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Respiratory (LECTURE NOTES) > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is TB

A

An infection caused by Mycobacterium tuberculosis that may affect any part of the body but most commonly affects the lungs

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2
Q

How is TB spread

A

By a person inhaling the bacterium in droplets coughed or exhaled by someone with infectious TB

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3
Q

How many people have the active disease

A

15-20 million

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4
Q

How many people have the latent disease

A

2 billion

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5
Q

What ethnic groups is TB highest in

A

Black African
Pakistani
Indian

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6
Q

What has caused the recent increase in notification rates

A

The patterns of immigration and increasing international travel

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7
Q

What other groups of people have a high incidence of TB

A

Alcoholics, homeless, those misusing drugs, those coinfected with HIV

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8
Q

What type of TB do young people get

A

Newly acquired TB

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9
Q

What type of TB do older age groups get

A

Reactivation of latent infection

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10
Q

What are the two main patterns of the disease

A

Primary and post-primary

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11
Q

What is primary tuberculosis

A

The pattern of disease seen with first infection in a person (often a child) without specific immunity to TB

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12
Q

How is primary tuberculosis acquired?

A

By inhalation of organisms from an infected individual

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13
Q

What appears on the CXR in primary tuberculosis

A

Ghon focus ( a peripheral area of consolidation)

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14
Q

What does healed primary focus appear as on a CXR

A

Calcified nodules

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15
Q

Bronchiectasis in which lobe is a very typical outcome of hilar node involvement by TB in childhood

A

Middle

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16
Q

What might haematogenous spread of infection result in

A

Early generalisation of disease that may cause miliary TB and the lethal complication of tuberculosis meningitis

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17
Q

Describe post-primary TB

A

The pattern of disease seen after the development of specific immunity

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18
Q

When would post-primary TB typically occur

A

Following direct progression of the initial infection or result from endogenous reactivation of infection or from exogenous reinfection in a patient who has had previous contact with the orgnaism and has developed a degree of specific immunity

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19
Q

Where is the most common pulmonary site of infection for post-primary TB

A

The apices of the lungs

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20
Q

What are the most typical chest symptoms of TB

A

Persistent cough, sputum production and haemoptysis

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21
Q

What are the most typical systemic symptoms of TB

A

Fever, night sweats, anorexia and weight loss

22
Q

What is the most common appearance of TB on a chest xray

A

Cavitating apical lesions

23
Q

How should sputum samples be examined in the lab

A

By the Ziehl-Neelsen method looking for AAFB that appear as red rods on a blue background

24
Q

What is the disadvantage of using the Ziehl-Neelsen method

A

It takes a long time for the laboratory tests to come back

25
Q

What is the current standard treatment of TB

A

6 months of rifampicin and isoniazid supplemented by purazinamide and ethambutol for the first 2 months

26
Q

Why is rifampicin and isoniazid used for so long?

A

To eradicate bacilli that may be lying dormant

27
Q

What should be instituted for patients who have difficulty complying with TB treatment

A

Directly observed therapy - observed to ensure that he or she swallows the medication

28
Q

How is directly observed therapy sometimes achieved

A

By giving high doses of the anti-TB medication three times per week with the patient attending a hospital or GP clinic to be given the medication under the supervision of a doctor or a nurse

29
Q

What are the adverse effects of isoniazid

A

Hepatitis, neuropathy

30
Q

What are the adverse effects of Rifampicin

A

Hepatitis, rashes, enzyme induction

31
Q

What are the adverse effects of pyrazinamide

A

Hepatitis and rashes and elevated uric acid

32
Q

What are the adverse effects of ethambutol

A

Optic neuritis

33
Q

What are the adverse effects of ethambutol

A

Optic neuritis

34
Q

What should be checked before commencing ethambutol

A

Visual acuity

35
Q

What is latent TB

A

The situation where a person has been infected with Mycobacterium tuberculosis at some time but does not currently have the active disease

36
Q

What are the factors that increase the risk of reactivation of TB

A 
Aging
Alcohol misuse 
poor nutrition
coinfection with HIV 
use of immunosuppressive drugs
37
Q

How is detection of latent infection carried out

A

Demonstrating an immune response to Mycobacterium tuberculosis using a tubercilin test or an interferon gamma based blood test

38
Q

What type of hypersensitivity response occurs during the tuberculin testing and what can be seen

A

Type 4 cell mediated - results in a raised area of induration and reddening of the skin

39
Q

How is the tuberculin solution injected in the Mantoux test

A

Intradermally

40
Q

What indicates a positive result to the Mantoux test

A

Redness and induration at least 10mm in diameter

41
Q

How is the Heaf test performed

A

With a spring loaded needled “gun”

42
Q

How is the reaction of the Heaf test graded

A

From 1- 4 according to the formation of papules and the extent of induration

43
Q

What does a negative tuberculin test indicate

A

BCG is recommended as it makes active TB unlikely and therefore there would be a lack of immunity

44
Q

What is the most useful and more specific diagnosis of a latent TB infection

A

Interferon Gamma blood tests but they should not be used as a routine diagnostic tool for active TB

45
Q

How long are sputum positive patients infectious for

A

Until they have completed 2 weeks of treatment

46
Q

What does screening of contacts consist of

A

Checking for symtpoms
Chest Xray
tuberculin testing
interferon-gamma test and assessment of BCG status

47
Q

What reduces the risk of future activation of the latent disease

A

Chemoprophylaxis

48
Q

What does chemoprophylaxis consist of?

A

6 months with isoniazid alone or for 3 months with isoniazid and rifampicin

49
Q

Why are only 1 or 2 drugs used in the treatment of latent TB and 4 in active TB

A

there are a thousand times fewer bacteria than in active TB

50
Q

Describe the screening process of immigrants for TB

A

For immigrants from areas with a high prevalence of TB (africa, indian subcontinent ) should be screened for TB on arrival in a country of low prevalence sucha s the UK
Adults have CXR and children have a tuberculin test.

51
Q

What is the BCG vaccination

A

A live attenuated strain of TB that provides about 75% protection against TB for about 15 years

52
Q

How is the BCG vaccination given

A

Intradermal injection

Respiratory (LECTURE NOTES) (19 decks)

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