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Respiratory > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is Tuberculosis?

A

infectious disease usually caused by Mycobacterium tuberculosis (MTB) bacteria. Tuberculosis generally affects the lungs

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2
Q

In what 8 countries is TB most prevalent?

A 
India (27%)
China (9%)
Indonesia (8%)
The Philippines (6%)
Pakistan (5%)
Nigeria (4%)
Bangladesh (4%)
South Africa (3%)
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3
Q

What percentage of TB cases across the world where in the 30 ‘high TB burden’ countries?

A

87%

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4
Q

How many people are infected with TB worldwide?

A

Estimated 2 billion

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5
Q

How many people die per year due to TB?

A

1.6 million (in 2017)

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6
Q

In the UK, where is TB most abundant?

What is the main cause of this?

A

London

Immigration

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7
Q

Roughly how many people in Scotland have TB?

A

Around 300

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8
Q

Who is most at risk of catching TB?

A

Those from high prevalence countries

HIV positive or the otherwise immunocompromised

Elderly, neonates, diabetics

Alcoholics, the homeless and those in prison etc (low socioeconomic class)

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9
Q

What bacterial group is responsible for TB?

A

Mycobacteria

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10
Q

What species of bacteria can cause human infection of TB?

A

M. tuberculosis
M. africanum
M. bovis (bovine TB - BCG)

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11
Q

What other conditions can be caused through infection by mycobacteria?

A

NTM infections

Leprosy

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12
Q

What causes leprosy?

A

M. leprae

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13
Q

Where are Mycobacterium found in the environment?

A

Soil and water

Although it is transmitted via airborne route

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14
Q

Describe mycobacteria’s:

  • Shape
  • Growth rate
  • Aerobic/anaerobic
A

It is a aerobic bacillus that is non-motile and very slowly growing

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15
Q

Mycobacterium have a thick, fatty cell wall.

What does this mean?

A

Resistant to acids, alkali and detergents

Resistant to neutrophil and macrophage destruction

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16
Q

Mycobacteria are described as being a type of AAFB

What does this stand for/mean?

A

Acid & alcohol fast bacilli

Not all AAFB’s are TB however

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17
Q

How is TB caught?

A

Inhaling air with mycobacterium suspended in it

Prolonged close contact required for successful infection

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18
Q

Why is there no/less risk of catching TB whilst outside?

A

Mycobacteria are killed by UV radiation and dilution

19
Q

What type of TB is not spread entirely by the airborne route?

A

M.bovis

Bovine TB

Spread through the consumption of un-pasteurised cows milk

20
Q

Describe the mechanism of infection of TB, and how this leads to the formation of a giant cell

A

M bacteria inhaled and go to the alveoli

Th1 cells activate macrophages

Macrophages shit themselves and try and phagocytose the bacterium

Bacterium is resistant to reactive oxygen species so replicates within macrophage

Other macrophages shit themselves and clump together around the infected macrophage

This leads to formation of a Langhan’s giant cell

21
Q

Infection by Mycobacteria causes the accumulation of macrophages, epithelioid and Langhan’s giant cells in the lungs

What is the accumulation called?

A

Granuloma

22
Q

What group of lymph nodes are the most likely to be infected by mycobacteria?

A

Hilar lymph nodes (at the hilum)

23
Q

What is a Ghon focus?

A

Small area of calcifying granulomatous inflammation

Usually in mid to lower zones of the lungs

24
Q

What are the possible outcomes of primary infection with TB?

A

Progressive disease

Latent infection (contained latent)

Infection resolved/cleared

TB bronchopneumonia 1%

Milliary TB 1-3%

25
Q

How does tuberculous bronchopneumonia occur?

A

Primary focus (lymph node) enlarges - cavitation

Compresses bronchi causing lobar collapse

Enlarged lymph node eventually discharges into bronchus

26
Q

What is the prognosis of TB bronchopneumonia?

A

Usually very poor

27
Q

What is milliary TB?

A

Widespread dissemination of Mycobacterium tuberculosis via hematogenous spread

Sporadic small granulomata

28
Q

What are the main symptoms/signs of TB?

A

Cough

Fever
Sweats (night)
Malaise

(Common for symptoms to be missing)

29
Q

Why might a blood test measuring CRP levels and ESR be misleading for diagnosing TB?

A

CRP levels normal in 15% of TB sufferers

ESR normal in 21% of TB sufferers

30
Q

What does post-primary TB look like on an CXR?

A

Soft fluffy/nodular appearance in upper zone of the lungs

Cavitation visible in 10-30% patients

31
Q

If a CXR is apparently normal, but a patient is still suspected of having TB, what is the next diagnostic tool?

A

CT scan

32
Q

What signs on a CXR would indicate primary TB?

A

Mediastinal lymphadenopathy

Pleural effusion

Pneumonic lesion with enlarged hilar nodes

33
Q

Aside from CXRs and CT scans

What ways are there to diagnose TB?

A

Sputum samples

Bronchioscopy with BAL

Endobronchial ultrasound (EBUS) with biopsy

Lumbar puncture (for CNS TB)

Urine sample (for Urogenital TB)

Biopsy from specific tissue

34
Q

What are the rules for taking sputum samples of a patient with suspected TB?

A

3 samples with 8-24 hour gap

At least 1 early morning sample should be taken

35
Q

Describe the clinical management of someone with TB

A

Multidrug therapy

At least 6 months

Test for HIV, Hep B and Hep C

36
Q

What drugs are used to treat TB

A

Isoniazid (H) Pyrazinamide (Z) Rifampicin (R) Ethambutol (E)

2 months RHZE then 4 months RH

Pyridoxine given alongside H to reduce risk of neuropathy

Steroids for certain types of TB

37
Q

What types of TB require steroid treatment?

A

CNS
Milliary
Pericardial

38
Q

What are the possible side effects of Rifampicin?

A

Orange ‘Irn Bru’ urine/tears/lenses

Induces liver enzymes, prednisolone, anticonvulsants

All hormonal contraceptive methods ineffective

Hepatitis

Rash

39
Q

What are the possible side effects of Isoniazid?

A

Hepatitis

Rash

Peripheral neuropathy (hence pyridoxine B6)

40
Q

What are the possible side effects of Pyrazinamide?

A

Hepatitis

Gout

Rash

41
Q

What are the possible side effects of ethambutol?

A

Optic neuropathy

Rash

42
Q

Who receives the BCG vaccination?

A

Neonates, or unvaccinated children under 5, whose parents/grandparents were born in a country with an annual incidence of TB of 40/100,000 or greater

43
Q

Who is screened for latent TB?

A

Contacts of people with active pulmonary or laryngeal TB who are aged ≤65 years (hepatotoxicity increases with age)

New entrants from high endemic areas

‘Pre-biologics’ (TNF-alpha inhibitors)

Outbreaks

44
Q

How is latent TB (LTBI) treated?

A

Rifampicin & Isoniazid for three months, or
Isoniazid only for six months, or
Rifampicin only for six months, or
Rifapentine & Isoniazide once weekly for 12 weeks (underserved population)

Respiratory (32 decks)

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