Tuberculosis Flashcards
Define TB and the likely pathogen
Communicable infectious disease caused by Mycobacterium Tuberculosis which produces silent , progressive active disease
Etiology of TB
Caused by Mycobacterium Tuberculosis =bacilli
Immunocompromised high risk
M. TB spread through micro size droplet nuclei through sneezing and coughing
Patients with laryngeal TB- increased risk when talking
Pathophysiology tb
Immune system identify M. Tuberculosis
And trigger macrophages and T-lymphocyte(CD4 and CD-8). TB is phagocytoses by alveolar macrophages , trigger recruitment of T-lymphocyte , formation of granuloma to contain infections and prevent spread , leading to latent TB .patient is asymptomatic but if Immunocompromised reactivation can occur lead to active TB
Signs and symptoms tb
Cough, weight loss ,night sweats, fatigue, fever
Bacteria can spread leading to extra pulmonary TB
Describe extra pulmonary TB
Affects other organs and tissues
Ie
Lymph nodes-lymphadenitis
Bones and joint-skeletal TB
Genitourinary-renal TB , genital TB
CNS -meningitis
Pericardium-pericardial
Skin and soft tissue -cutaneous TB
Diagnosis?tb
Sputum smear microscopy-acid -fast bacilli staining/smear
Microbiology, sputum:culture and sensitivity
GeneXPert-diagnose TB and resistance to rifampicin
Chest X ray
Clinical presentation
Give indication for culture and DST (tb)
All children
Symptomatic individuals at high risk of MDR-TB ie lab workers
Patients suspected of cryogenic TB
Relapse patient
HIV positive with 2 negative smears
Diagnosis for paediatric(tb)
Chest X-ray
Tuberculin skin test(TST) -purified protein derivative (PPD)
Microscopy and culture to collect sputum from child you can do induced sputum collection, saliva induction through like lemon juice
Risk factors for TB
HIV status and Immunocompromised
Comorbidities-DM, alcoholism,malnutrition
Prolonged treatment with steroids
History TB
Exposure to pt with pulmonary TB
Males and being black
Children <5 years
Risk factors for paediatric tb
History of recent contact with TB case
Age<3years
Malnutrition
Immune status
Time since exposure ie likely develop within 1 year
Goal of management of TB
Early collection of specimen
Initiate appropriate regimen
Isolation patient with active disease
Prevent TB transmission
Restore quality of life
Resolution of symptoms
Non pharmacological management tb
Isolation to prevent spread
Contact tracing
Replenishment >normal weight
1st line management of TB
RIPE(HRZE)
1. HRZE for 2 months initial phase then HRE for 4 months continuation phase
H-isoniazid - 10mg/kg daily
R-rifampicin-15mg /kg daily
Z-Pyrazinamide-35mg/kg daily
E-ethambutol-20mg/kg daily
S-streptomycin -15mg/kg daily
Management of relapse, treatment failure tb
- HRZES for 2 months and , HRE for 5 months
- 1 month HRZE and HRE 5 months
Paediatric regimen tb
<30kg : 2HRZE/4 HR
>30kg 2HRZE/4HRE
Retreat: 2HRZES/5HRE