

A

Airborne
Someone with TB in lungs coughs - TB bacteria attaches to aerosol droplets which can remain in air for hours - someone breathes in - requires prolonged contact
Can be spread by unpasteurised infected cows milk

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9
Q

Describe the immunopathology of TB?

A

Activated macrophages activate epithelioid cells which activate Laghan’s giant cells
Accumulation of all these cells creates a granuloma
Central caseating necrosis

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10
Q

How is Th1 mediated reaction good and bad?

A

Good - Eliminates/ reduces the no. of invading mycobacteria
Bad - tissue destruction is a consequence of macrophage activation

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11
Q

What causes the infection and susceptibility?

A

Infection - number and virulence
Susceptibility - age, nutrition, immunosuppression and genetics

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12
Q

Describe the primary infection of TB?

A

No preceding exposure or immunity
Mycobacteria spread through lymphatics draining to hilar lymph nodes
Usually no symptoms - can cause fever, malaise, erythema nodosum but rarely chest pains

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13
Q

What happens to majority of people with primary infection of TB?

A

Initial lymph node and local lymph node. Heals with or without scar. May calcify
Associated with development of immunity to tuberculoprotein

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14
Q

What are the 3 outcomes of primary infection?

A

Progressive disease
Contained latent
Cleared cured

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15
Q

Describe tuberculous bronchopneumonia

A

Primary infection that progresses in small number
Primary focus begins to enlarge - cavitation
Enlarged hilar lymph nodes compress bronchi, lobar collapse
Enlarged lymph node discharges into bronchus
Poor prognosis

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16
Q

Describe Miliary TB?

A

In a small number of primary infection this develops
Hematogenous spread of bacteria to multiple organs
Fine mottling on x-ray, widespread small granulomata
CNS TB in 30%

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17
Q

Describe the two main hypothesis of post-primary disease?

A
  1. TB entering a dormant stage with low or no replication over prolonged periods of time
  2. Balanced state of replication and immune destruction
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18
Q

How long does miliary, meningeal or pleural TB take to happen?

A

6-12 months

19
Q

How long till post primary disease, pulmonary or skeletal TB occurs?

A

1-5 years typically
Maybe 30-40 years

20
Q

How long till genitourinary or cutaneous TB occurs

A

Typically 10-15 years
Maybe 30-40 years

21
Q

What are the clinical presentations of TB?

A

Cough
Fever
Sweats which are mainly at night
Weight loss
CRP is normal in 15% and ESR normal in 21%

22
Q

When should CT be considered in tuberculosis?

A

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

23
Q

Describe classical post-primary TB in chest x-ray

A

Apices, soft fluffy or nodular
In upper zone
Cavitation in 10-30%
Lymphadenopathy is rare

24
Q

How do you diagnose primary pulmonary TB?

A

Mediastinal lymphadenopathy
Pleural effusion
Miliary (1-3%)

25
Q

What diagnosis would be given to person with Pneumonic lesion w enlarged hilar nodes?

A

Consider primary TB

26
Q

What investigations are made to diagnose a patient with TB?

A

Sputum sample, induced sputum, bronchoscopy with BAL, Endobronchial biopsy, Lumbar puncture in CNS TB, Urine sample in urogenital TB, aspirate/ biopsy in tissue

27
Q

How would a sputum sample be taken?

A

3 samples needed - 1 early morning sample required
8-24 hr break

28
Q

What are the TB drugs used today?

A

Isoniazid
Pyrazinamide
Rifampicin
Ethambutol

29
Q

What are the rules for treatment of TB?

A

Multiple drug therapy is essential
Therapy must continue for at least 6 months
TB therapy is a job for committed specialists only
Legal requirement to notify all cases
Test for HIV, Hepatitis B and C

30
Q

What does single agent treatment lead to?

A

Drug resistant organisms after 14 days

31
Q

What is the standard treatment for TB?

A

2 R/H/Z/E + 4 R/H
Standard 70kg patient takes 12 tablets daily
6 months duration

32
Q

What is the duration for treatment?

A

6 months
Monoresistance - 7-9 months
12 months - CNS TB, H monoresistance extensive disease
9-12/ 18-20 months - MDR-RR TB

33
Q

Why is pyridoxine given with isoniazid?

A

Pyridoxine is vitamin B6
Reduces risk of neuropathy

34
Q

When are steroids given in treatment?

A

In CNS, miliary TB and pericardial

35
Q

What are the side effects of rifampicin?

A

Orange urine/tears/lenses
Induces liver enzymes, prednisolone and anticonvulsants
All hormonal contraceptive methods ineffective
Hepatitis

36
Q

What are the side effects of Isoniazid?

A

Hepatitis and peripheral neuropathy so vitamin B6 given

37
Q

What are the side effects of pyrazinamide?

A

Hepatitis and Gout

38
Q

What are the side effects of Ethambutol?

A

Optic neuropathy

39
Q

What can all 4 drugs cause?

A

Rash

40
Q

When is the BCG vaccine given?

A

Given selectively too risk groups since 2005
Neonates, or unvaccinated children under 5, whose parents/grandparents were born in a country with an annual incidence of TB of 40/100,000 or greater
Unimmunised contacts of cases and high risk employees

41
Q

Who should we screen for latent TB?

A

Contacts of people with active pulmonary or laryngeal TB who are aged ≤65 years - hepatotoxicity risk increases with age those aged 66 years or older: CXR only to rule out active TB only
New entrants to Grampian from high incidence areas
‘Pre-biologics’ (TNF-alpha inhibitors

42
Q

How are people screened for latent TB?

A

Mantoux skin test or interferon gamma release assay (IGRA) blood test

43
Q

When is LTBI diagnosis given?

A

Asymptomatic
Normal CXR
Normal examination
Positive Mantoux skin test or IGRA

44
Q

What is the treatment for latent TB?

A

Rifampicin & Isoniazid for three months
Isoniazid or Rifampicin only for six months
Rifapentine & Isoniazid once weekly for 12 week

Respiratory (24 decks)

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