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Year 3 > Tuberculosis (RESP) > Flashcards

Tuberculosis (RESP) Flashcards

1
Q

Define TB.

A

An infectious, chronic, granulomatous disease

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2
Q

Which organism is TB caused by?

A

Mycobacterium tuberculosis

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3
Q

What body parts does TB affect?

A

Typically lungs (pulmonary TB) especially upper lobes, but can spread to any organ haematologically to cause extrapulmonary TB

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4
Q

Describe the disease progression from primary to secondary TB.

A
  • Mycobacterium tuberculosis is dormant in many patients before it progresses to active TB
  • primary TB is asymptomatic and occurs in immunocompetent individuals who are exposed to M. tuberculosis - this usually heals
  • (initial infection may be pulmonary or rarely GI and is typically lower lobe initially)
  • if host becomes immunocompromised, the initial infection may become reactivated into secondary TB
  • miliary TB occurs if there is haematogenous dissemination of TB
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5
Q

What does accumulation of lymphocytes and macrophages cause in TB?

A

Accumulation of lymphocytes and macrophages in the initial phase –> formation of caseating granulomas (associated with necrosis) in the lungs and other organs –> develop latency

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6
Q

What is miliary TB?

A

Potentially fatal form of TB resulting from haematogenous dissemination of TB:

  • kidneys causing sterile pyuria
  • meningitis
  • lumbar vertebrae –> Pott disease
  • adrenals causing Addison’s
  • liver causing hepatitis
  • cervical lymph nodes
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7
Q

What are some risk factors for TB? (7)

A
  • exposure to infection
  • immunosuppression (diabetes, Cushing’s, steroid use)
  • silicosis (form of lung fibrosis)
  • HIV
  • malignancy
  • birth in an endemic country (India, Bangladesh, Sub-Saharan Africa)
  • overcrowded areas
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8
Q

What are some examples of immunosuppression that increase TB risk? (3)

A
  • diabetes
  • Cushing’s
  • steroid use
  • (HIV)
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9
Q

Birth in which endemic countries increase TB risk? (3)

A
  • India
  • Bangladesh
  • Sub-Saharan Africa
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10
Q

What are the clinical features of TB? (10)

A
  • cough - productive (may have haemoptysis) + does not respond to conventional Abx therapy
  • fever (chronic, fluctuating)
  • weight loss
  • night sweats
  • SOB
  • anorexia
  • malaise
  • pleuritic chest pain
  • cervical lymphadenopathy + hilar lymphadenopathy
  • Pott’s disease –> spread to bones
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11
Q

What are some clinical features of miliary TB? (4)

A
  • fever
  • weight loss
  • meningitis
  • yellow caseous tubercles spread to other organisms
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12
Q

What might you see on examination in TB? (6)

A
  • chest exam may be normal in mild-moderate disease
  • crackles
  • bronchial breath sounds
  • amphoric breath sounds (distant hollow breath sounds heard over cavities)
  • clubbing (chronic disease)
  • erythema nodosum, erythema induratum
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13
Q

What is the 1st-line investigation for TB?

A

Chest X-ray

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14
Q

What can CXR show for TB? (4)

A
  • caseating granulomas - cavitating lesion in upper lobe
  • consolidation / fibronodular opacities (in upper lobes usually) with or without cavitation
  • bilateral hilar lymphadenopathy
  • pleural effusion
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15
Q

What is the gold-standard diagnostic test for TB?

A

Sputum culture - most sensitive and specific test

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16
Q

What is a sputum acid-fast bacilli smear for TB?

A
  • uses a Ziehl-Neelson stain or auramine stain
  • acid fast bacillus +ve in TB
17
Q

What test for another disease is offered to TB patients?

A

HIV test

18
Q

What test is usually offered for contacts of infected TB patients and what does it screen for?

A

Mantoux test - screens for latent TB

(Purified protein derivative - PPD is injected intradermally, erythema occurs after 72h)

19
Q

What can cause a false negative on the Mantoux test for latent TB? (4)

A

Immunosuppression:

  • sarcoidosis
  • steroid use
  • lymphoma
  • AIDS
  • (age extremes, fever, hypoalbuminuria, anaemia)
20
Q

What might FBC show in TB?

A
  • leukocytosis
  • anaemia seen in 10%
21
Q

What is seen on histology in TB?

A

Caseating granulomas

22
Q

What are some differential diagnoses for TB? (6)

A
  • COVID-19
  • community acquired pneumonia
  • lung cancer
  • non-tuberculous mycobacteria
  • fungal infection
  • sarcoidosis
23
Q

What is the 1st line management for latent TB? (2)

A
  • 3 months of isoniazid (with pyridoxine) and rifampicin
  • OR 6 months of isoniazid (with pyridoxine)
24
Q

What is the 1st line management for active TB? (4)

A

RIPE

  • Rifampicin - 6 months
  • Isoniazid - 6 months
  • Pyrazinamide - 2 months
  • Ethambutol - 2 months
25
Q

How do we manage meningeal TB?

A

RIPE for prolonged period (at least 12 months) + steroids

26
Q

What is a side effect of rifampicin (TB)?

A

Red/orange secretions - tears, urine

27
Q

What are some side effects of isoniazid (TB)? (2)

A
  • drug-induced lupus
  • peripheral neuropathy - give pyridoxine (vitamin B6) to prevent
    • e.g. pellagra (vitamin B3 deficiency) –> triad of dementia, diarrhoea and dermatitis –> death if untreated
    • e.g. sideroblastic anaemia
28
Q

What is a side effect of pyrazinamide (TB)?

A

Can cause gout due to hyperuricaemia

29
Q

What is a side effect of ethambutol (TB)?

A

May cause optic neuritis (colour blindness, loss of visual acuity, and restriction of visual fields)

30
Q

How do we manage meningeal TB?

A

RIPE for at least 12 months + steroids

31
Q

What is a complication of TB treatment?

A
  • immune reconstitution disease
  • occurs typically 3-6 weeks after starting treatment
  • often presents with enlarging lymph nodes
32
Q

What needs to be done before giving BCG vaccine for TB?

A

Tuberculin skin test to check for past exposure to TB

33
Q

What is MDR-TB?

A

TB that is resistant to 2+ first-line drugs including rifampicin and isoniazid - risk factors:

  • previous drug treatment for TB
  • incorrect dosages
  • non-adherence
  • travel to endemic regions
  • social risk factors (alcohol, drugs, homeless, prison)
  • exposure to patient with MDR-TB
  • HIV seropositivity
34
Q

What are some complications of TB? (7)

A
  • transmission of TB
  • immune reconstitution inflammatory syndrome
  • ARDS
  • pneumothorax
  • haemoptysis
  • bronchiectasis
  • empyema
35
Q

What is the mortality rate for TB without treatment?

A

> 50%

36
Q

What is the prognosis like for treated TB?

A

In general, patients can expect to do well with minimal or no sequelae

Year 3 (208 decks)

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