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Pediatrics PULMONARY > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

How many people gets infected with TB each year?

A

100 000 000

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2
Q

How many new TB cases is there?

A

8 800 000 new cases of TB (140/100 000)

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3
Q

How many of the new cases of TB are smear positive?

A

4 000 000

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4
Q

How many people die from TB?

A

1 700 000 peopl (100 000 children) die from TB

- 200 people/hour die with TB

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5
Q

How many children are orphans as a result of paerental deaths caused by TB?

A

9 mln

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6
Q

LTI =

A

Latent TB Infection

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7
Q

What is Latent TB Infection (LTI)?

A
  • Subclinical infection without clinical, bacteriological or radiological signs or symptoms of disease.
  • Positive TST
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8
Q

What is Tuberculosis?

A

Clinically, bacteriologically and/or radiographically confirmed disease

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9
Q

What is chemoprophylaxis used for?

A

Chemoprophylaxis: treatment of infection with M. Tuberculosis to prevent progression to active TB

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10
Q

What is preventive chemotherapy?

A

Preventive chemotherapy: treatment of individuals at risk of aquiring TB who are not infected

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11
Q

Etiology - Mycobacterium tuberculosis complex:

A
  • Mycobacterium africanum
  • Mycobacterium bovis
  • Mycobacterium EAI ( East African-Indian)
  • Beijing
  • Haarlem
  • LAM (Latin-American and Mediterranea)
  • CAS (Central and Middle Eastern Asia)
  • European X family
  • European T family
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12
Q

Transmission of TB:

A
  • Airborne
  • Ingestion of unpasteurized milk (M. Bovis)
  • Inborne
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13
Q

Pathogenesis of TB

A
  • clearance of the organism
  • rapid progressive disease (primary disease)
  • active disease many years after the infection
  • chronic or latent infection
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14
Q

Risk factors of TB INFECTION:

A
  • household contact
  • profession-due contact
  • alcoholics, drug addicts, homeless people
  • immigrants from high prevalence countries
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15
Q

Risk factors for developing TB DISEASE:

A
  • immunosupression (iatrogenic, HIV)
  • malnutrition
  • age <5yrs
  • neoplastic disease
  • chronic disease: DM, chronic kidney failure
  • stomach resection
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16
Q

What are the clinical features of primary infection:

A
  • local inflammation with granuloma formation
  • lymphadenopathy (hilar, mediastinal)
  • lobar collapse due to bronchial compression (may lead to bronchestasis)
  • pleural effusion (lymphocytic exudate with high protein but low glucose concentration)
  • erythema nodosum
  • in children manifestation may be scarce and non-specific
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17
Q

What are the clinical features in latent infection:

A
  • no clinical features
  • immunological record:
    • tuberculin skin test
    • interferon gamma release test
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18
Q

Post primary tuberculosis:

A
  • direct progression of primary infection
  • hematogenous spread
  • reactivation pf primary disease
  • exogenous reinfection
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19
Q

What is the pulmonary symptoms of post-primary tuberculosis?

A
  • cough
  • sputum
  • hemoptysis
  • chest pain
  • dyspnoea
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20
Q

What are the general symptoms of post-primary tuberculosis?

A
  • fever
  • night sweats
  • weight loss
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21
Q

What are the clinical signs of pulmonary TB?

A
  • reduced breath sounds and consolidation
  • wheezing in bronchial narrowing
  • signs of extrapulmonary involvment
22
Q

What is so special about TB in children?

A
  • higher risk of severe primary progressive disease after infection
  • higher proportion of disseminated and extrapulmonary disease
  • unreliable symptoms and signs
  • bacteriological examination difficult
23
Q

3-8 weeks after primary infection of TB in children:

A
  • TST response

- erythema nodosum

24
Q

1-3 months after primary infection of TB in children:

A
  • hematogenous spread (meningitis and miliary in infants)
25
Q

3-7 months after primary infection of TB in children:

A
  • bronchial disease(<5 years)

- pleural effusion (>5 years)

26
Q

1-3 years after primary infection of TB in children:

A
  • osteo-articular disease
  • calcification
  • adult-type disease
27
Q

What is special about patients with HIV and TB?

A
  • higher frequency of extrapulmonary TB
  • higher frequency of atypical localisation
  • greater frequency of general symptoms
  • shorter duration of symptoms before diagnosis
28
Q

Diagnostic materials:

A
  • gastric aspirate
  • bronchial washings
  • cerebrospinal fluid
  • pleural fluid
  • urine
  • sputum (more useful in adults)
  • other body fluids
29
Q

Diagnostic tests:

A
  • AFB smears
  • Culture: solid media up to 10 weeks, liquid media up to 6 weeks
  • PCR
30
Q

What is the gold standard to confirm tuberculosis?

A

Culture

31
Q

TST =

A

Tuberculin Skin Test

32
Q

The tuberculin skin test (TST):

A

Can not differentiate between latent and active disease.

Tool available for diagnosis of TB infection

33
Q

IGRA =

A

Interferon Gamma Release Assay

34
Q

Interferon gamma release assay (IGRA):

A

Cell mediated immunity - circulating lymphocytes are extracted from the venous blood nad exposed to antigens of M. Tuberculosis and after 6-24hrs the production of interferon gamma ins measured

35
Q

Serology-

A

Blood tests to measure the humoral response to M. tuberculosis

36
Q

What does the interpetation of TST depend on?

A
  • diameter of the induration

- person’s risk of being infected with TB and risk of progression to disease if infected

37
Q

Diameter of induration of _> 5mm is considered positive in:

A
  • HIV-infected children

- severly malnourished childreen (with clinical evidence of marasmus or kwashiorkor)

38
Q

Diameter of induration of _> 10mm is considered positive in:

A
  • all other children (whether or not they have recieved BCG vaccination)
39
Q

Positive TST:

A
  • active TB disease
  • latent TB infection
  • recent exposure to M. tuberculosis
  • exposure to enviromental mycobacteria
  • BCG-vaccination
41
Q

Causes of false positive TST results:

A
  • incorrect interpetation of test
  • BCG vaccine
  • infection with nontuberculous mycobacteria
42
Q

IGRA pros and cons:

A
  • good tool in diagnostics of latent TB
  • unlike TST, IGRA is negative in healthy vaccinated individuals
  • may be false negative in active TB
  • not enough experience in hcildren <5 years
43
Q

Basic principles of treatment:

A
  • combination of antibiotoics
    • rapid killing of mycobacteria
      • interrruption of the chain transmission
  • long duration of treatment
    • sterilization of lesions
      • prevention of relapse
44
Q

First line TB drugs:

A
  • Rifampicin
  • Isoniazid
  • Pyrazinamide
  • Ethambutol
  • Streptomycin
45
Q

Rational treatment standard:

A
  • intensive phase (2 months)
    • rapid killing
  • continuation phase (4-6 months)
    • sterilization
46
Q

DOT =

A

Direct Observed Therapy

47
Q

Direct Observed Therapy (DOT):

A

Recommended by WHO for all cases, at least in the intesive phase

48
Q

DOTS =

A

Directly Observed Therapy Short-Course

49
Q

What is the BCG vaccine?

A

BCG vaccine is a live vaccine prepared from attenuated strains of M. bovis

50
Q

What is the BCG vaccine used to for?

A

BCG vaccine is used to prevent disseminated and other life-threatening infections of M. tuberculosis in infants and young children.
- is used in more than 100 countries

51
Q

NOT DONE SLIDE 41 and 18

A

Meh

Pediatrics PULMONARY (4 decks)

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