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Respiratory and Cardio > Tuberculosis > Flashcards

Tuberculosis Flashcards

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1
Q

Regions with highest cases of TB

A

China

India

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2
Q

Regions with highest incidence of TB

A

Sub-Saharan Africa

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3
Q

What populations is TB concentrated in the uk?

A 
Urban poor
IVDUs
Poor
Alcoholics
Inmates
Alcoholics
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4
Q

Risk factors/social risk factors for TB

A 
Urban homeless
IVDU
AIDS/HIV
Alcohol misuse
Prison
Deprivation
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5
Q

How many main mycobacterial species are in the ‘Mycobacterium tuberculosis complex’

A 
4:
M.Tuberculosis
M.bovis
M.aricanum
M.microti
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6
Q

What does TB grow inside of, and what does this make it?

A

Macrophages

Obligate intracellular parasite

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7
Q

What stains TB red?

A

Zeheil-Neilson stain

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8
Q

Shape of TB:

A

Rod-shaped

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9
Q

Is TB anerobic or aerobic?

A

Strict aerobe

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10
Q

Why does TB have a waxy cell wall?

A

Mycolic acid

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11
Q

Once inhaled, what happens to TB?

A

Taken up by alveolar macrophages

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12
Q

What can happen to TB once taken up by alveolar macrophages (4)

A
  1. Cleared
  2. Heal with scaring
  3. Lie dormant
  4. Primary progressive disease
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13
Q

What cell primarily makes up granuloma?

A

Macrophages

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14
Q

Gohn focus =

A

Primary lesion. Small area of granulomatous inflammation

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15
Q

When is a Gohn focus detectable on CXR?

A

When it calcifies

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16
Q

Gohn complex =

A

Gohn focus + infection of lymphatics

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17
Q

Ranke complex =

A

Gohn focus undergoes fibrosis and calcification

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18
Q

Milliary TB =

A

Widespread dissemination of TB via hematogenous route

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19
Q

When is miliary TB more common?

A

Immunosuppressed patients

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20
Q

What is very important in Tb immunity?

A

Cell mediated immune response

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21
Q

What cytokines are important in TB/markers of infection

A

TNF-a

INF-y

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22
Q

Name some clinical conditions which increase risk of TB infections

A

HIV
SIlicosis
Diabetes
Chronic renal failure

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23
Q

What treatments can increase risk of TB infection

A

TNF-a therapy

Solid organ transplants

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24
Q

How does silicosis increase TB risk?

A

Disrupts macrophages/granulomas

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25
How does HIV, diabetes and chronic renal failure increase TB risk?
Impairs cell mediated response
26
How can infectious particles be aerosolised?
Coughing Sneezing Talking (if laryngeal)
27
What secretions aren't too important for infection?
Large secretions | fomites
28
Fomites =
Inanimate objects that carry disease
29
How long does unrestrained TB multiplication occur before cell mediated response kicks in?
Weeks (2-3 weeks)
30
What do alveolar macrophages do when infected with TB?
- Form granuloma: release TNF, adhesion molecules - Cellular influx: chemokine secretion - IL-6 secretion - MHC II expression - CD4+ cells - IL-10 secretion: limit inflammatory response
31
Function of IL-10
Limit inflammatory response
32
Tissue necrosis occurs if antigen load is
High
33
Necrosis in TB =
Caseous
34
Symptoms of TB
Productive, chronic cough Chest pain Haemoptysis Systemic: chills, fecer, night sweats, appetite loss, weight loss, fatigue
35
Standard view of CXR =
PA (posterior-anterior)
36
What can trigger post-primary tuberculosis?
``` Age Immunosuppression Disease Alcohol Drugs ```
37
What is post-primary TB?
Reactivation of latent TB
38
Extra-pulmonary TB occurs in what % of cases?
50%
39
Whats more infectious, pulmonary or extra-pulmonary TB
Pulmonary
40
Examples of metastatic organ spread:
``` Kidneys Bone Brain Muscle Retina Lymph nodes ```
41
Features of metastasis to kidneys:
Hematuria Proteinuria Back pain
42
Potts disease =
Vertebral TB
43
Features of metastasis to brain
Tuberculomas in brain
44
In muscle, TB may cause a
Cold abscess
45
How many/when should sputum specimens be collected?
3 specimens, 3 consecutive days
46
If patient not producing enough sputum, what can be used to induce it?
Hypertonic saline solution
47
If patient cannot induce sputum, what can be used for specimen?
Gastric aspirate | Bronchoscopy
48
Baseline diagnostic exams for TB:
CXR Sputum specimen - AFB microscopy and mycobacterial cultures Drug-susceptibility testing
49
CEPHAID test
Detects DNA sequences specific for M.tuberculosis and rifampicin resistance by PCR
50
How long does a CEPHAID test take?
90 mins
51
Ways to diagnose latent TB/corroborate active TB
Heaf test Mantoux test INF-y test
52
Mantoux test looks for
Immune response to mycobacteria antigens
53
What can the mantoux test react to that the INF-y test doesn't?
BCG vaccine
54
INF-y test measures what
- Amount of INF-y (ELIZA) | - Number of T cells producing INF-y (ELISPOT)
55
More specific test =
INF-y test
56
When should you consider treating for TB:
Postive AFB smear Hx of cough and weight loss Characteristic CXR findings Emigration from country of high incidence
57
Once treatment stats, what should you do:
- HIV test - CD$+ count for HIV+ - Liver and vision baselines
58
4 1st line TB treatments:
Isonazid Rifampin Pyrazinamide Ethambutol
59
Ex of 2nd line TB class
Fluoroquinolones
60
Fluoroquinolones suffix
-floxacin
61
Moa of fluororquinoles
Topoisomerase II inhibitor (DNA gyrase)
62
MOA rifampin =
RNA polymerase inhibitor
63
MOA Ethambutol
Cell wall inhibitor
64
MOA pyrazinamide
Cell membrane
65
MOA isoniazid
Cell wall inhibitor
66
Combos for Tb treatment:
1. first 2 months --> rifampicin + isonazid + pyrazinamide +/- ethanmbutol 2. 4 months (OR 7 IF SMEAR +VE) --> rifampicin + isoniazid
67
Pyridoxine =
B6
68
What should B6 be given with
Isonazid
69
What can turn urine orange
Rifampicin
70
Why does rifampicin interact with other drugs strongly
Potent cytochrome p450 inducer
71
Ex of drugs rifampicin can interact with
Warfarin Contraception Analgesia
72
MDR-TB =
Multi-drug resistant TB. Resistant to isoniazid and rifampicin
73
At risk of MDR-TB
- Hx of treatment - Contact with or from country with MDR-TB - Smears +ve despite 2 months treatment - Lack of compliance - Single drug therapy - Dispencing error
74
XDR-TB =
Extensively drug resistant TB | Resistant to any flurorquinole and at lead 1 of 3 injectable 2nd line drugs

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