Tuberculosis Flashcards
What is primary TB
non-immune host gets exposed to Mycobacterium tuberculosis
formations of granulomas
What is meant by secondary TB
host becomes immunocompromised and initial infection may become reactivated
reactivation occurs in apex of lungs
What are the risk factors of TB
having lived in Asia, Latin america, Eastern europe or Africa
HIV
Immunocompromised
Silicosis
apical fibrosis
What may someone with TB present with
coughing
haemoptysis
fever
weight loss
erythema nodosum
can have extrapulmonary manifestations
arthritis , meningitis , clubbing
Where in the lungs does TB usually affect
apical and upper zones of the lungs
What is stepwise plan for investigating TB
ISOLATE patient
arrange CXR - may show central apical changes or pleural effusion
Obtain sputum samples
at least 3 samples
Ziehl-Neelsen stain for acid fast bacilli
blood tests
What else should be done with sputum samples
Ziehl-neelsen stain for acid fast bacilli
Culture using Lowenstein-jensen medium which takes 4-8weeks hence not practical
Nucleic acid amplification tests - NAAT
allows rapid diagnosis with 2 days
more sensitive than smear , less than culture
What is the stepwise management for active TB
ISOLATE
Drug therapy - 6 months total
2 months of RIPE
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Continuation phase nect 4 months
Rifampicin
Isoniazid
How do you screen for TB
Mantou test
then interferon-gamma blood test if mantoux test is positive or equivocal
How do you manage latent TB
3 months of Isoniazid + pyridoxine + rifampicin
OR
6 months of Isoniazid + pyridoxine
How do you treat meningeal TB
treat for 12 months and steroids
What are side effects of rifampicin
hepatitis
orange secretion
flu-like symptoms
What are side effects of Isoniazid
peripheral neuropathy - PYRIDOXINE for prevention
hepatitis
agranulocytosis
What are side effects of Pyrazinamide
Hyperuricemia causing gout
arthralgia
myalgia
hepatitis
What are side effects of ethambutol
optic neuritis
dose needs adjusting for patients with renal impairment
