Tuberculosis and Sarcoidosis Flashcards
How do you diagnose Active tuberculosis
- CXR
- sputum smear
- Sputum culture - Gold standard
- NAAT - more specific than a sputum smear
How do you treat tuberculosis for active TB and for latent TB
Active TB
- Rifampicin - full 6 months (if they have TB of the CNS then 10 months)
- Isoniazid - full 6 months (if they have TB of the CNS then 10 months)
- Pyrazinamide - first 2 months
- Ethambutol - first 2 months
Latent TB
- 3 months of isoniazid and rifampicin or 6 months of isoniazid
What would you find in a biopsy of sarcoidosis
- non caseating granuloma
What is the treatment for sarcoidosis and what are the indications for these treatments
If symptomatic:
- steroids
- Anti-TNF
Indications
- parenchymal lung disease on CXR
- uveitis
- hypercalcaemia
- neurological ro cardiac involvement
What is the prognosis of sarcoidosis
- 80% have no problem
- 20% lung, eye - steroid treatment
- 2% - brain and lung transplant
What causes TB
- mycobacterium tuberculosis
- M. bovis
- Mycobacterium africanum
What stain is used to diagnose TB in a sputum smear
Zihel nelson stain
What is a microscopic feature of TB
Chording - when the M Tuberculosis bacteria stick together
What does a CXR look like of tuberculosis
- Upper Lobe cavitation
- Bilateral hilar lymphadenopathy (BHL)
How many people worldwide are affected by TB
- 3 billion infected (latent TB)
- 12 million cases at any one time
- 10.4 million new cases each year
- 2.6 million infectious diagnosed cases
What are the risk factors for developing TB
- recent contacts
- migrants from high incidence areas
- people who work or reside in homeless shelters and prison
What is the risk factor for developing serious problems from TB
Immunosuppression
- HIV
- Substance abuse
- silicosis
- kidney disease
- Diabetes
- low body weight
- transplant
- head and neck cancer
what are the social risk factors for TB
- alcohol misuse (5%)
- homelessness (5%)
- drug use (4.3%)
- imprisonment (3.5%)
how does TB affect the most deprived versus the least deprived
56% TB cases in the most deprived versus 7.4% in the least deprived
how much of TB does multi resistant TB make up
3.5% of all TB
What is multi resistant TB (MDRTB)
TB that is resistant to
- isoniazid
- rifampicin
what is XDRTB (extremely drug resistant TB)
cases where people are resistant to isoniazid, rifampicin as well as the 2nd line drugs such as
- amikacin
- fluroquinolones
- cure rate is 35%
- historical cure rate without treatment is 33%
What is the DOTS strategy (directly observed treatment) and what criteria is needed in order for DOTs to take place
- This is whereby a nurse comes every morning to make sure that the person is taking the medication and watches them take it to prevent the development of multi resistant TB
Conditions:
- those who have previously been treated for TB
- history of homelessness, drug or alcohol Misuse,
- in prison
- major psychiatric, memory or cognitive disorder
- in denial of TB diagnosi s
- have multi drug resistant TB
- are too ill to administer medication themselves