Tuberculosis Flashcards

1
Q

What is tuberculosis?

A

Granulomatous Disease causde by Mycobacterium tuberculosis.

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2
Q

What is primary TB?

A
  • Initial infection with TB
    • Normally pulomary (aquired by inhalation of cough of infected person)
    • occasionally GI
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3
Q

What is Milliary TB?

A

Results when there is haematogenous dissemination.

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4
Q

What is post-primary TB?

A

Caused by reinfection or reactivation

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5
Q

What is the epidemiology of TB?

A
  • Annual mortality 3 million (95% in developing countries)
    • 2 Billion infected worldwide
  • annual UK incidence 6000
  • Incidence in Asian immigrants >30 times native UK white population.
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6
Q

What kind of pathogen is Mycobacterium Tuberculosis?

A

Intracellular, aerobic organism (also known as acid-fast bacilli, AFB) which survives after being phagocytosed by macrophages

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7
Q

What does the primary infection with mycobacterium tuberculosis cause?

A
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8
Q

What are risk factors of tuberculosis?

A
  • Lived in endemic country (Asia, Latin America, Eastern europe, Africa) for years
  • Exposure to someone with infectious TB
  • HIV infection
  • Immunosuppressive medication
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9
Q

What is the association between immunosupression and TB?

A
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10
Q

What are symptoms of primary Tuberculosis?

A

Mostly asymptomatic

  • may have fever, malaise
  • cough, wheezeerythema nodosum and phlyctenular conjunctivitis (allergic manifestations).
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11
Q

What are signs and symptoms of milliary tuberculosis?

A
  • Fever, weight loss, meningitis
  • yellow caseous tubercles spread to other organs (e.g. in bone and kidney may remain dormant for years)
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12
Q

What are signs and symptoms of Post-primary Tuberculosis?

A
  • Fever/night sweats, malaise, weight loss,
  • Pulmonary TB: breathlessness, cough, sputum, haemoptysis, pleuritic pain, signs of pleural effusion, collapse, consolidation, fibrosis.
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13
Q

In which patient group is non-pulmonary TB particularly common?

A
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14
Q

What are non-pulmonary sites of TB infections?

A
  • Lymph nodes: Cervical/ Supraclavicular lymph nodes leading to abscesses (spread to skin) (most common extra-pulmonary manifestation)
    • Normally painless, rubberym firm texture
  • Gastrointestinal: Subacute obstruction, change in bowel habit, weight loss, peritonitis, ascites
  • Genitourinary: Urinary tract infection symptoms renal failure, epididymitis, endometrial or tubal involvement, infertility
  • CNS: Meningitis, tuberculoma.
  • Skin: Lupus vulgaris (jellylike reddish-brown glistening plaques).
  • Heart: Pericardial effusion, constrictive pericarditis
  • Adrenal: Insufficiency.
  • Bone/joints: Osteomyelitis, arthritis, paravertebral abscesses and vertebral collapse spinal cord compresson from abscesses.
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15
Q

Which investigations would you do in a patient with suspected Tuberculosis?

A
  • Sputum(pleural,bronchial): culture, microscopy,
    • low sensitivity, takes up to 6 Weeks
  • Tuberculin test
  • Interferon C test
  • Imaging
    • CXR
    • CT - lymoh nodes, other extra-pulmonary
  • HIV testing (2% might be +ve)
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16
Q

Explain the use and result of a Tuberculin test

A
  • Shows antibodies against TB
    • positive in previous Tuberculosis or BCG vaccine
    • Mantoux test (intradermal injection) –> redness after 72hrs
    • Heaf test (drop on skin) –> redness after 3-7 days
17
Q

What are expected finding of a patient with TB on a CXR?

A
  1. Primary infection: Peripheral consolidation, hilar lymphadenopathy.
  2. Miliary: Fine shadowing
  3. Post-primary: Upper lobe shadowing (greatest oxygenation –> aerob) , streaky fibrosis and cavitation, calcification, pleural effusion, hilar lymphadenopathy, pleural effusion