Tuberculosis

Question 1

Define TB

Answer 1

• Infection by bacteria Mycoplasma tuberculosis, transmitted through airbourne spread
• Mainly affects lungs
• Can affect lymph nodes, CNS, liver, bones, GI/GU

Question 2

What are the risk factors for TB

Answer 2

• Birth in endemic region*
• Exposure*
• HIV infection/immunosuppression

Other

• Malignany
• IVDU
• Malnutrition
• Alcoholism
• Diabetes
• Age
• Smoking

Question 3

What are the common symptoms in TB?

Answer 3

• Cough - haemoptysis
• Night sweats
• Malaise
• Weigh loss/anorexia
• Fever
• Pleuritic chest pain

Question 4

What are the common sign of TB?

Answer 4

• Clubbing
• Erythema Nodosum
• Crackles
• Bronchial breath sounds

Question 5

What are the investigations for TB?

Answer 5

Bloods

• Standard FBC for infection
• HIV, Hep B an Hep C always tested as different regime

Imaging
-CXR*

Culture
->3 sputum samples (one from early in the morning) = send for acid fast bacilli using zhiel nelson staining

Other
-Mantoux for household contacts

Question 6

What are the CXR signs for TB?

Answer 6

• Infiltrates
• Pleural effusion
• Millet seeds for military TB
• Ghon complex - calcified focus of infection with associated lymph nodes

Question 7

What is the management strategy for TB?

Answer 7

RIPE

1. Rifampicin (SE: orange secretions) = 6 months
2. Isonazid (SE: peripheral neuropathy) = 6 months
3. Pyrazimid (SE: joint pain and gout) = 2 months
4. Ethambutol (SE: optic neuritis and decrease VA) = 2 months