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Respiratory > Tuberculosis and its treatment > Flashcards

Tuberculosis and its treatment Flashcards

1
Q

which parts of the world have a high incidence of TB?

A 
sub-saharan africa 
india 
russian federation
myanmar
thailand, indonesia
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2
Q

in the UK which ethnicities have a high TB incidence?

A 
indian
pakistani
bangladeshi 
black-african
white (elderly people who had TB as children and gets reactivated)
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3
Q

What are the risk factors for TB?

A 
born in area of high prevalence 
IVDU
homeless
alcoholic
prisons
HIV+
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4
Q

Describe what happens in pulmonary INFECTION

A

majority of people mount an effective immune response , which capsulates and contains the organism, macrophages and lyphocytes seal in and contain majority of infecting bacilli - so majority do not have any DISEASE
the bacilli settle in the apex of the lung

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5
Q

What are the features of M. tuberculosis itself?

A 
aerobic
non-motile
non-sporing
bacilli (slightly curved)
waxy capsule
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6
Q

Describe the DISEASE pulmonary TB

A
  1. Primary (Ghon) focus = granuloma formation
  2. mediastinal lymph nodes enlarge + primary focus = Ghon complex
  3. granuloma grows and forms a cavity in apex
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7
Q

What are the systemic features of TB?

A 
weight loss
night sweats 
malaise
anorexia
low grade fever
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8
Q

What are the pulmonary syptoms of TB?

A

cough for 3 weeks
chest pain
breathlessness
haemoptysis

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9
Q

how does pleural effusion occur in TB?

A

the primary focus ruptures into the pleural space

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10
Q

How does bronchopneumonia occur in TB?

A

the primary focus (caseous nodes) erode into the bronchus

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11
Q

How does a pericardial effusion occur in TB?

A

caseous nodules rupture into the pericardium

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12
Q

When can dissemination occur?

A

after primary infection or after reactivation

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13
Q

What are the findings of blood tests?

A 
Normochromic normocytic anaemia
Thrombocytosis (raised platelets)
Raised ESR / CRP
Hypoalbuminemia
Hypergammaglobulinemia
Hypercalcemia
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14
Q

Where can samples can be taken from?

A 
Sputum
Urine
CSF
Pleural fluid
Biopsy specimen
Any Lymph nodes: Cervical, axillary, inguinal, mediastinal, abdominal
Peritoneum omentum
Bone
Brain
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15
Q

Which test is used to diagnose latent TB?

A

tuberculin skin prick test (Mantoux)

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16
Q

What type of hypersensitivity reaction is triggered by the mantoux test?

A

type 4 delayed hypersensitivity

T cell mediated response

17
Q

Which drugs in the standard therapy are bacteriocidal?

A

rifampacin
isoniazid
pyrazinamide
RIP! Bacteriocidal drugs

18
Q

Which drug in the standard therapy is bacteriostatic?

A

ethambutol (think e static so static electricity)

19
Q

Which drugs are given only for the first two months?

A

pyrazinamide
ethambutol
PE first thing :0)

20
Q

Which drugs block cell wall synthesis?

A

isoniazid
ethambutol
(the vowels block cell wall synthesis)

21
Q

What are the side effects of rifampicin?

A

red urine, hepatitis, drug interactions

22
Q

What are the side effects of isoniazid

A

hepatitis, neuropathy

23
Q

what are the side effects of pyrazinamide?

A

hepatitis, arthralgia/gout, rash

24
Q

What is a side effect of ethambutol?

A

optic neuritis

drug starts with e so affects eye

25
Q

Why is treatment with standard therapy so long?

A

to kill any bacteria that come out of dormancy and reactivate

26
Q

Give a disadvantage of the IGRA (interferon-γ release assay) method

A

only detects the memory T cell response, may not be dormant bacteria in the body as the immune system may have destroyed these

27
Q

What is multidrug resistant TB defined as?

A

resistance to at least rifampicin and isoniazid

28
Q

What are the risk factors of drug resistance?

A

previous treatment
high risk area
contact with resistant TB
poor response to therapy

29
Q

What are the problems with drug resistant TB?

A 
drugs need to be taken for 20-22 months
more drugs need to be taken
get more side effects 
huge increase in cost 
increased relapse rate
higher mortality and morbidity
30
Q

What are the menthods of prevention of spread of TB?

A

find cases of pulmonary TB early to treat them early
detect and treat latent TB ie by the Mantaux test or IGRA
BCG (Bacillus Calmette–Guérin) vaccination particularly for neonates
chemoprophylaxis to high risk groups eg HIV+ and those with contacts

31
Q

What are the different ways of giving chemoprophylaxis?

A

either 6 months isoniazid or 3 months rifampicin and isoniazid

32
Q

How does and interferon gamma release assay work?

A

relies on the fact that T-lymphocytes will release IFN-γ when exposed to specific antigens.

33
Q

How does the BCG vaccination worK?

A

The live attenuated strain of Mycobacterium bovis known as bacillus Calmette-Guérin (BCG) uses shared antigens to stimulate the development of cross-immunity to Mycobacterium tuberculosis and Mycobacterium leprae.

Respiratory (12 decks)

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