Tuberculosis

Question 1

Tuberculosis is what kind of disease?

C/G

Answer 1

Chronic granulomatous disease

Question 2

Causative organism(s)?

Answer 2

Mycobacterium tuberculosis complex

which includes M. tuberculosis, M. bovis and M. africanum

Question 3

How is it spread?

Answer 3

Via droplets - the inhalation of these infected droplets coughed up from an infected persons’ lungs

Question 4

What happens if M. tb is inhaled - pathophysiologically speaking?

Answer 4

Macrophages eat them and move to hilar lymph nodes

These can disseminate into the blood stream => miliary TB - bad

Granulomas may form to encapsulate the bacteria - 80% are eliminated, the rest are considered to be dormant TB

Active TB is rare from primary infection

Question 5

General symptoms

Answer 5

Fatigue, malaise
Fever
Weight loss 
Anorexia, failure to thrive
Pyrexia of unknown origin

Question 6

Pulmonary symptoms

Answer 6

Resp TB = 60% UK cases
Chronic cough with bloody sputum

(may lead to -lobar collapse, bronchiectasis, pleural effusion or pneumonia)

Question 7

Other symptoms

Answer 7

GU - sterile pyuria etc
MSK - pain, arthritis, nerve root compression etc
CNS - non specific then GCS down and focal neuro signs
GI - abdo pain, bloating, obstruction
Lymph nodes - tender/firm
Skin - erythema nodosum
Pericardial

Question 8

Investigations

Answer 8

Chest X ray
Sputum sample + Ziehl-Neelsen stain (acid fast bacilli)

For contacts - mantoux test or interferon gamma test

Question 9

Management

Answer 9

Tell Public health England
2 months of isoniazid, rifampicin, pyrazinamide and ethambutol
Then
4 months just rifampicin and isoniazid