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Microbiology > Tuberculosis > Flashcards

Tuberculosis Flashcards

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1
Q

What Gram stain is TB?

A

Positive

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2
Q

Is it aerobic or anaerobic?

A

Aerobic

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3
Q

Which stain is used to diagnose TB

A

Ziehl-Neelsen

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4
Q

Typical lesion on CX-ray

A

Caseating Granuloma

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5
Q

Presentation of TB

A 
Cough +/- Haemoptysis
Fever (with night sweats)
Weight Loss (anorexia)
Malaise
Ethnicity
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6
Q

Features of post-primary infection?

A 
?Re-activation/re-infection
Upper lobes
Progresses rapidly to cavitation
CLassic: caseating granuloma
Miliary spread rare
Healing by fibrosis+calcification
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7
Q

Features of primary infection in children, elderly and immunocompromised

A

Multiplies at pleural surface (Ghon focus - sub pleural lesion in mid-lower zones)
Taken to LN by macrophage (Primary complex)
Generalised lymphohaematogenous spread
Granuloma (Langhans giant cells)
Can be asymptomatic esp in children
Rarely:
Tuberculoma
Progressive primary - focus or node ulcerates - pneumonia, cavity, bronchiectasis, consolidation, collapse
Miliary TB - Progressive, dissemintaed, haematogenous spread. Rich foci

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8
Q

1st Line Treatment of TB

A

Rifampicin - Drug interactions (rasied transaminases, induces cytochrome p450), orange secretions, hepatotoxicity
Isoniazid - peripheral neuropathy )give B6), hepatotoxicity
Pyrazinamide - Hyperuricaemia, hepatotoxicity
Ethambutol - Optic neuritis, visual disturbances
4 for 2 months then 2 for 4
TB meningitis - 4 for 2 then 2 for 8-10
Latent TB - 6 mo INA
DOTS, adherence is key, Vit D supplements

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9
Q

2nd Line treatment of TB

A

Injectables (capreomycin, kanamycin, amikacin)
Quinolones (moxifloxacin)
Cycloserine, Ethionamide/Protionamide, PAS, Linezolid, Clofazamine

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10
Q

Resistance patterns of TB

A

Mono - one drug
MDRTB - RIF + INA
XDRTB - RIF + INA + Injectables + Quinolones

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11
Q

Investigations for TB

A

Imaging - CXR (Upper lobe cavitation - post primary), CT
Culture - Suptum x3, bronchoaveolar lavage, urine (early morning), pus in Lowenstein Jensen medium (gold standard)
Sputum microscopy - Ziehl-Neelsen stain
Fram +ve rods, acid fast, aerobic, intracellular
Tuberculin skin Tests - Mantoux, Heaf testing
IGRA - interferon gamma release assays
NAAT - PCR-line probe assays
Liquid culture mediums

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12
Q

Symptoms of TB meningitis

A 
Subacute
Weight loss
Fever
Night sweats
Headache
Neck stiffness
Personality change
Drop in GCS
Focal neuro deficit
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13
Q

Diagnosis of TB Meningitis

A

CT - tuberculomata

LP - Lymphocytic

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14
Q

Treatment of TB MEningitis -

A

12/12 anti-TB

Steroids

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15
Q

Symptoms of extra pulmonary TB

A 
Lymphadenitis
Pericarditis
Abdominal - peritonitis, ileitis
Genito-urinary, renal, testicular
Misc - Skin, liver
Increased risk of HIV co infection
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16
Q

Risk factors of TB

A 
Recent migrant
HIV+
Homeless
Drug user
Prison
Close contacts
Young
Elderly
17
Q

Rsik factors for TB reactivation

A

Immunosuppression
Malnutrition
Ageing
Chronic Alcohol excess

18
Q

Symptoms of Spinal TB

A 
Fever
Sweats
Weight loss
Back pain
Haematogenous spread - vertebral destruction, collapse, anterior extension, iliopsoas abscess
19
Q

Investigations for Spinal TB

A

MRI/CT

Biopsy Aspirate

20
Q

Treatment for spinal TB

A

12/12 Anti TB

21
Q

BCG vaccination

A

Attenuated strain of M Bovis
Efficacy 0-80%
Bad for pulmonary Tb good for leprosy, meningitis and disseminated
Babies born in or with grand/parents with incidence over 40/100000
Previously unvaccinated immigrants
Contraindicated in HIV

22
Q

Features of Leprosy

A 
M. Leprae and M Lepromatosis
Life long
Incubation 2-10 years
Poor tranmission via nasal secretions
Most disability secondary to nerve damage
23
Q

Treament of Leprosy

A

Rifampicin
dapsone
clofazimine - if multibacillary

24
Q

Manifestations of Leprosy

A

Skin - depigmentation, macules, plaques, nodules, trophic ulcers
Nerves - thickened nerves, sensory neuropathy
Eyes - Keratitis, Iridocyclitis
Bone - Periositis aseptic necrosis

25
Q

CLinical spectrum of leprosy

A

Tuberculoid - Paucibacillary. Th1 mediated depigemntd lesions
BT - Nerve damage
Borderline - multple plaques
BL
Lepromatous - Multibacillary, Th2 mediated, Neuropathic ulcers

26
Q

Features of other mycobacterium infections

A

Environmental
No transmission
ASsoc with impaired immunity
Poor response to standard drugs

27
Q

Features of M. Avium

A

Children - Pharyngitis, cervical adenitis
Pulmonary - Underlying lung disease (resembles TB)
Disseminated - cytotoxics, lymphoma
AIDS - Disseminated multibacillary infection, mycobacteraemia

28
Q

Features of M Marinarum

A

Fish tank granuloma
Single or clusters of papules/plaques
Swimming pool?aquarium owners

29
Q

Features of M Ulcerans

A 
Insect transmission
Tropics/Aus
Buruli Ulcer
Early - painless nodule
SLow progression to ulceration and scarring + contractures
Seldom fatal, hideous deformity

Microbiology (27 decks)

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