Week Two - Case Three Flashcards
what is TB and what is it caused by
chronic infection disease, caused by mycobacterium tuberculosis. (MTB)
what are the three types that infect humans
- M.tuberculosis (commonest)
- M.bovis (bovine TB)
- M.africanum
in how much of the global population is tuberculosis present in
about 30% of the global population, but in developed countries it is rate since the advent of TB inoculation
what happens to MTB when it is encountered by the immune system
it is engulfed by macrophages
what does the MTB and macrophages complex form
granulomas
where do these granulomas typically occur
the lungs, but the bacteria can also be carried to distant sites throughout the lymphatics, and granulomas can form at other sites
what is the test for latent TB
interferon gamma release assay (IGRA) or tuberculin skin testing (TST)
what is the test for active TB
XCR and microbiology (usually sputum) for acid fast bacilli
how is TB transmitted
via droplet spread - only the pulmonary form is infectious
usually needs sustained close contact with the infectious case
roughly how much of the worlds population has been infected with TB
roughly one third
in what patients do a signifiant amount of cases occur
those co-infected with HIV
how many cases are reported each year in the UK
9000 cases each year
what are the risk factors for TB
HIV (13% cases also have HIV)
Overcrowding/close contact with active case (1/3 chance of contracting from household member)
Ethnic minority groups
Malnutrition
IV drug use
Homelessness
Chronic lung disease
Immunosuppression
how many people will patients with active TB infect per year
on average 10-15
next few questions are on the pathogenesis
where does the mycobacteria go
the pulmonary alveoli
what happens to these mycobacteria
these are engulfed by alveolar macrophages and replicated within them
where is the primary site of infection
Primary site of infection (in the lungs) = “Ghon focus” (generally in upper lobe)
what surrounds the infected macrophages
lymphocytes and fibroblasts
what does this surrounding causes
granuloma formation
what does this granuloma formation prevent
dissemination of bacteria - prevents extra-pulmonary TB
what happens inside these lesions/granulomas
the bacteria may develop abnormal cell death in the centre (caseous necrosis) and can eliminate the bacteria
what is this sometimes called
LTBI - latent tuberculosis infection
what is the risk that LTBI will develop into active TB
there is a 10% chance that LTBI can develop into active TB during a patient’s lifetime.
the risk is greatest during the first two years of infection