Tuberculosis Flashcards
State effects of systemic miliary TB on different organs x5
Kidneys - sterile pyuria and raised WBC in urine
Brain - meningitis
Adrenal glands - Addisons disease
Lumbar vertebrae - Potts disease
Liver - hepatitis
Clinical features of TB x5+
Most common- Cough, dyspnea
Systemic- fever, night sweats, anorexia, decreased activity
Approach to TB diagnosis x6
Careful history and examination
Tuberculin skin test and CXR
Bacteriological confirmation and HIV testing
Risk factors for TB in children x4
Contacts with a case of pulmonary TB
Age less than 5 years
HIV infection
Severe malnutrition - can cause reactivation
Physical signs highly suggestive of extra pulmonary TB x2
- Gibbus- collapse in vertebrae resulting in kyphosis
- Non painful enlarged cervical lymphadenopathy
When is a TST used in children x2
- In a suspected child with negative contacts
- In an exposed child
When should a TST be regarded positive x2
In immunosuppressed >5mm transverse diameter of induration
In other children > 10mm transverse diameter induration
3 advantages of cultures in MTB
1.TB in young children is paucibacillary ie few so culture amplifies it
2.It differentiates between M.tuberculosis and non tuberculous mycobacteria
3. It allows drug susceptibility testing
Indications of bacteriological confirmation x3
- Suspected drug resistant TB
- Complicated or severe TB
- HIV infection
Advantages of Xpert MTB/RIF test x3
Takes less time- 2 hours
It is non hazardous
Detects M.tuberculosis +/- genetic mutations for rifampicin resistance
Children living with HIV have an increased risk of what in relation to tb x4
TB exposure and infection
Progression of tb disease
TB related morbidity and mortality
Challenges in diagnosis of tb in hiv positive children x4
- TST is less sensitive
- Co infection can mask response to therapy
- High Incidence of lung diseases other than tb
- Overlap of radiographic findings in tb and hiv related lung diseases
Who gets isoniazid preventive therapy x2
HIV positive contacts of any age
HIV negative children < 5 years
Objectives of anti tb treatment x5
Cure tb
Prevent death from tb or its late effects
Prevent relapse of tb
Reduce transmission to others
Prevent development and transmission of drug resistant tb
Dosage of isoniazid
10-15 mg/kg max 300mg/day
Dosage of rifampicin
15mg/kg max 600mg/day
Dosage of pyrazinamide
35mg/kg range 30-40
Dosage of ethambutol
20mg/kg range 15-25
Indications of corticosteroid in tb treatment x3
1.Pericardial tb to reduce risk of developing constrictive pericarditis
2.TB meningitis
3.Complications of airway obstruction by tb lymph glands
Function and Indications of pyridoxine(B6) x3 + dose
It protects against isoniazid induced peripheral neuropathy
All children
HIV positive
Malnourished children
25mg/day
Prevention of tb x5
Neonatal BCG vaccination
Prevention of mother to child transmission of hiv
TB screening in all hiv children
Screening all children with infectious tb cases
HIV Testing for all children with tb and their families
Effect of BCG in hiv positive infants x2
Fatal disseminated BCG disease
BCG induced IRIS (immune reconstitution inflammatory syndrome)
