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Respiratory (Annie) > TUBERCULOSIS > Flashcards

TUBERCULOSIS Flashcards

1
Q

what is tuberculosis, TB?

A

a bacterial infection affecting the lungs.

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2
Q

how is TB spread?

A

spread from person to person through inhaling tiny droplets of coughs and sneezes of a infected person.

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3
Q

what are the 4 types of mycobacterium that cause TB collectively known as?

A

collectively known as Mycobacterium Tuberculosis Complex (Mtb).

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4
Q

What are the 4 types of mycobacterium that cause TB?

A

1) mycobacterium tuberculosis
2) mycobacterium bovis
3) mycobacterium africanum
4) mycobacterium microti

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5
Q

what are the 3 different types of tuberculosis?

A

1) primary TB
2) latent TB
3) re-activation TB
4) Pulmonary TB
5) extra-pulmonary TB
6) Miliary TB
7) Bovine TB

8) lymph node TB
9) GI TB
10) TB of bone and spine

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6
Q

what is primary TB?

A

describes the FIRST INFECTION with Mtb

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7
Q

what is latent TB?

A

= dormant M. tuberculosis infection that can reactivate decades after initial infection.

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8
Q

What role does the immune system have in TB?

A
  • people who are first infected with M. tuberculosis

- the immune system contains the infection and the patient develops a cell mediated immune memory to the bacteria.

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9
Q

what is reactivation TB?

A

the majority of TB cases are due to reactivation of latent infections.
- the initial contact occurred many years or decades earlier.

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10
Q

what is pulmonary TB?

A

= active tuberculosis affecting the lungs

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11
Q

what are the symptoms of pulmonary TB?

A
  • productive cough
  • occasionally haemoptysis

Systemic symptoms;

  • weight loss
  • fever
  • sweats

If there is laryngeal involvement;

  • hoarse voice
  • severe cough

If disease involves pleura;
- pleuritic chest pain

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12
Q

what is extra pulmonary TB?

A

= active tuberculosis affecting other organs

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13
Q

what is miliary TB?

A

= active tuberculosis spread by the blood throughout the body

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14
Q

What is bovine TB?

How is M. Bovis acquired?

What do people with M. Bovis presents with?

How is M. Bovis treated?

A

= tuberculosis caused by M. Bovis

Acquired form;

  • ingesting infected cows’ milk
  • farmers working with infected cows for over 3 years
  • abattoir workers (manage slaughtered animals)

They present with;

  • similar symptoms to ordinary TB in the chest
  • but extra pulmonary sites of infection are common
  • immunosuppression is a risk factor

Treatment;

  • isoniazid, rifampicin, ethambutol
  • resistance to pyrazinamide is common
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15
Q

what is lymph node TB?

A

= tuberculosis that affects the lymph nodes

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16
Q

what does lymph node TB do to the lymph nodes?

A
  • causes SWELLING of lymph nodes

- lymph nodes are firm, non-tender enlargement of cervical or supraclavicular node.

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17
Q

what is GI TB?

A

= tuberculosis or infection that affects the peritoneum, hollow or solid abdominal organs and abdominal lymphatics

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18
Q

what are the risk factors for getting TB?

A

1) recent immigration
2) malnutrition
3) overcrowding or homelessness
4) immune defects
5) smoking & alcohol

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19
Q

what are the symptoms of TB?

A
  • coughing that lasts a prolonged period of time
  • haemoptysis
  • chest pain, or pain when breathing or coughing
  • unintentional weight loss
  • fatigue
  • fever
  • night sweats
  • chills
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20
Q

describe some different in features between latent and active tuberculosis infections.

A

LATENT;

  • bacilli present in Ghon focus
  • sputum smear & culture negative
  • Chest X-ray normal
  • asymptomatic
  • not infectious to others

ACTIVE;
- bacilli present in tissues or secretions
- sputum commonly smears & culture positive
- Chest X-ray shows signs of consolidation
- symptomatic;
= night sweats
= fevers
= weight loss
= cough common
- infectious to others if bacilli detectable in sputum.

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21
Q

what are 3 things that allow you to diagnose TB?

A

1) stains
2) cultures
3) nucleic acid amplification

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22
Q

what 2 stains could be used to diagnose TB?

A

1) Auramine-rhodamine staining

2) Ziehl Neelson (ZN)

23
Q

Out of these two stains;
- Auramine rhodamine and
- Ziehl Neelson
Which one is most used and why?

A

Auramine rhodamine is most commonly used.

Because;

  • it is more sensitive than ziehl Nelson (ZN)
  • but it is less specific
24
Q

how do you treat TB?

A
  • 6 months of treatment

= Two months of 4 drugs
= Four months of 2 drugs

25
Q

What are the 4 drugs involved in the two months of treatment?

What 4 letter word helps you remember them?

A

1) rifampicin
2) isoniazid
3) Pyrazinamide
4) Ethambutol

= RIPE

26
Q

What are the 2 drugs involved in the four months of treatment?

A

1) Rifampicin

2) isoniazid

27
Q

when treating tuberculosis that affects the CNS, what is the recommended duration for treatment?

A

recommended duration is AT LEAST 12months

28
Q

In what sort of TB’s should corticosteroids be used and why?

A

should be used in CNS & pericardial diseases

- it reduces long term complications.

29
Q

what effect does Rifampicin have on the liver?

A
  • induces liver enzymes, which may be elevated in the serum of patients.
  • induction of liver enzymes means that naturally accompanying drug treatments may be less effective.
30
Q

what effect does rifampicin have on the colour of body secretions and body fluids?

A
  • it stains the body secretions pink

- there is a change in colour of their urine, tears and sweat

31
Q

is oral contraception still effective when taking rifampicin?

A
  • NO.

- so alternative birth control methods should be used.

32
Q

what side effects of isoniazid have?

A
  • it has very few side effects.

But examples are;
- can cause allergic reactions e.g. skin rashes & fevers
- at high doses it may produce a polyneuropathy
= this is rare when the normal dose is given
- it can also give rise to hepatitis in 1% of cases

33
Q

as polyneuropathy is an unwanted side effect of isoniazid, what is a polyneuropathy and how is it caused?

A

Its is a degeneration of peripheral nerves the spread towards the centre of the body.

Caused due to;
= a B6 deficiency, as isoniazid interacts with pyridoxal phosphate

34
Q

what are the unwanted side effects of pyrazinamide?

A

1) hepatic toxicity
2) reduces renal excretion of rate
3) may precipitate hyperuricaemic gout

35
Q

what side effect does ethambutol produce?

A
  • can cause a dose related optic retrobulbar neuritis

Presents as;

  • colour blindness for green
  • reduction in visual acuity
  • central scotoma

= usually reverses provided the drug is stopped

36
Q

how does drug resistance arise?

A

1) incomplete drug treatment

2) incorrect drug treatment

37
Q

how can drug resistance be spread?

A
  • it can be spread from person to person
38
Q

what are the 3 types of drug resistance that can occur?

A

1) mono-resistance
2) multi-drug resistance
3) extensive drug resistance

39
Q

what does mono-resistance mean?

and what drug is it most commonly resistant to?

A

= means it is resistant to a SINGLE drug

- most commonly resistance to isoniazid

40
Q

what drugs are multi-drug resistant dugs resistant to?

A

1) rifampicin

2) isoniazid

41
Q

what drugs are extensive drugs resistance drugs resistant to?

A

1) rifampicin
2) isoniazid
3) quinolone
4) at least one INJECTABLE AGENT, such as - amikacin, capreomycin or kanamycin

42
Q

what is the link between TB and HIV?

A
  • there has been an increase in TB seen over the years in association with incidence of HIV infection
43
Q

what specific areas have the incidence of TB increased in correlation with HIV?

A
  • africa
  • india
  • parts of Eastern Europe & Russia
44
Q

why is there issues with treating TB & HIV?

A
  • incidence of drug interactions & intolerability
  • increased risk of treatment toxicity
  • higher incidence of drug resistance
45
Q

what is chronic kidney disease (CKD) a risk factor of?

A

chronic kidney disease is a risk factor for reactivation of latent TB infections due to relative immune paresis.

46
Q

how are latent TB infections (LTBI) diagnosed?

A
  • diagnosed by demonstrating immune memory to mycobacterial proteins
47
Q

what 2 tests ensure the diagnosis of LTBI?

A

1) tuberculin skin test

2) interferon gamma release assay

48
Q

how is a positive tuberculin skin test result indicated?

A
  • indicated by a delayed hypersensitivity reaction event 48-72hours after the intra-dermal injection of purified protein derivative (PPD).
49
Q

what type of patients are false negative tuberculin skin tests common in?

A

patients with immunosuppression due to HIV infection.

50
Q

how do false positive results occur?

A

due to cross-reactivity with non-tuberculosis mycobacteria & BCG vaccination.

51
Q

what do interferon gamma release assays detect?

A

they detect T cells secretion of IFN-gamma following exposure to M. tuberculosis specific antigens

52
Q

what vaccine can be given to help TB?

A

BCG vaccine

53
Q

what sort of vaccine is the BCG vaccine?

A

a live attenuated vaccine derived from M. Bovis that has lost its virulence

Respiratory (Annie) (47 decks)

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