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RESPIRATORY > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

what us tuberculosis

A

mycobacteria infection that is spread in air

occurs in many body sites

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2
Q

what type of reaction occurs in TB

A

Delayed Type IV hypersensitivity (granulomas with necrosis)

T cell response (NOT antibody response

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3
Q

in TB is the damage to the lung due to the bacteria or the T cell response

A

T cell response

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4
Q

why can TB be described as immunity + hypersensitivity

A

immunity: enhanced macrophage killing
hypersensitivity: Type IV granulomatous inflammation, tissue necrosis and scarring

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5
Q

4 bacteria that cause TB

A

Mycobacterium tuberculosis
mycobacterium bovis
mycobacterium africanum
mycobacterium microti

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6
Q

how is mycobacterium tuberculosis presented on a. Gm stain

A

rod shaped Gm=ve bacillus

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7
Q

what people are more likely to get TB

A

immunocomprimised

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8
Q

what test is used to diagnos mycobacterium tuberculsosis

A

zeihl-Neelson

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9
Q

what opportunistic pathogens cause TB in immunocompromised individuals

A

Virus (CMV)
bacterium (mycobacterium avium intracellulare)
Fungi (aspergillus, candida pnumonocystis)
Protozoa (cryptosporodoa, toxoplasma)

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10
Q

In TB infection does/does not mean disease

A

does not
infected people can still be healthy
1/3 of people are infected

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11
Q

2 types of TB

A

active (5-10% get sick, 8 weeks to present)

latent (lies dormant in body)

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12
Q

what determines TB’s clinical outcome

A

immune response

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13
Q

what is the immune response to TB

A

1) Tb evades phagocytosis
2) Slow onset Th1 adaptive immunity: 8 week
3) enhanced effector mechanism (MTB-sepcitid CD4+ T cells, IFN-y, TNF-a)
4) granuloma (walled off infection

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14
Q

what is the characteristics of TB

A

caseous necrosis
granuloma forms, growing collection fo phagocytic cells that bacteria infects and replicates in
little oxygen so bug adapts and lies dormant then reactivated with patient is old, immunosuppressed, on steroids

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15
Q

what type if immunity occurs in TB

A

Th-1 biased immunity

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16
Q

what factors have contributed to the global TB rise

A 
HIV pandemic
Displacement & migration
Poverty 
Disruption to health infrastructure from political changes / conflict
Poorly managed TB programmes
Anti-TB dug resistance: MDR
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17
Q

risk factors for TB

A

contact with TB infected person (TB in sputum)
immigrants from Africa/India
poverty, homelessness, alcoholism
HIV

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18
Q

what happens to patients with open (contagious) TB

A

positive smear test = kept in hospital

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19
Q

how is positive TB classified

A

first exposure and up to 5 years later

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20
Q

what type of reaction occurs in primary TB

A

Delayed Type IV sensitivity reaction

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21
Q

what are the characteristics of Primary TB

A

 Small focus (ghon focus)
 Peripheray of mid zone of lung
 Large hilar nodes (granulomatous)

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22
Q

what is the most common type of TB

A

latent TB

re-infection or re-activation

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23
Q

what causes re-acivation of TB

A

Age
HIV
immunosuppressive therapy eg. steroids

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24
Q

characteristics of secondary TB

A

at apices of lung (upper lobe)
 Fibrosing + Cavitating apical lesions
 Similar to cancer
 Large increasing in size

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25
Q

what type of TB are people with chronic kidney disease likely to suffer from

A

latent TB
increased risk of treatment toxicity
dialysis

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26
Q

what is given to reduce the risk of active infection to some people with latent TB

A

chemoprophlaxis

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27
Q

what people are more likely to get TB

A 
people born in other countries migrate to country where it is less common (secondary TB) 
deprivation
immunocomprimised
young adults & elderly 
more in men
silicosis
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28
Q

symptoms of TB

A 
productive cough occasional haemoptysis
night sweats
fever
weight loss
can affect different organs
pleuritic pain
jaundice
meningitis
GI pain/bowel obstrcution
spinal pain
cold absess
pericardiac tamponade
renal failure
hypoadrenalism
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29
Q

where is latent TB more likely to occur

A

it is asymptomatic wakes up in parts of lung where more oxygen

30
Q

in patients with septic arthritis and TB symptoms what are never injected into solitary arthritic joints

A

steroids incase it is TB

31
Q

what is primary lymph node TB

A
  • Common in kids
  • Pneumonia associated
  • Extrathoracic (most common) nodes
  • Firm, non-tender enlargement of a cervical or supraclavicular nde
  • Node = necrotic, can liquefy
  • No abscess formation/no erythema
32
Q

if a patient is diagnosed with TB what other test should be carried out

A

HIV test

33
Q

how is TB diagnosed in examination

A

upper zone crackles

swollen lymph glands

34
Q

what test is carried out to check for TB in bronchial washings

A

Zeihl Nelson Stain

35
Q

how can samples be collected from TB patients

A

sputum
bronchial washings
drain pleural effusions
needle in cold absess

36
Q

what does an X-ray of a patient with TB show

A 
consolidation 
pleural effusion
thickening of mediastinum (hilarious adenopathy) 
cavity formation
fibrosis
upper lobe predominancy
bulky lymph nodes
scarring/shrinkage
heals with calcification
37
Q

what is ghon focus - seen on chest x-ray of TB patient

A

Small calcified nodule in upper parts of upper lobe or lower parts of upper lobes (midzone)

38
Q

what causes the unilateral calcification as seen in patients with Tb

A

emphysema

pus in airways

39
Q

what Is milary TB

A

person has poor immune controlled spread everywhere in lung + blood + to CNS
tree in bud

40
Q

how is milary TB usually diagnosed

A

blood culture
bronchoalveolar lavage fluid: smear negative, culture positive
lumbar puncture checks CNS involvment

41
Q

if no sputum produced how should a sample be collected

A

bronchoscopy from upper Lobe

42
Q

what test is done on samples in suspected Tb

A

zeihl-neelson (misses Tb 50% of time) detects mycobacterium

auramine via microscopy

43
Q

what is the most important test on samples from suspected TB

A

culture
drug sensitivities
solid/liquid phases

44
Q

latent TB is culture negative/positive

A

negative

45
Q

what does nucleic acid amplification detect

A

TB mycobacterium and non TB mycobacterium
high specificity
identifies MDR

46
Q

what test is carried out on the skin

A

Mantoux (tuberculin test)
detects previous exposure to TB and BCG
takes 2 days
Type IV sensitivity reaction

47
Q

what can the Mantoux test not distinguish

A

the type of TB

48
Q

what would give a false negative In the Mantoux test

A

immunosuppressed - HIV infection
sarcoidosis
drugs - chemo, anti-TNFs, steroids

49
Q

what would give a false positive in the Mantoux test

A

BCG vaccine

non-tuberculosis mycobacterium

50
Q

what test is more effective at diagnosing TB than the mantoux test

A

IGRA
take blood, 1 visit
detects T cell secretion of IFN-y following exposure to M.tuberculosis specific antigens
high sensitivity and specificity (does not react with BCG)
detects all TB types

51
Q

what tests for active TB

A 
PCR: primary TB test 
answer in 90mins/2hours
spit or cartage 
sensitivity of 3 samples  (90% affective)
misses 1 in 4
52
Q

other than TB detection what is else does PCR tell us

A

if organism is resistna two rifampicin

53
Q

how is TB treated

A

BCG vaccine
Anti-TNF drugs given
cured in 6 months
do not give patients steroids/immunosuppressants

54
Q

what drugs are given for active TB treatment

A

4 drugs for 2 months: Rifampicin, Isoniazid (H), Pyrazinamide, Ethambutol
2 drugs for further 4 months:
Rifampicin + Isoniazid

55
Q

if TB is in the brain/CNS how long should treatment last

A

4 drugs for 2 months

2drugs for 10 months

56
Q

side effects of Anti-TB drugs

A 
	Need to stop the pill
	Liver problems
	Hepatitis (common)
	Vomiting   nausea (most common)
	Lack of appetite
	Arthralgia
	Cutaneous reactions
	Cutaneous hypersensitivity
	Retrobular neuritis (colour blindness  blindness)
57
Q

side effect of Rifampicin

A

pink/orange urine/sweat/tears

induces cytochrome enzyme (rapid steroid breakdown eg, contraception and breakdown of opiate analgesics)

58
Q

why is isoniazid prescribed with pyridoxine

A

to prevent B6 deficiency/polyneuropathy

allergic reactions with hepatitis: skin rashes/fever

59
Q

side effects of ethambutol

A

optic neuritis: reversible colour blindness

60
Q

side effects of pyrazinamide

A

hepatic toxicity

61
Q

side effect of stretomycin

A

Irreversible damage to vestibular nerve in elderly/those with renal impairment
Only used if MDR/very ill

62
Q

what is DOTS: Directly Observed Therapy Short-Course

A

for people who lead chaotic lifestyles/unlikely to take medication
responsible observer administers drug and observes ingestion

63
Q

what TB is not treated in UK

A

latent TB due to low transmission rates, treated in USA

64
Q

treatment for latent TB

A

2 drugs, 3 months: Rifampicin, Isoniazid or 1 drug 6 months: isoniazid
treat prior to immunosuppressive therapy
other treatments: Furoquniolones and TMC207 (bedaquilline)used if resistant to everything else

65
Q

what is MDR-TB

A

multi drug resistant TB
resistant to first line therapy: Rifampicin + Isoniazid
common in Russia/estonia/china
must stay in hospital

66
Q

how long do patients with MDR-TB need to take medication for

A

2 years

67
Q

what treatment is given to patients with Isoniazid resistance

A

need to take drug for another 3 years

68
Q

what is XDR-TB

A

resistant to second line therapy

MDR + Fluquinolones + injecables

69
Q

prognosis of Tb

A

global epidemic, kills most people as single pathogen
5-10% risk of infection
HIV carry 10% extra TB risk each year

70
Q

what is TB diagnosis confirmed by

A

PCR
AAFB
Culture

71
Q

what people should you suspect TB in if the symptoms are present

A

returning travellers
immunocompromised
non-resolving pneumonia

RESPIRATORY (12 decks)

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