Tuberculosis Flashcards
If you have what then you are more likely to get TB?
HIV
Where are the TB incidence rates the highest?
Southern africa
Saharan africa
South east asia
Causative organisms of TB
Mycobacterium tuberculosis Mycobacterium bovis (bovine TB) Mycobacterium avium-intracellulare (HIV)
Transmission of mycobacterium tuberculosis
Respiratory droplets - coughing and sneezing
Transmission of mycobacterium bovis
Consumption of infected cows milk - deposited in cervical and intestinal lymph nodes
Pathology of TB
Infected with TB
Mycobacteria spread by lymphatics to draining hilar lymph nodes
Haematogenous seeding of mycobacteria to all organs of the body
Presentation of TB
Usually no symptoms Fever Malaise Erythema nodosum Rarely chest signs Initial lesion + local lymph node Lesion may calcify
Complications of TB
Primary focus continues to enlarge - cavitation
Enlarged hilar lymph compresses bronchi, lobar collapse
Enlarged lymph node discharges into bronchus (TB bronchopneumonia)
In a small number (1%) 6 - 12 months after infection, after the infection…….
Miliary TB fine mottling on X ray, widespread small granulomata
Meningeal TB, severe, CSF high protein, lymphocytes
TB pleural effusion
Possible causes post primary disease of TB
Reactivation of mycobacterium from latent primary infection spread by blood stream around the body
New reinfection from outside source, susceptible previously infected host
What in the body can TB affect?
Pulmonary disease Lymph nodes, usually cervical (scrofuloderma) Renal CNS (tuberculous meningitis) Bone and joint; spine (vertebral bodies - potts disease), hip GI tract GU Infertility Van deferens and fallopian tube effects Constrictive pericarditis, pericarditis Ascites Ileal TB - obstruction Addisions disease Lupus vulgaris
When does post primary disease of TB occur?
1 - 5 years
What is post primary TB?
Reactivation of latent disease
Features of post primary TB
May occur at any age
May be no symptoms for months
Progressive and occur over several months
Presentation of post primary TB
Cough Sputum Haemoptysis Pleuritic pain SOB Malaise + weight loss + night sweats (systemically unwell)
Who should you have a high index of suspicion of TB in?
Immunocompromised (HIV, corticosteroid therapy) Malnutrition Alcoholism Vagrants Previous gastric surgery Malignancy DM Adolescence Elderly Recent immigrants from high prevalent countries
What are the investigations of TB?
3 sputum specimens on successive days
- Sputum smear - Ziehl-Neilsen stain (ZN stain)
- Sputum culture
- Sputum PCR
CXR
- patchy (shadowing, often apices/upper zones or apex of lower lobes), often bilateral
- cavitation if advanced
- may calcify if chronic or healed TB
Further investigations if sputum -ve
- CT thorax
- Bronchoscopy with bronchoalveolar lavage
- pleural aspiration and biopsy if pleural effusion
What is cavitation?
Formation of an empty space