Tuberculosis and its treatment Flashcards
which parts of the world have a high incidence of TB?
sub-saharan africa india russian federation myanmar thailand, indonesia
in the UK which ethnicities have a high TB incidence?
indian pakistani bangladeshi black-african white (elderly people who had TB as children and gets reactivated)
What are the risk factors for TB?
born in area of high prevalence IVDU homeless alcoholic prisons HIV+
Describe what happens in pulmonary INFECTION
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
What are the features of M. tuberculosis itself?
aerobic non-motile non-sporing bacilli (slightly curved) waxy capsule
Describe the DISEASE pulmonary TB
- Primary (Ghon) focus = granuloma formation
- mediastinal lymph nodes enlarge + primary focus = Ghon complex
- granuloma grows and forms a cavity in apex
What are the systemic features of TB?
weight loss night sweats malaise anorexia low grade fever
What are the pulmonary syptoms of TB?
cough for 3 weeks
chest pain
breathlessness
haemoptysis
how does pleural effusion occur in TB?
the primary focus ruptures into the pleural space
How does bronchopneumonia occur in TB?
the primary focus (caseous nodes) erode into the bronchus
How does a pericardial effusion occur in TB?
caseous nodules rupture into the pericardium
When can dissemination occur?
after primary infection or after reactivation
What are the findings of blood tests?
Normochromic normocytic anaemia Thrombocytosis (raised platelets) Raised ESR / CRP Hypoalbuminemia Hypergammaglobulinemia Hypercalcemia
Where can samples can be taken from?
Sputum Urine CSF Pleural fluid Biopsy specimen Any Lymph nodes: Cervical, axillary, inguinal, mediastinal, abdominal Peritoneum omentum Bone Brain
Which test is used to diagnose latent TB?
tuberculin skin prick test (Mantoux)
What type of hypersensitivity reaction is triggered by the mantoux test?
type 4 delayed hypersensitivity
T cell mediated response
Which drugs in the standard therapy are bacteriocidal?
rifampacin
isoniazid
pyrazinamide
RIP! Bacteriocidal drugs
Which drug in the standard therapy is bacteriostatic?
ethambutol (think e static so static electricity)
Which drugs are given only for the first two months?
pyrazinamide
ethambutol
PE first thing :0)
Which drugs block cell wall synthesis?
isoniazid
ethambutol
(the vowels block cell wall synthesis)
What are the side effects of rifampicin?
red urine, hepatitis, drug interactions
What are the side effects of isoniazid
hepatitis, neuropathy
what are the side effects of pyrazinamide?
hepatitis, arthralgia/gout, rash
What is a side effect of ethambutol?
optic neuritis
drug starts with e so affects eye
