Tuberculosis Parts II

Question 1

The typical clinical manifestations OF TB

Answer 1

fatigue, weight loss, night sweats and fever

Question 2

Clinical features of pulmonary TB

Answer 2

productive cough
bleeding or coughing blood
hoarse voice
pleural effusion

Question 3

Clinical features of extra-pulmonary TB

Answer 3

Virtually any organ system can be involved
* Common, important sites are:
* TB meningitis (infection of the meninges or lining of the brain)
very serious, frequently causing brain damage and death

• Bone and joint disease (causing a chronic arthritis or osteitis affecting spine and other
  joints)
• Isolated lymphadenitis causing swelling of lymph nodes
• Peritoneal or pericardial TB
• Urogenital TB
• TB of the gastro-intestinal tract
• Extra-pulmonary TB can occur with or without pulmonary TB

Question 4

Clinical features in HIV positive persons vary according to degree of immunocompromise

Answer 4

• With preserved immunity (higher CD4 counts) patients will have more typical clinical features
• In advanced HIV infection with decreased cell mediated immunity maybe not

Question 5

In advanced HIV infection

Answer 5

Don’t develop characteristic granulomas
* Unable to control dissemination (spread) of TB bacilli throughout body
* So more likely to have extra-pulmonary TB

Question 6

Clinical features of miliary TB

Answer 6

don’t have classic symptoms of
pulmonary TB like cough or haemoptysis or even fever

usually weak and sick

Question 7

Patients at risk of miliary TB

Answer 7

advanced HIV, young infants, other immunocompromised patients

Question 8

miliary Tb in patient

Answer 8

Widespread small granulomas in many organs
* Due to failure of host response to control infection
* the Mantoux test is frequently negative due to lack of host immune response
* May not have classical acute medical emergency with risk of death - need prompt
anti-TB treatment

Question 9

Treatment of tuberculosis: principles

Answer 9

Importance of multi-drug combination treatment
* Use drugs that kill mycobacteria effectively and or act at different sites or stages of infection
* Treatment needs to be prolonged

Question 10

Importance of multi-drug combination treatment.

Answer 10

use a combination of drugs that work in different ways, thereby
significantly reducing the chance of drug resistance emerginG.

Question 11

Use drugs that kill mycobacteria effectively and or act at
different sites or stages of infection

Answer 11

• Mycobacteria are innately resistant to most antibacterial agents
• So specific antituberculosis drugs must be used

Question 12

Name these drugds

Answer 12

ampicin, isoniazid, pyrazinamide,

Question 13

WHY Treatment needs to be prolonged?

Answer 13

Because of slow replication rate and because most antimicrobials only work on growing
organisms.

Question 14

Increasing problem of drug resistant tuberculosis

Answer 14

1. can be because of non-adherence
2. acquired from someone with drug resistant TB.

Question 15

Prevention of tuberculosis:

Answer 15

vaccination:

• Currently the only available TB vaccine is a live attenuated M.bovis strain

Calmette-Guerin (BCG) vaccine

Question 16

Prevention of tuberculosis by chemoprophylaxis

Answer 16

Give prophylactic anti-TB drugs to prevent them developing TB disease and/or to kill the relatively fewTB bacilli that may be present now

Question 17

Current chemoprophylaxis regimen in South Africa=

Answer 17

isoniazid

Question 18

what is Chemoprophylaxis?

Answer 18

The use of drugs (antimicrobials) to prevent disease.

Question 19

Chemoprophylaxis is for:

Answer 19

for infected people but asymptomatic and people who is at high risk of developing active disease.