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MDRS > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

definition of TB

A

contagious chronic bacterial infection caused by Mycobacterium tuberculosis

  • primarily affect lungs , can affect any part of the body
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2
Q

How is Tb classified?

A

primary
post-primary
disseminated tuberculosis

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3
Q

What is primary tuberculosis

A

Primary infection stage

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4
Q

What is postprimary tuberculosis

A

–Reactivation TB
–Reinfection TB
–Secondary TB

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5
Q

What is Disseminated tuberculosis

A

–Extrapulmonary TB
–Miliary TB
–Tuberculosis-disseminated

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6
Q

How does primary tuberculosis manifest

A
  1. Begins when inhaled bacilli implant in the alveoli
  2. bacilli multiply over 3-4 wks initial response is inflammatory
  3. influx of leukocytes and macrophages move into the infected area to engulf-but not fully kill- the bacilli
  4. Pulm. capillaries dilate, interstitium fill with fluid and alveoli swell with edema, and then eventually consolidate

Clinically this phase coincides with a + tb skin test

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7
Q

pathology of primary tuberculosis

A

surrounds infected area produces a protective wall called tubercle or granuloma on X-ray small, sharply defined opacities

As it progresses the combination of the tubercles and lymph notes: Ghon complex

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8
Q

What is the fxn of tubercle

A

contain TB preventing further spread if the central core breaks down it fills with necrotic tissue AKA caseous lesion (B)

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9
Q

What is the ghon complex

A

primary pulmonary lesion where infection is encased

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10
Q

What is the Primary TB Symptoms

A
  • if bacilli are isolated within the tubercles and immunity develops–> TB can be dormant for months/years
  • Most are asymptomatic
  • Only indication of TB is +skin test or blood test
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11
Q

what is the post-primary TB

A

the reactivation of TB months or years after initial infection

–> due to live tubercle bacilli remain dormant

–> TB can be reactivated with depressed immune systems or if individual have high risk factors

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12
Q

What if TB is uncontrolled

A

cavitation of granulomas develop& pt. progresses

–> lead to Cavitary Fibrocaseous

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13
Q

What is Cavitary Fibrocaseous TB?

A
  • erosion into a bronchus
  • cavity formed
  • o2 tension favours growth of organism
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14
Q

What are the clinical manifestation of progressive pulmonary Tb?

A
  • night sweats
  • malaise
  • anorexia &weight loss
  • low grade fever, chills
  • chest pain
  • cough with purulent sputum with increasing frequency
  • pulmonary hemorrhage as disease progresses – hemoptysis
  • increasing dyspnea
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15
Q

What are other complication of TB

A

Gradual wasting of the body called consumption
–> pt is contagious at this stage

severe cases a deep turbercle can rupture and allow air and pus into the pleura
–>broncho-pleural fistula: pneumothorax

persistent cavity may be colonized by aspergillosis (fungus)

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16
Q

what is Disseminated/Miliary TB?

A
  • Refers to the escape of tiny granulomas (pinhead size) from tubercle that travel to sites throughout the body by means of bloodstream & lymphatics
  • can lead to necrotizing infection and organ damage, typically with ↑oxygen tension in other sits
17
Q

what is the Anatomic Alterations of the Lungs

A
  • Alveolar consolidation
  • Alveolar-capillary destruction
  • Caseous tubercles or granulomas
  • Cavity formation
  • Fibrosis and secondary calcification of the lung parenchyma
  • Distortion and dilation of the bronchi
  • Increased bronchial airway secretions
18
Q

How is TB transmitted?

A
  1. Requires close, frequent and prolonged exposure to a source
  2. through inhalation of aerosols (airborne) –N95 mask fit tested

and these factors must be present:
–Viable bacilli in sputum or larynx of source
–Aerosolization of sputum by cough, bronchoscopy
–Adequate concentration of bacilli in air
–A susceptible host
–A sufficient length of time the host is breathing bicillary-laden air

19
Q

What is the etiology

A
  • caused by Mycobacterium tuberculosis
  • Highly aerobic organisms
  • non-motile, non-sporulating
  • rod-shaped, acid-fast bacillus
  • Resists staining, has a hard, waxy outer coat which protects against phagocytes, drugs
  • slow growing aerobe - multiplies faster where there is high oxygen tension
    e. g. Apex of lung, hilar regions
20
Q

What is the Populations at Risk?

A
  • close contacts with persons known to have TB (especially HCP), Public Health
  • foreign-born
  • medically unsupervised low-income, crowded populations (homeless shelters, LTC & correctional facilities
21
Q

How to diagnosis for TB

A
  • Mantoux tuberculin skin test
  • Sputum Culture
  • QuantiFERON®-TB Gold Test
22
Q

What is the TB skint est guideline

A

Who

  • a recently diagnosed individual with active TB
  • Persons at ↑ risk of exposure
  • people with impaired immunity
  • healthcare workers susceptible to frequent exposure to TB
23
Q

How i the mantoux test performed?

A

Mantoux skin test Injection of purified protein derivative (PPD) of TB

  • subcutaneous/intradermal injection of M. tuberculosis on forearm
  • Look for presence or absence of induration

**an induration of 10mm or greater is considered positive
this only tells if patient is exposed and infected with TB germ (not WHEN)

24
Q

What is Tb skin test Interpretation

A

•Wheal less than 5 mm: negative

Wheal 5 mm to 9 mm: considered suspicious, retest req’d

Wheal 10 mm or greater: positive

  • positive rxn is fairly sound evidence of recent or past infection or disease
  • doesn’t confirm active TB
25
Q

what is the false negatives TB interpretation

A 
–Active TB persons
–Poor technique
–Recent viral infections
- corticosteriods
-metabolic disturbancecs 
–Age extremes
26
Q

What is the false positives TB interpretation

A

–BCG vaccine
-Reaction to other non-tuberculousis mycobacterium
(M.avium, M kansasii)

27
Q

What is the 2 step TB skin test include

A
  • for high risk groups
  • Helps rule out false negatives
  1. If +ve after the 1 st test, assess for active disease; start treatment
  2. If -ve, give the 2nd test in 1-4 wks

if there is positive rxn, it’s called the booster phenomenon, ie: exposed to TB in the past - this is not a new exposure

28
Q

What is BCG

A

Bacille Calmette-Guerin

its a vaccine

29
Q

characteristic of BCG

A
  • live weakened bacterium M. Bovis

- TB skin test is always positive if vaccinated as adult

30
Q

What is the contraindication for skin test

A
  1. blistering from past skin tests
  2. burns or eczema
  3. patients with clear presentation or Hx of TB, or previous Tx for TB
  4. major viral infection or recent live virus vaccination in past month

MDRS (23 decks)

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