Tuberculosis Flashcards
What are the side effects of tuberculosis medications?
Isoniazid - peripheral neuropathy, hepatitis
Rifampicin - hepatitis, enzyme inducer
Ethambutol - hepatitis, retro-bulbar neuritis
Pyrazinamide - hepatitis
What are the clinical features of old tuberculosis infection?
Apical fibrosis
Thoracoplasty
Pneumonectomy
Lobectomy
Phrenic nerve crush (left supraclavicular scar)
Recurrent pneumothoraces
What is the prevalence of tuberculosis?
2 billion individuals worldwide, with 8 million new diagnoses every year
What are the risk factors for developing tuberculosis?
Immigrant population
Immunocompromised
Elderly patients
Alcoholics
Malnutrition
Homeless individuals
Occupational exposure
What are the acute complications of tuberculosis?
Respiratory: Pneumothorax, Pleural effusion, Empyema, Collapse, ARDS, respiratory failure
Tubulointerstitial nephritis
Tuberculous meningitis
Miliary TB
What are the chronic complications of tuberculosis?
Pulmonary fibrosis
Bronchiectasis
Cor pulmonale
Aspergilloma
Reactivation
How would you investigate a patient with suspected tuberculosis?
Blood tests including HIV serology
CXR: upper lobe cavitating lesion, mediastinal lymphadenopathy
Sputum: three samples, Ziehl-Neilson staining for acid-alcohol fast bacilli
CT scanning
Bronchoscopy
How would you treat pulmonary tuberculosis?
Rifampicin, isoniazid, pyrizinamide and ethambutol for 2 months followed by rifampicin and isoniazid for 4 months
If multi-drug resistant, treatment with at least three different drugs should be continued until the sputum culture becomes negative, and then at least two different drugs should be continued for 12-24 months
What are the past methods of treatment for PTB?
Intended to render affected lungs hypoxic to kill bacteria
- Pneumonectomy
- Thoracoplasty (removal of section of rib to collapse the lung)
- Phrenic nerve crush (supraclavicular fossa scar)
- Iatrogenic pneumothoraces
- Plombage (insertion of inert substance into pleural space to collapse lung)
