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Tuberculosis Flashcards

1
Q

Is the disease burgen from TB globally falling or rising?

A

Falling

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2
Q

How are worldwide incidences of TB changing each year?

A

Falling by 2%

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3
Q

How have TB deaths changed since 2000?

A

Fallen 29%

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4
Q

What number of killer of communicable disease is TB?

A

Number 1

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5
Q

How does deaths caused by TB compare to HIV and malaria?

A

TB kills more than HIV and malaria combined

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6
Q

Where are 2/3 of TB cases?

A

Across 8 countries

India

China

Indonesia

Philippines

Pakistan

Nigeria

Bangladesh

South Africa

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7
Q

What 3 countries have the most TB deaths?

A

1) India
2) China
3) Indonesia

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8
Q

How many people are infected with TB worldwide?

A

2 billion

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9
Q

How does incidence of TB change within countries?

A

Different regions can have higher incidences, such as London having 39% of all UK cases

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10
Q

Who are vulnerable groups in the UK?

A

People from high prevalence countries

HIV positive, immunocompromised

Elderly, neonates, diabetes

Homeless, alcohol, mental health problems, prison

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11
Q

What percentage of UK TB cases are from non-UK born people?

A

70%

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12
Q

How many cases are from the homeless, alcohols, mental health problems and prisons?

A

1 in 10

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13
Q

What is TB caused by?

A

Mycobacterium

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14
Q

Where is mycobacterium found?

A

Soil and water

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15
Q

What species of mycobacterium are responsible for TB?

A

Tuberculosis

Africanum

Bovis

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16
Q

What species of mycobacterium cause disease other than TB?

A

Leprae (leprosy)

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17
Q

What is mycobacterium that causes disease other than TB called?

A

Atypical

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18
Q

How can the growth of mycobacterium be described?

A

Non-motile bacteria

Very slowly growing

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19
Q

What does non-motile bacteria means?

A

Lacks the ability to propel themselves through the environment

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20
Q

Is mycobacterium anaerobic or aerobic?

A

Aerobic

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21
Q

How would you describe the cell wall of mycobacterium?

A

Very thick fatty cell wall

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22
Q

What are the consequences of mycobacterium having a very thick, fatty cell wall?

A

Resistant to alcohol

Resistant to neutrophil and macrophage destruction

Acid and alcohol fast bacilli (AAFB)

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23
Q

What can be said about acid and alcohol fast bacilli (AAFB) and TB?

A

Not all AAFB cause TB

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24
Q

How is TB spread?

A

Airborne

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25
What is the process of TB spreading airborne?
Someone with TB in their lungs coughs Attaches to aerosol droplets and remain suspended in the air for many hours Someone else breathes them in
26
What is an exception to mycobacterium being spread airborne?
Mycobacterium bovis
27
How is mycobacterium bovis spread?
Consumption of unpasteurized infected cow milk
28
What is the immunopathology of TB?
1) Activated macrophages 2) Epitheloid cells 3) Langhan's giant cells 4) Accumulation of the above 3 leads to a granumla
29
What leads to a granuloma with TB?
Activated macrophages Epitheloid cells Langhan's giant cells
30
What is the immune response of TB mediated by?
TH1
31
What does TH1 do in response to TB?
Eliminated invading mycobacterium but also causes tissue destruction due to activation of macrophages
32
What does the outcome of a TB infection depend on?
Infection Susceptibility
33
What factors determine the infection ability of TB?
Virulence Number
34
What factors determine the susceptibility of someone to TB?
Genetics Nutrition Age Immunosuppresion
35
What is virulence?
Pathogens ability to infect host
36
What is a pathogens ability to infect the host called?
Virulence
37
What happens during a primary TB infection?
No preceding exposure or immunity Mycobacterium spreads via lymphatics to draining hilar lymph nodes Usually no symptoms, can be fever, malaise
38
How does mycobacterium spread in a primary TB infection?
Lymphatics to draining hilar lymph nodes
39
What are some possible symptoms of primary TB?
Fever Malaise
40
What is malaise?
General feeling of discomfort, illness or unease whose exact cause is difficult to identify
41
What is the general feeling of discomfort, illness or unease whose exact cause is difficult to identify called?
Malaise
42
What are the possible outcomes of primary infection?
Progressive disease Contained latent Cleared (cured)
43
In what percentage of people does the infection progress to tuberculosis bronchopneumonia?
1%
44
What does tuberculous pneumonia cause?
Primary focus continues to enlarge, leading to cavitation Enlarged hilar lymph compress bronchi, lobar collapse Enlarged lymph nodes discharges into bronchus
45
What is the prognosis of tuberculous pneumonia like?
Poor
46
What is cavitation?
Formation of an empty space within a solid object or body
47
What is formation of an empty space within a solid object or body called?
Cavitation
48
In what percentage of people does the primary infection lead to military TB?
1-3%
49
What are examples of diseases that primary tuberculosis can progress to?
Tuberculous pneumonia Military TB
50
How does military TB develop?
Haematogenous spred of bacteria to multiple organs
51
What does haematogenous mean?
Originating or carried by the blood
52
Why are post primary diseases only present in humans?
Animals usually succumb to the primary disease
53
What are the 2 possible post primary diseases?
TB bacteria entering dormant stage with low or no replication over a prolonged period of time Balanced state of replication and destruction by immune mechanisms
54
What are the clinical presentations of TB?
Cough Fever Sweats (mainly at night) Weight loss
55
What is important to remember about the typical clinical presentations of TB?
They are not present in all cases: Fever absent in 37% Sweats absent in 39% Weight loss absent in 38% All 3 absent in 25%
56
What does diagnosing primary TB use?
Chest X-ray
57
What is typically seen in the chest X-ray of primary TB?
Mediastinal lymphadenopathy (mainly unilateral, 15% bilateral) Pleural effusion
58
What is typically seen in the chest X-ray of post primary TB?
Apices, soft fluffy/nodular upper zone Cavitation in 10-30% Normal chest X-ray in 13% Lymphadenopathy is rare
59
When should you consider getting a CT?
Normal chest X-ray but clinical suspicion Military TB Cavitation Lymphadenopathy
60
What is lymphadenopathy?
Abnormal size or number of lymph nodes
61
What is abnormal size of number of lymph nodes called?
Lymphadenopathy
62
What does a proper diagnosis require?
Sample of the bug
63
How is a sample of the bug obtained?
Sputum Bronchoscopy with BAL Endobronchial ultrasound (EBUS) with biopsy Lumbar puncture in CNS TB Urine in urogenital TB Aspirate/biopsy from tissue
64
What does EBUS stand up for?
Endobronchial ultrasound
65
What was the first TB drug?
Streptomycin
66
When was streptomycin discovered?
1944
67
What other TB drugs have been discovered since streptomycin?
Isoniazid (H) Pyrazinamide (Z) Rifampicin (R) Ethambutol (E)
68
What is the evolution of TB treatment?
Monotherapy (streptomycin) 2 drugs in 1950s, duration 18-24 months 3 drugs in 1960s, duration 12-18 months 3 drugs late 1960s, duration 9 months 4 drugs 19702, duration 6 months
69
What are the rules for the treatment of TB?
Multiple drug therapy is essential Single agent treatment leads to increased drug resistance within 14 days Therapy must continue for at least 6 months TB is a job for commited specialists only Legal requirment to notify all cases of TB Test for HIV, hep B and hep C
70
What is a legal requirment in terms of TB?
Notify of all cases
71
When someone has TB, what should you also check for?
HIV Hep B Hep C
72
How long must therapy for TB continue for?
At least 6 months
73
Why is multiple drug therapy essential?
Single agent treatment leads to drug resistance within 14 days
74
What is the standard treatment for TB?
2 R/H/Z/E + 4R/H per day 6 month duration at least Pyridoxine (vitamin B6) with isoniazid to reduce risk of neuropathy Steroids Vitamin D substitution
75
What is given with TB treatment to reduce the risk of neuropathy?
Pyridoxine (vitamine B6) with isoniazid
76
When does treatment last for longer than 6 months?
7-9 months if monoresistant 12 months for CNS TB 9-12 months, or 18-20 months if multidrug resistant
77
What percentage of MTB is dead within 2 days when treatment uses isoniazid?
90%
78
What percentage of MTB is dead within 14 days when treatment uses isoniazid and rifampicin?
99%
79
What is the annotation for the number of drugs and months?
80
What are some side effects of rifampicin?
Orange urine/tears Induces liver enzymes All hormonal contraceptives ineffective Hepatitis
81
What are side effects of isoniazid?
Hepatitis Peipheral neuropathy
82
What are side effects of pyrazinamide?
Hepatitis Gout
83
What is gout?
A form of arthiritis caused by excess uric acid
84
What is a form of arthiritis caused by excess uric acid?
Gout
85
What are side effects of ethambutol?
Optic neuropathy
86
What vaccine is used to fight TB?
BCG
87
Who is the BCG given to?
Neonates Unvaccinated children under 5 whose parents/grandparents were born in a country with an annual incidence of TB of 40/100,000 or greater Unimmunised contacts of cases Unimmunised high risk employees
88
What must the incidence of TB be to get the BCG?
40/100,000
89
When is screening for TB done?
Contacts of people with active pulmonary or laryngeal TB who are aged less than 65 (hepatoxicity increases with age) New entrants from high endemic areas Pre biologics Outbreaks
90
What is the treatment for latent TB?

respiratory system 2 (37 decks)

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