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ESA 3 - Respiratory System > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What do mycobacteria possess?

A

A lipid-rich cell wall

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2
Q

What does the lipid-rich cell well of mycobacteria do?

A

Retains some dyes, even resisting decolourisation with acid (acid-fast)

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3
Q

How is TB spread from person to person?

A

By the aerosol route

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4
Q

What is the first site of infection for TB?

A

The lung

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5
Q

What is the outcome of primary TB?

A

Most infections resolve with local scarring

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6
Q

What does TB post-primary infection refer to?

A

The development of tuberculosis beyond the first few weeks

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7
Q

What may happen in TB post-primary infection?

A

The infection may progress throughout the body

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8
Q

What is it called when TB spreads throughout the body?

A

Miliary spread

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9
Q

What is the outcome of miliary spread of TB?

A
  • May resolve spontaneously
  • May develop into localised infection
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10
Q

Give an example of a localised infection that may result from miliary spread of TB

A

Meningitis

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11
Q

What happens to Mycobacterium TB once inside the body?

A

It is ingested by macrophages

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12
Q

What happens to Mycobacterium TB once it has been ingested by macrophages?

A

It escapes from the phagolysosome to multiply in the cytoplasm

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13
Q

What does the intense immune response to Mycobacterium TB cause?

A

Local tissue destruction and cytokine-mediated systemic effects

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14
Q

What does local tissue destruction as a result of TB infection cause?

A

Cavitation in the lung

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15
Q

What cytokine-mediated systemic effects are caused by infection with TB?

A

Fever and weight loss

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16
Q

What organs may TB affect?

A

Any organ of the body

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17
Q

What does TB mimic?

A

Both inflammatory and malignant diseases

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18
Q

How may pulmonary TB present?

A
  • Chronic cough
  • Haemoptysis
  • Fever
  • Weight loss
  • Recurrent bacterial pneumonia
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19
Q

What happens if pulmonary TB is left untreated?

A

It follows a chronic, deteriorating course

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20
Q

How does tuberculous meningitis present?

A
  • Fever
  • Slowly deteriorating level of consicousness
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21
Q

How may a kidney infection present?

A
  • Local infection
  • Fever
  • Weight loss
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22
Q

What are the potential complications of a kidney infection?

A
  • Ureteric fibrosis
  • Hydronephropathy
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23
Q

What is a common site of bone infection?

A

The lumbosacral spine

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24
Q

What may progression of a bone infection in the lumbosacral spine cause?

A
  • Vertebral collapse
  • Nerve compression
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25
Q

What may inflamamation of large joints lead to?

A

Destructive arthritis

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26
Q

What does Mycobacterium TB stimulate once it has escaped from macrophages?

A

An immune response, with the release of IL-12

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27
Q

What is the effect of IL-12?

A

It drives the release of IFN-γ and TNF-α from NK and CD4 cells

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28
Q

What is the effect of IFN-γ and TNF-α?

A

They activate and recruit more macrophages to the site of infection, resulting in the formation of granulomas

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29
Q

What are the primary changes in TB?

A
  • Few symptoms
  • Lymph nodes may become englarged in young people
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30
Q

What is the classical presentation of post-primary TB?

A
  • Cough (not always productive)
  • Fevers towards the end of the day, or at night
  • Weight loss and general debility
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31
Q

What does a chest x-ray show in a patient with post-primary TB?

A
  • Pulmonary shadowing, which may be patchy with solid lesions
  • Cavitated solid lesions
  • Streaky fibrosis
  • Flecks of calcification
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32
Q

What are the signs of respiratory TB?

A

Non-specific

  • Pallor
  • Fever
  • Weight loss
  • Clubbing
  • Palpable lymph nodes
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33
Q

What are the symptoms of respiratory TB?

A

Primary usually asymptomatic

  • Tiredness and malaise
  • Weight loss and anorexia
  • Fever
  • Cough
  • Breathlessness
  • Occasionally, haemoptysis
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34
Q

What are the x-ray changes shown in respiratory TB?

A
  • Shadowing
  • Cavities
  • Consolidation
  • Calcification
  • Cardiomegaly
  • Miliary seeds
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35
Q

Who is pleural TB more common in?

A

Males

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36
Q

What are the two mechanisms of pleural involvement in TB?

A
  • Hypersensitivity response to primary infection
  • Tuberculous empyema with ruptured cavity
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37
Q

What does tuberculous empyema have a tendancy to do?

A

Burrow through the chest wall

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38
Q

What is almost always present with pleural tuberculosis?

A

Some pulmonary disease

39
Q

Who is lymph node TB more common in?

A
  • Children
  • Women
  • Asians
40
Q

What is often true of lymph node TB?

A

It is painless

41
Q

Where does lymph node TB most commonly occur?

A

In the neck

42
Q

What happens in oesto-articular TB?

A

TB burrows into bone

43
Q

Give two types of osteo-articular TB

A
  • Poncet’s disease
  • Tuberculous Spondylitis
44
Q

What is the most common form of oestoarticular TB?

A

Tuberculous Spondylitis

45
Q

What is the passage of Tuberculous Spondylitis?

A
  • Starts in sub-chondral bone
  • Spreads to vertebral bodies and joint space
  • Follows longitudinal ligaments, anterior and posterior to spine
46
Q

Where does Tuberculous Spondylitis mainly occur?

A

In the lower thoracic and lumbar spine, but can be very high

47
Q

What is it called when Tuberculous Spondylitis occurs very high?

A

Cervical tuberculosis

48
Q

What may result from Tuberculous Spondylitis?

A

Parapledia and quadriplegia

49
Q

In what % of Tuberculous Spondylitis cases does parapledia and quadripledia result?

A

25%

50
Q

What is Poncet’s Disease?

A

Aseptic polyarthritis

51
Q

Where does Poncet’s disease affect?

A

Knees, ankles, and elbows

52
Q

What happens in miliary TB?

A

Bacilli spread through the blood stream

53
Q

When does miliary TB occur?

A

Either during primary infection or as reactivation

54
Q

When are the lungs involved in miliary TB?

A

Always

55
Q

How is mililary TB spread throughout the lungs?

A

Evenly

56
Q

Why is miliary TB spread throughout both lungs?

A

It is in the blood

57
Q

How can miliary TB in the lungs be visualised?

A

Many visibile on an x-ray

58
Q

What do headaches suggest in miliary TB?

A

Meningeal involvement

59
Q

What are the clinical features of miliary TB?

A
  • Ascites may be present
  • Retinal involvement in children
  • Few respiratory symptoms
60
Q

How is TB diagnosed?

A
  • Clinical features
  • Radiological features
  • Microbiology
61
Q

What clinical features aid in the diagnosis of TB?

A
  • Cough
  • Night fever
  • Weight loss
62
Q

What radiological features aid in the diagnosis of TB?

A
  • Shadowing
  • Cavities
  • Consolidation
  • Cardiomegaly
  • Miliary seeds
63
Q

What microbiological features aid in the diagnosis of TB?

A
  • Indentification of bacillus
  • Direct smear and subsequent culture of the appropriate body fluid
64
Q

What is important when considering the microbiology of TB?

A

To isolate organism and determine its susceptibility to drugs

65
Q

How is TB treated?

A

Initially, patients are treated with four drugs for two months, after which two of them are dropped and the others continued for another four months

66
Q

What drugs are used in the initial phase of treatment of TB?

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
67
Q

What drugs are used in the continuation phase of treatment of TB?

A
  • Rifampicin
  • Isoniazid
68
Q

Why are multiple drugs used in the treatment of TB?

A

In an attempt to combat resistance

69
Q

What % of TB patients are resistant to isoniazid?

A

5-10%

70
Q

Why does TB treatment have problems with compliance?

A

It is quite a long regime, with several different pills to take

71
Q

How is compliance with TB treatment improved in the US?

A

15% of patients receive Directly Observed Therapy (DOT)

72
Q

What are the benefits of Directly Observed Therapy?

A

Improved cure rate, reduction in rate, drug resistance, and relapses

73
Q

What are the potential reactions to rifampicin?

A
  • Hepatitis
  • Rash
  • Flu-like symptoms
  • Shock
  • ARF
  • Thrombocytopenic purpura
74
Q

What are the potenital reactions to isoniazid?

A
  • Rash
  • Peripheral neuropathy
  • Hepatitis
75
Q

What are the potential reactions to pyrazinamide?

A
  • Rash
  • Hepatitis
  • Arthralgia
76
Q

What are the potential reactions to ethambutol?

A

Optic neuritis

77
Q

What is happening to the incidence of multidrug-resistant TB?

A

There is a rising trend

78
Q

How many TB bacilli are spontaneously resistant?

A

About 1 in a million

79
Q

What is a case of multidrug-resistant TB (MDRTB) suggested by?

A
  • A history of previous incomplete treatment
  • Residence in a country with high incidence of MDRTB
  • Failure to response clinically to an adequate regimen
80
Q

What is used to attempt to combat TB resistance?

A

A regimen of several drugs at once

81
Q

What is the BCG vaccine?

A

A vaccination against TB that is prepared from a strain of the Attenuated Liver Bovine Tuberculosis Bacillus

82
Q

What must be true for the TB bacteria to act as a vaccine for human TB?

A

They must retain a strong enough antigenicity

83
Q

What are the problems with the BCG vaccine?

A
  • The vaccine has variable efficacy
  • Efficacy only lasts 15 years at most
84
Q

What does the efficacy of the BCG vaccine depend on?

A

Genetic variation of populations and BCG strains

85
Q

What are the UK regulations regarding the BCG vaccine?

A

Up until 2005, all children ages 13 were immunised along with all neonates born into high-risk groups.

Post 2005, the vaccination was only given to high-risk groups

86
Q

Why was the BCG vaccine only given to high-risk groups post 2005?

A

Falling incidence of TB had reduced the vaccine’s cost effectiveness

87
Q

What groups are at high risk of TB?

A
  • HIV
  • Silicosis
  • Malnutrition
  • Overcrowding
  • IV drug abusers
  • Chronic lung disease
  • Asians
  • Diabetes
  • Corticosteroid users
  • Anti α-TNF antibody (infliximab) users
88
Q

Where may overcrowding be a problem?

A
  • Prisons
  • Homeless shelters
89
Q

Who is at risk of developing chronic lung disease?

A

Smokers

90
Q

By how much does the risk of developing TB increase in HIV infected people compared to uninfected people?

A

Estimated to be 20-37 times greater

91
Q

What is the problem with TB in HIV patients?

A

Its a leading cause of morbity and mortality

92
Q

What happens if a patient has suspected TB?

A

Contact is immediately made with TB radiology. The patient goes straight into a TB clinic, with no waiting times, and is given a questionnaire and sputum samples taken

93
Q

How long after TB is suspected does treatment begin?

A

Within 7 days

ESA 3 - Respiratory System (14 decks)

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