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MDCN 370: Course 3 > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

TB Tests:

– __ smear, culture. GeneXpert for organ system involved (___ type)

– ____ or ___ to identify latent tuberculosis infection

A

• Order the correct tests to diagnose MTB disease (“active”) and the correct
tests for MTB infection (“latent”)
– AFB smear, culture. GeneXpert for organ system involved (active)

– TST or IGRA to identify latent tuberculosis infection

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2
Q

Igra based test helps dx ___ TB

A

latent

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3
Q

TB: Airborne Infectious Disease caused by ___
tuberculosis. Requires ____ _____ staining.

A

TB: Airborne Infectious Disease caused by MYCOBACTERIUM tuberculosis. Requires ACID FAST staining.

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4
Q

2 specific acids in the cell wall of mycobacterium

A

arabinogalatan and mycolic acid. prevents them from catching staining. need acid fast visualizeation.

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5
Q

TB transmission

A

-through inhalation– AIRBORNE. aeruosol particles generated by coughing, sneezing, talking of person with active pulmonary TB.

rarely ingested in countries where milk is not pasteurized.

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6
Q

T/F TB can last on a surface for a long time

A

false. no fomite transmission. not like measels.

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7
Q

3 broad transmission factors of TB

A
  1. infectiousness of person with TB: bacterial burdan, caivtary disease, type of TB (laryngeal tb is very infectious), amount of coughing.
  2. duration of exposure (ex/ same household)
  3. envirnoment in which exposure occured: air circulation, UV light exposure (can kill bacteria), crowsing.
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8
Q

most infectious type of TB disease

A

laryngeal TB is more infectious than others. also if they ahve cavitary manifestations or an overall high bacterial burden.

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9
Q
A

myococavitation

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10
Q

outline the flowchart of the pathogenesis of tuberculosis.

A

a lot of TB just becomes latent/dormant.

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11
Q

TB Immune response:

__ ___ ingest MTB organism but
can’t kill them initially

MTB ___ inside an unprimed alveolar
macrophage (and can destroy it releasing more
MTB)

Eventually __-___ immunity / delayed-
type ____ are stimulated

• Alveolar macrophages signal ____lymphocytes
and become activated

• Activated ____ are able to kill MTB

A

TB Immune response:

ALVEOLAR MACROPHAGE ingest MTB organism but
can’t kill them initially

MTB MULTIPLIES inside an unprimed alveolar
macrophage (and can destroy it releasing more
MTB)

• Eventually cell-mediated immunity / delayed-
type hypersensitivity are stimulated

• Alveolar macrophages signal CD4 lymphocytes
and become activated

• Activated macrophages are able to kill MTB

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12
Q

how does HIV play a role in tuberculosis immune response

A

normally, macrophages ingest the TB and signals CD4 cells to become activated and causing further macrophage activation and cytokine response . in HIV, there are low CD4 levels. have increase risk of reduced immune response.

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13
Q

how is cell-mediated immunity demonstrated?

A

by positive TST/mantoux test or positive IGRA test. NOTE: TST and IGRA do not demonstrate active disease!! just latent.

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14
Q

two dermatological conditions that can indicate TB cell-related immunit

A

Erythema nodosum
• Phyctenular conjunctivitis

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15
Q
A
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16
Q

Latent TB:
diagnosed with ___ or ___

  • type of symptoms
  • rate of infection?
A

dx with TST or IGRA

  • usually asymptomatic, but at risk for progression to active TB if immunocompromised
  • non-infectious
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17
Q

active tb:

diagnosed by:

  • symptoms:
  • infectiousness?
A

diagnosed by smear and culture or granuloma evidence.

  • symptoms for sure; dyspnea, fever, infection-like symptoms
  • infectious if PULMONARY INVOLEMENT.
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18
Q

two branches of active tb

A
  1. pulmonary (infectious)
  2. extra-pulmonary
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19
Q

most common antibiotic to treat history

A

rifampin

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20
Q

t/f TB is the Leading infectious
disease related cause of
death worldwide

A

true.

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21
Q

what groups in canada have higher rates of TB

A

aboriginal individuals have had TB rates at a steady state, whereas non-indigenous canadians have lower and lower levels.

  • foreign born canadians also higher rates– especially filipino canadians.
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22
Q

epidemiologic risk factors for active tb

A
  • foreign born
  • recent travel
  • indigenous
  • health acre provider
  • travel history
  • knoen exposure to pulmonary TB patient
  • previous TB diagnosis.
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23
Q
A
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24
Q

symptoms of pulmonary tuberculosis (the infectious type)

A

cough, hemotysis, fever, dyspnea, weight loss, night sweats, subacute or chronic presentation. need to do CXR

  • possible lymph node involvement.
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25
Q

most common peripheral/extrapulmonary TB site besides lung/pulmonary involvement

A

peripheral lymph nodes

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26
Q

pulmonary TB investiagtions: most important imaging is ___. It determines the __ of the patient.

A

CXR. can help determine infeciousness.

27
Q

chest xr findings of pulmonary tb

A
  • typical clouding in a segment of the lobe (usually upper middle)
  • cavitation
  • volume loss
  • unilateral pleural effusino
  • mediastinalhilar lymphadenopathy
28
Q
A

hilar lymphadenopathy

29
Q
A

focal opacity in characteristic LUL.

  • gotta still do more tests, can also be cnacer or something.
30
Q
A

small nodular opacities in the RLL. also TB

31
Q
A

normal CXR! (this patient still tested positive for TB on smear)

32
Q

At least___ sputum specimens should be collected
and tested with microscopy as well as
mycobacterial culture

A

3

• Sputum specimens (either spontaneous or
induced) can be collected on the same day, a
minimum of 1 hour apart

33
Q

3 ways of collecting sputum for TB test

A
  1. expectorated samples or with salt water
  2. bronchoscopy
  3. gastric aspirate (usually children)
34
Q

during the smear and culture assessment, to test positive, there is a ___ to ____ bacteira per ml

A

5000 to 10,000 bacteria/ml for smear

35
Q

Outline the scheme for “cough, dyspnea and fever”: the first two branches are normal CXR vs abnormal CXR

A
36
Q

If you think patient may have pulmonary TB…..

A

ISOLATE patient (Airborne Isolation)

• Try to make diagnosis (eg. Send sputum
for AFB smear, culture, PCR test)

• Avoid using fluoroquinolones for treatment
while awaiting further information

37
Q

samples must be in ____ when sending

A

saline. not formaline

38
Q

Extra-Pulmonary Investigations

A

• Get samples!!
– Send fluid and/or tissue (FNA or biopsy) for
AFB smear, culture, +/- GeneXpert

– Must send for culture in SALINE not formalin – Ideally need culture to confirm diagnosis and do drug susceptibility testing

– Send tissue for histopathology – look for
granulomas/granulomatous inflammation

Extrapulmonary TB may be associated
with pulmonary TB so always do CXR, if
abnormal……

39
Q

Tuberculous Pleurisy

thoracentesis findings

A

• Thorocentesis: Exudative

• Lymphocyte predominate
effusion

40
Q
A

Pericardial TB

  • massive enlarged heart or pericardial effusion– pericardial TB
41
Q

tests to be done on this patient if you suspect tb

A

this could be lymph node tb– an extrapulmonary manifestation of TB.

  • need a FNA: might see granulomas.
  • excision biopsy
  • chest xray and culture
42
Q
A

spinal TB. could have potts diseases- compression of spinal cord due to inflammatory response

43
Q

Miliary Tuberculosis

A

Progressive
disseminated
hematogenous TB

44
Q

in miliary TB (systemic), you can get ___ on the lungs and get. hypotension due to ____ insufficeincy. this is mostly seen in ___ patients or those who are ____.

A

in miliary TB (systemic), you can get NODULES on the lungs and get. hypotension due to ADRENAL insufficeincy. this is mostly seen in ELEDELY patients or those who are IMMUNOCOMPROMISED.

45
Q

T/f sputum culture is sufficient to diagnose miliary TB

A

false. sputum culture in miliary tb is only 10% positive. you need other confirmatory tests: gold standard is transbronchial biopsies, liver biopsy, bone marrow, urine or blood tests.

46
Q

TB meningitis, what would by the glucose, protein, cell differential seen on CSF samply

A

low glucose, high protein. lymphocyte predominent. need AFB and culture. Start empiric treatment. this is an emergency

47
Q
A

tuberoma

48
Q

broad management of active TB

A

– Isolation-Airborne

– Antibiotic treatment

– HIV testing/Diabetes testing

– Follow Up / Medication Side effect monitoring– must be watched taking the meds

49
Q

empiric treatment for active TB (RIPE)

A

must take a combo of 4 drugs (antibiotics). do not one to develop resistance. needs to be directly observed.

RIPE = rifamin, isoniazid, pyrazinamide, ethambutol

50
Q

standard treatment duration of active TB on RIPE meds

A

6 months. stop ethambutold if fully susceptible. pyrazidamide is only used in first 3 months. 9 months of treatment needed if the patient can’t use the pZA.

51
Q

all antibiotics can have side effects. rifampin is a big one though. outline side efects

A
  • biggest one is medication interactions– blocks oral contraceptives. can also cause hepatitis, rash, myelosupression.
52
Q

second line drugs (other than RIPE) to treat MDR or XDR TB.

A
  • fluroquinolones, aminoglycosides, cycloserine, pas, bedaquiline, liinezolid.

XDR has a high mortality because of its ressitance to fluoquinoline

53
Q

what tests to do on sick contacts when managing the spread of TB

A
  • id those infected or contact with the infection with 2 TSTs!
  • can take 8 weeks to develop a cell-mediated immune response that is picked up by tst. usually do a tst twice– once at exposure and then 8-10 weeks later.
54
Q

T/F for latent tb, you can give monotherapy antibiotics

A

true. you need to use a 4-drug combo for active tb though

55
Q

Latent TB: Identify who is appropriate for testing. Who?

A

HIGH RISK: HIV, abnormal chest xray, renal failure, revent TB infection, silicosis, transplant recipients.

MODERATE RISK: TNFalpha inhibitor use, prednisone use, young age when infected.

56
Q

Normal TST expansion on arm for those who are immunocompromised, and then for those who are healthy

A

>5mm expansion for those with HIV, TB contact, presence of fibronordular disease on chest xray, tnf alpha inhibirots, renal disease, transplantation.

>10mm for those at lower risk (diabetes, malnutrition, silicosis, healthy)

57
Q

cons of TST

A

TST is not for active TB

58
Q

IGRA is a blood test that asseses the production of ___ ___ by t lymphocytes after TB exposure. measures ___ tb

A

production of interferon gamma by t lymphocytes after exposure to M.tuberculosis antigen

59
Q

Why aren’t TST/QFT used to diagnosis ACTIVE T

A
60
Q

note: IGRA only needed to test those at moderate risk for latent TB. You need both TST and IGRA is high risk

A
61
Q

treatment of latent tuberculosis

A
  • rifampin daily for 4 months.
  • may also use isoniazid and rifampin for shorter duration, or isoniazid alone for 9 months.
62
Q

• 34 year old female never smoker • Cough x 4 months • PMHx: sickle cell anemia • Immigrated from Nigeria 10 years ago​

DDX?

A

fibronodular disease (at higher risk for TB)

  • myocbacterial balls
63
Q

MDR TB is resistant to ___ and ___.

XDR TB is resistant to ___ , ___ , ___, and ___

A

MDR: resistant to INH and rifampin

XDR: resistnat to INH and rifamin and fluoroquinolone and aminoglycoside,

MDCN 370: Course 3 (90 decks)

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