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Clinical Microbiology > Tuberculosis > Flashcards

Tuberculosis Flashcards

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1
Q

Which drug used in the treatment of TB targets actively growing organisms?

A

Isoniazid

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2
Q

Which drug used in the treatment of TB targets semi-dominant organisms inhibited by an acid environment?

A

Pyrazinamide

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3
Q

Which drug used in the treatment of TB targets semi-dormant organisms with. spurts of metabolism?

A

Rifampicin

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4
Q

Which drug used in the treatment of TB targets completely dormant organisms?

A

These organisms are not killed by standard drugs

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5
Q

What staining method is used to detect m.tuberculosis?

A

Zheil-neelsson

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6
Q

M.tuberculosis is a fast growing organism. T/F?

A

False

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7
Q

Give an example of a molecular test which can identify TB directly from samples

A

Gene XPert

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8
Q

Which protein which is anchored to the inner cytoplasmic membrane of M.tuberculosis is a major immune stimulator during infection?

A

Mannose-capped lipoarabinomannan (LAM)

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9
Q

Which cytokine is particularly important in the immune response to TB infection?

A

Interferon gamma

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10
Q

What patient factors may result in an increased likelihood of reactivation of TB?

A

Immunosuppression
HIV infection
Smoking

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11
Q

Describe the Mantoux test for the diagnosis of TB

A

A standard dose of tuberculin is injected intradermally and. read 48-72 hours later
A person who has been exposed to the bacteria is expected to. mount an immune response in the skin containing the bacteria proteins
The reaction is read by measuring t he diameter of induration (palpable, raised, hardened area) across the forearm in mm.

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12
Q

Describe the T spot test for TB diagnosis

A

Counts the number of anti-TB effector T cells which produce INF-gamma in a sample of blood. Gives overall measurement of immune response against TB, which can reveal the presence of even latent TB infection.

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13
Q

The Montaux test is less influenced by previous BCG vaccination than the T spot test. T/F?

A

False - the opposite is true

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14
Q

What is the quatiferon Tb test?

A

This is a whole blood test which is used to diagnose TB infection, including latent TB by mixing blood samples with. antigens and controls

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15
Q

Where in the tuberculous granuloma are foam cells most commonly found?

A

At the rim of the necrotic centre

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16
Q

Where in the tuberculous granuloma are bacteria most commonly found?

A

In the central necrotic area of the granuloma

17
Q

Other than macrophages, what cell types may populate the tuberculous granuloma?

A 
Neutrophils
Dendritic cells
B cells
T cells
NK cells
Fibroblasts
18
Q

What does a Ghon. complex consist of?

A

A Ghon focus and a pulmonary lymphadenopathy within a nearby pulmonary lymph node

19
Q

A Ghon complex is a source. of long-term TB infection. T/F?

A

True

20
Q

What type of necrosis occur within a Ghon focus?

A

Caseous necrosis

21
Q

What are the signs and symptoms of tuberculosis?

A 
Fever
Night sweats
Fatigue
Loss of appetite / weight. loss
Lymphadenopathy
Cough +/- haemoptysis
Dyspnoea
Meningitis
Choirditis
Constrictive percarditis
Dysuria / haematuria
Ileocaecal/abdominal pain
Lupus vulgaris
22
Q

What are the risk factors for the development of active tuberculosis?

A 
Untreated HIV
Immunosuppression due to transplantation
Silicosis
Chronic renal failure requiring dialysis
Recent TB infection
Abnormal CXR
INF-alpha inhibitors
Steroids
Diabetes mellitus
Young age when infected
Underweight
Cigarette smoker
23
Q

What imaging should be conducted on a patient with suspected TB?

A

CXR

24
Q

How should adults and children with latent TB be treated?

A

Isoniazid for 6 months

25
Q

How should children <15 with latent TB in from countries with a high TB incidence be treated?

A

Rifampicin and isoniazid daily for 3 months

26
Q

How should adults with latent TB in from countries with a high TB incidence be treated?

A

Rifampicin. and isoniazid weekly for three months

27
Q

How is active TB treated?

A

Rifampicin and isoniazid for 6 months

Ethambutol and pyrazinamide for 2 months

28
Q

What are the drug interactions / adverse events which can occur with rifampicin?

A

CYP450 inducer
Turns bodily secretions orange
Flu-like illness

29
Q

What are the drug interactions / adverse events which can occur with isoniazid?

A

Liver injury

30
Q

What are the drug interactions / adverse events which can occur with ethambutol?

A

Toxic optic neuropathy

31
Q

What are the drug interactions / adverse events which can occur with pyrazinamide?

A

Liver injury

Raised lactate

32
Q

How can resistance of Tb to both rifampicin and isoniazid be detected rapidly?

A

Molecular testing. (gene Xpert)

33
Q

How is multi drug resistant TB treated?

A

18 months to 2 years. of treatment with pyrazmdamide alongside fluoroquinolone, 2nd line injectable, ethionamid/prothionamide and cycloserine/p-aminosalicyclic acid for >8 months

34
Q

How should multi drug. resistant TB which is also resistant to flurorquinolone be treated?

A

No standard treatment

Surgical intervention should be considered

35
Q

Tb has a predilection for bones of the vertebral column. This can extend to form which complications?

A

Spinal/paraspinal abscess +/- cord compression

Extension of TB infection into the of the psoas muscle

36
Q

What are the two main types of infection which can occur if TB spreads to the brain?

A

TB meningitis

Cerebral TB

37
Q

What is TB meningitis?

A

A slow progressive condition with altered consciousness and progressive lower cranial nerve palsies

38
Q

What is cerebral TB?

A

A foci of infection in the cerebrum which can behave as a space-occupying lesion with seizures and venous system signs

39
Q

Other than the lungs, brain and bones, what organ systems can TB typically affect?

A 
Renal tract
Testes/ovaries
Larynx
Skin
Eye 
Liver

Clinical Microbiology (17 decks)

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