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Systems: Respiratory AB > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Why was there a decline in TB incidence pre 1980s?

A

There was advancements in housing, better diets and hygiene.

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2
Q

Where in the UK is TB a major problem?

A
  • West Midlands

- London

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3
Q

What bacteria is responsible for TB?

A

Mycobacteria

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4
Q

Where do mycobacterium live?

A

In soil and water

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5
Q

What species of mycobacterium are responsible for TB?

A
  • Mycobacterium tuberculosis

- Mycobacterium bovis

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6
Q

What species of mycobacterium is responsible for leprosy?

A

Mycobacterium leprae

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7
Q

What other species of mycobacterium are there?

A
  • M. avium-intracellulare
  • M. kansasii
  • M. maimonese
  • M. xenopii
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8
Q

What kind of disease is TB?

A

Very slow grow growing, progressive disease that requires long treatment

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9
Q

What kind of bacteria is mycobacterium?

A
  • Non-motile bacillus

- Aerobic

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10
Q

Where does mycobacterium have a predilection for?

A

Apices of the lungs

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11
Q

Describe the structure of mycobacteria.

A
  • Very thick cell wall

- Contains lipids, peptidoglycans and arabinomannans

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12
Q

What is mycobacteria resistant to?

A
  • Acids, alkalis and detergents

- Neutrophil and macrophage destruction

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13
Q

What test is used to identify mycobacteria?

A

Acid and alcohol fast bacilli using a ZN stain

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14
Q

What is the source of transmission of mycobacteria?

A
  • Respiratory droplets evaporate
  • Droplet nuclei contain mycobacteria
  • Droplets remain airborne for very long periods
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15
Q

How are outdoor mycobacteria eliminated?

A

By UV radiation and infinite dilution

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16
Q

What happens when mycobacteria droplets are inhaled?

A
  • Larger droplet nuclei impact on large airways and are cleared
  • Small droplet nuclei organisms impact in alveoli and slowly proliferate.
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17
Q

How is TB contracted through mycobacterium bovis?

A
  • Consumption of infected cows milk

- Deposited in cervical and intestinal lymph nodes

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18
Q

How do activated macrophages cause necrosis?

A
  • Activated macrophages can kill off TB organisms but at the same time they release enzymes and free radicals which cause tissue damage
  • Acculmulation of macrophages, epithelioid and Langhan’s cells cause granulomas
  • Central caseating necrosis which may later calcify
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19
Q

What mediates the immunological response?

A

Th1 cells

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20
Q

What does the Th1 mediated immunological response lead to?

A
  • Elimination/ reduction in number of invading mycobacteria

- Tissue destruction as a consequence of activation of macrophages

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21
Q

What factors affect susceptibility?

A
  • Genetics
  • Race
  • Nutrition
  • Age
  • Immunosuppression
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22
Q

What affects outcome of infection?

A
  • Virulence

- Number of organisms

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23
Q

How might a resistant host become a susceptible host?

A

With age

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24
Q

How might a susceptible host become a resistant host?

A

With a better diet

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25
Q

Who is usually affected by primary infection?

A

Usually children with infected focus in alveolus

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26
Q

How is mycobacteria spread in the body?

A
  • Spread via the lymphatics to draining hilar lymph nodes.

- Haematogenous seeding of mycobacter to all organs of the body

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27
Q

What are the symptoms of primary infection TB?

A
  • Usually no symptoms
  • Can be fever
  • Malaise
  • Erythema nodosum
  • Rarely chest signs
28
Q

What occurs in most people with primary infection?

A
  • Initial lesion and local lymph node creating primary comlex
  • Heals with or without scar which may calcify creating Ghon focus
29
Q

What is primary infection associated with?

A

Development of immunity to tuberculoprotein

30
Q

What does intra-dermal administration of tuberculoprotein result in?

A

Lymphocytic and macrophage based area of inflammation after 48 hrs

31
Q

What are the 3 outcomes of primary infection?

A
  • Progressive disease
  • Contained latent
  • Cleared and cures
32
Q

How can a primary infection progress?

A
  • Primary focus continues to enlarge and forms a cavity
  • Enlarged hilar lymph compress bronchi causing lobar collapse
  • Enlarged lymph node discharges into the bronchus causing tuberculous pneumonia
33
Q

What occurs in some individuals 6-12 months after infection?

A
  • Miliary TB fine mottling on X-ray, wide-spread granuloma
  • Meningeal TB, severe, CSF high protein, lymphocytes
  • tuberculosis pleural effusion
34
Q

What are 2 mechanisms of post primary disease?

A
  • Reactivation of mycobacterium from latent primary infection disseminated by the blood stream around the body
  • New re-infection from outside source, susceptible previously infected host
35
Q

What tissues can TB affect?

A

Just about any

36
Q

When may post primary pulmonary tuberculosis occur?

A

At any age but there may be no symptoms for many months

37
Q

What are the respiratory symptoms of post primary pulmonary tuberculosis?

A
  • Cough
  • Sputum
  • Haemoptysis
  • Pleuritic pain
  • Breathlessness
38
Q

What are the systemic symptoms of post primary pulmonary tuberculosis?

A
  • Malaise
  • Fever
  • Weight loss
  • Night sweats
39
Q

Past medical history of post primary pulmonary TB.

A
  • Diabetes
  • Immunosuppressive diseases
  • Previous TB
40
Q

Drug history of post primary pulmonary TB.

A

Immunosuppressive drugs

41
Q

Personal/social history of post primary pulmonary TB.

A
  • Alcohol
  • IDVA
  • Poor social circumstances
  • Immigrants from high incidence areas
42
Q

What are the signs of post primary pulmonary TB?

A
  • May be none
  • Advanced: crackles, bronchial breathing
  • Finger clubbing very rare unless in chronic infection
43
Q

Who is included in high index of suspicion?

A
  • Immunosuppressed
  • Malnourished
  • Alcoholics
  • Vagrants
  • Previous gastric surgery
  • Malignancy
  • Diabetes mellitus
  • Adolescents, elderly
  • Recent migrants from high prevalence countries
44
Q

What essential investigations are there?

A
  • Sputum sample

- Chest X-ray

45
Q

How is sputum sampling carried out?

A
  • 3 sputum samples on successive days
  • Sputum smear- ZN stain- immediate answer if AAFB
  • Sputum culture which can take 8 weeks
46
Q

What might be observed on a chest x-ray?

A
  • Patchy shadowing, often apices/upper zones or apex of lower lobe
  • Cavitation if advanced
  • May calcify if chronic or healed TB
47
Q

What further investigations can be carried out if the sputum samples are negative?

A
  • CT scan of thorax
  • Bronchoscopy with bronchoalveolar lavage, transbronchial biopsy
  • Pleural aspiration and biopsy if pleural effsuion
48
Q

What was the treatment of TB up until 1950?

A
  • Fresh air
  • Sunshine
  • Bed rest
  • Good food
  • Improving immunity
  • Vitamin D and cathelecidin
49
Q

What surgery was used to treat TB?

A
  • Collapse down the cavity
  • Anaerobic conditions- phrenic crush
  • Artificial pneumothorax
  • Pneumoperitoneum
  • Thoracplasty
  • Lung resection
50
Q

What are the rules for modern treatment of TB?

A
  • Multiple drug therapy is essential
  • Single agent treatment leads to drug resistance organisms with 14 days
  • Therapy must continue for at least 6 months
  • TB therapy is a job for committed specialists only
  • Legal requirement to notify all cases
  • Low threshold for HIV testing, AIDS defining condition
51
Q

What drugs are patients on for 2 months?

A
  • Rifampicin
  • Isoniazid
  • Ethambutol
  • Pyrazinamide
52
Q

What drugs are patients on for 4 months?

A
  • Rifampicin

- Isoniazid

53
Q

When is TB rendered non-infectious?

A

After 2 weeks

54
Q

What are the side effects of rifampicin?

A
  • Orange urine
  • Tears
  • Induces liver enzymes which alter metabolism of prednisolone and anticonvulsants
  • OCP ineffective
  • Hepatitis
55
Q

What are the side effects of isoniazid?

A
  • Hepatitis

- Peripheral neuropathy

56
Q

What are the side effects of ethambutol?

A

Optic neuropathy

57
Q

What are the side effects of pyrazinamide?

A

Gout

58
Q

What does likelihood of infection with TB depend on?

A
  • Duration of contact

- Intensity of infection

59
Q

Who should be screened first?

A

Close household contacts

60
Q

If the close contacts have been infected who should be screened?

A

Casual contacts

61
Q

What are the tuberculin tests?

A
  • Mantoux

- Heaf

62
Q

Who should have no immunity to tuberculoprotein?

A

-Younger than 16 with NO BCG

63
Q

What should be carried out if there is a positive heaf test?

A

Chest x-ray

64
Q

If the chest x-ray is normal what should be done?

A

Chemoprophylaxis to kill mycobacteria

65
Q

If the chest x-ray is abnormal what be done?

A

Treat as TB

66
Q

If the heaf test is negative, what should be done?

A
  • Repeat test after 6 weeks
  • If 2nd test negative= BCG
  • If 2nd test positive= recent infection
67
Q

If someone is over 16 and has a BCG then how should they be screened?

A
  • Chest x-ray
  • Normal= reassure and discharge
  • Abnormal= investigate and treat

Systems: Respiratory AB (39 decks)

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