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Year 3 - CR > Tuberculosis and Sarcoidosis > Flashcards

Tuberculosis and Sarcoidosis Flashcards

1
Q

How do you diagnose Active tuberculosis

A
  • CXR
  • sputum smear
  • Sputum culture - Gold standard
  • NAAT - more specific than a sputum smear
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2
Q

How do you treat tuberculosis for active TB and for latent TB

A

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

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3
Q

What would you find in a biopsy of sarcoidosis

A
  • non caseating granuloma
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4
Q

What is the treatment for sarcoidosis and what are the indications for these treatments

A

If symptomatic:

  • steroids
  • Anti-TNF

Indications

  • parenchymal lung disease on CXR
  • uveitis
  • hypercalcaemia
  • neurological ro cardiac involvement
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5
Q

What is the prognosis of sarcoidosis

A
  • 80% have no problem
  • 20% lung, eye - steroid treatment
  • 2% - brain and lung transplant
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6
Q

What causes TB

A
  • mycobacterium tuberculosis
  • M. bovis
  • Mycobacterium africanum
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7
Q

What stain is used to diagnose TB in a sputum smear

A

Zihel nelson stain

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8
Q

What is a microscopic feature of TB

A

Chording - when the M Tuberculosis bacteria stick together

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9
Q

What does a CXR look like of tuberculosis

A
  • Upper Lobe cavitation

- Bilateral hilar lymphadenopathy (BHL)

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10
Q

How many people worldwide are affected by TB

A
  • 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
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11
Q

What are the risk factors for developing TB

A
  • recent contacts
  • migrants from high incidence areas
  • people who work or reside in homeless shelters and prison
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12
Q

What is the risk factor for developing serious problems from TB

A

Immunosuppression

  • HIV
  • Substance abuse
  • silicosis
  • kidney disease
  • Diabetes
  • low body weight
  • transplant
  • head and neck cancer
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13
Q

what are the social risk factors for TB

A
  • alcohol misuse (5%)
  • homelessness (5%)
  • drug use (4.3%)
  • imprisonment (3.5%)
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14
Q

how does TB affect the most deprived versus the least deprived

A

56% TB cases in the most deprived versus 7.4% in the least deprived

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15
Q

how much of TB does multi resistant TB make up

A

3.5% of all TB

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16
Q

What is multi resistant TB (MDRTB)

A

TB that is resistant to

  • isoniazid
  • rifampicin
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17
Q

what is XDRTB (extremely drug resistant TB)

A

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%
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18
Q

What is the DOTS strategy (directly observed treatment) and what criteria is needed in order for DOTs to take place

A
  • 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
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19
Q

What TB symptoms do you need to know

A
  • cough
  • fever
  • night sweats
  • weight loss
20
Q

What are the common and uncommon symptoms of TB

A

Common

  • cough
  • sputum
  • fever
  • malaise
  • loss of appetite

Uncommon

  • haemoptysis
  • night sweats
  • weight loss
  • lymphadenopathy
21
Q

What do you ask when someone coughs up blood

A
  • when did it start
  • what time of day
  • how much
  • bright or dark red
  • streak or blob
22
Q

what can cause you to cough up blood

A
  • pulmonary embolism
  • tuberculosis
  • lung cancer
  • bronchiectasis
  • aspergilloma
  • anticoagulation
23
Q

What are the ways in which the body can react to TB

A
  • immediate clearance
  • latent infection
  • primary disease
  • reactivation disease
24
Q

describe primary TB

A
  • TB with no pre-exsiting immunity
  • non infectious
  • high mortality in immunocompromised
  • often outside the lung
  • children and elderly
  • HIV co-infection
25
Q

Describe post-primary TB

A
  • TB with pre-existing immunity
  • infection
  • cavities with TB biofilm
  • well tolerated
  • young adults
  • immunocompetent - CD4, CD8
26
Q

How do you diagnosis of TB

A

Sputum

  • PCR: Mtb and drug resistant
  • culture and drug sensitivity testing

CXR
Inflammatory markers
Histology

27
Q

Name ways to diagnosing TB

A
  • CXR
  • microscopy ziehl nelson stain - Sputum smear
  • sputum culture - GOLD STANDARD
  • interferon gamma release assay
  • manntoux test
  • gene Xpert MTB/RIF
  • genotype MDRTBPlus
28
Q

Isoniazid

  • action
  • site of action
  • adverse effects
A

Action
- Bactericidal

Site of action
- cell wall - Inhibits mycolic acid synthesis

Adverse effects

  • Liver damage
  • peripheral neuropathy
  • nausea
  • tiredness
29
Q

Rifampicin

  • action
  • site of action
  • adverse effects
A

Action
- Bacteriostatic

Site of action
- Ribosome - inhibits bacterial DNA dependent RNA polymerase preventing the transcription of DNA into mRNA

Adverse effects

  • liver damage
  • flu like symptoms
  • low platelets
  • makes urine go orange
30
Q

Pyrazinamide

  • action
  • site of action
  • adverse effects
A

Action
- Bacteriostatic

Site of action
- converts into pryazinamic acid which makes the pH of the bacteria acidic and inhibits fatty acid synthase

Adverse effects

  • flushing
  • arthritis
  • liver damage
  • gout
31
Q

Ethambutol

  • action
  • site of action
  • adverse effects
A

Action
- Bacteriostatic

Site of action
- cell wall - inhibits the enzyme arabinosyl transferase which polymerises arabinose into Arabinan

Adverse effects
- Optic neuritis

32
Q

how many people can a TB patient affect

A
  • 10-15 people
    Depends on
  • smear positive - 10000 organisms/ml of sputum
  • how many people they met t
33
Q

describe the management of TB

A

Stage 1
- If they have symptoms

Stage 2

  • Mantoux if under 65 years
  • chest x ray if over 65 years

Investigations

  • send sputum early
  • chest x ray (if not done)
  • inflammatory markers
  • immunological test
34
Q

What happens in the Mantoux test

A
  • purified protein derviative - collection of TB antigens injected
  • the hard area is then measured in 48 hours
  • can be positive in people who have BCG
  • greater than 15mm suggests TB infection
35
Q

What is the gold standard for diagnosing latent TB

A
  • QuantiFERON - TB gold - used with the ELISA
36
Q

What does BCG vaccine do

A
  • Attenuated M.bovis
  • cell mediated response
  • destroys the surrounding tissue
  • forms memory cells
  • forms scar
  • some protection against active disease
37
Q

What does BCG stand for

A
  • Bacillus Calmette- Guerin
38
Q

why do they think sarcoidosis occurs

A
  • exaggerated immune response
39
Q

What is the incidence of sarcoidosis

A
  • 1 - 35.5 per 100,000 (5% of TB)
  • Less than 64 per 100,000
  • age 25-45 (2nd peak in 50-70 in females)
40
Q

What are the symptoms of sarcoidosis

A

Acute symptoms

  • erythema nodosum
  • BHL
  • swinging fever
  • polyarthralgia

Insidious symptoms

  • dysnpneoa
  • non productive cough
  • malaise
  • weight loss

Skin
- lupus pernio

Hypercalameia

Other

  • breathlessness
  • thirst/polyuria
  • neurological
  • uveitis
41
Q

What happens in sarcoidosis to

  • FBC
  • calcium
  • CRP
  • SACE
  • CXR
  • IGRA
A
  • FBC = normal
  • calcium = raised
  • CRP = normal
  • SACE = raised
  • CXR = Bilateral Hilar Lymphadenopathy, midzones
  • IGRA = 5% are positive
42
Q

Describe the diagnosis pathway of sarcoidosis

A 
Diagnosis and Investigations 
First line 
CXR 
-	Stage 0 – normal 
-	Stage 1 – BHL 
-	Stage 2 – BHL and intersitial infiltrates 
-	Stage 3 – diffuse intersitital infiltrates 
-	Stage 4 – diffuse fibrosis

Others
- Spirometry – restrictive defect
- Tissue biopsy – non caseating granuloma
Biopsy
- Exclude other causes of granuloma
- Greater than in 1 organ – exclude other causes of multi system granulomatous diseases

43
Q

What syndromes are associated with sarcoidosis

A

Lofgrens Syndrome
- An acute form of the disease characterised by bilateral hilar lymphadenopathy, Erythema nodosum, fever and polyarthralgia

Heerfordt’s syndrome
- Parotid enlargement, fever, uveitis secondary to sarcoidosis

44
Q

What is the treatment of sarcoidosis

A
  • Most of the time it goes away on its own - monitor lung function and SACE

Symptomatic
- Steroids

other indications for treatment

  • hypercalaemia
  • eye disease
  • neurological disease
  • worsening lung function
45
Q

What investigations can be used to confirm the diagnosis of extra-pulmonary sarcoidosis

A
  • bronchoalveolar lavage
  • ultrasound - hepatosplenomeagly
  • bone x rays
  • CT/MRI
46
Q

What are the indication for corticosteroid treatment in sarcoidosis

A
  • parenchymal lung disease
  • uveitis
  • hypercalacaemia
  • neurological or cardiac involvement
47
Q

What else can cause a bilateral hilar lymphadenopathy

A
  • Sarcoidosis
    • Infection, eg tb, mycoplasma
    • Malignancy, eg lymphoma, carcinoma, mediastinal tumours
    • Organic dust disease, eg silicosis, berylliosis
    • Hypersensitivity pneumonitis
    • Histocytosis x (Langerhan’s cell histiocytosis).

Year 3 - CR (44 decks)

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