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Pulmonary Tuberculosis
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- 1Symptoms and signs of Pulmonary tuberculosisHistory of cough, weight loss, fever, night sweats, sputum, malaise, pleurisy ( pleuritis), haemoptysis, pleural effusion, or superimposed pulmonary infection.
- 2Presentation of Genito Urinary TB.may manifest as pyelonephritis ( fever, back pain, pyuria) , Dysuria, frequency, loin/ back pain, haematuria, sterile pyuria ( presence of elevated number of white cells >10 white cells/mm3.
- 3Presentation of Bone TBWeight-bearing joints are most commonly involved. Progressive or constant pain in involved bones and chronic or subacute arthritis (usually monoarticular). In Pott disease, spinal cord compression produces neurologic deficits, including paraplegia; paravertebral swelling may result from an abscess.
- 4Presentations of Skin TBJelly like nodules on face or neck ( lupus vulgaris)
- 5Presentation of peritoneal TBAbdominal pain, GI upset, Intestinal invasion generally causes hyperplasia and an inflammatory bowel syndrome with pain, diarrhea, obstruction, and hematochezia.
- 6Presentation of TB meningitisDevastating disease with 30% mortality.
Prodrome: fever, headache, vomiting,,abdominal pain , drowsiness, delirium. +_ seizures. CNS signs: tremor, papilloedema ( swelling of optic nerve secondary to raised intracranial pressure), cranial nerve palsies. - 7Microbiology of tuberculosisMycobacteria are small slow growing ( 20h division), aerobic bacilli with complex thick waxy wall of mycolic acid. Resists gram stain and decolorisation by acid ( ACID FAST). Stains for acid fast: Ziehl-Neelsen (stains organisms red) and Auramine ( fluorescent). Lowenstein-Jensen culture medium ( 3-6 weeks for MTB). PCR can be used but not as sensitive as culture.
- 8Patient groups predisposed to TBImmigrants, elderly, Diabetics
Immunocompromised: HIV, lymphoma, long term steroid/ chemotherapy.
Alcoholics/ homeless - 9Investigations and diagnosis of Pulmonary tuberculosis.If CXR suggests TB, take sputum samples (>_ 3, with one early morning sample) MC&S for AF bacilli. PCR : rapid identification of rifampicin resistance.
Tuberculin skin test (TST) or interferon-gamma release assay (IGRA).nitial tests are chest x-ray and sputum examination and culture. If the diagnosis of active TB is still unclear after chest imaging and sputum examination, TST or IGRA may be done. Nucleic acid–based tests (eg, PCR) can be diagnostic. - 10Investigations and diagnosis of non-pulmonary tuberculosisTry hard to get samples: sputum, pleura and pleural fluids, urine, pus, ascites, peritoneum, bone marrow or CSF. Send surgical samples for culture. Should have CXR
- 11Pathogenesis of tuberculosisAfter infection, the host either develops a primary infection immediately, or no initial infection occurs and the disease remains latent within the body. Upon inhalation, tuberculosis bacteria travel to the lungs, attacked by the body's macrophages in alveoli. engulfed by macrophages
but are relatively resistant to destruction by lysosomal enzymes. They are not destroyed by phagocytosis. Once inside the macrophages M. tuberculosis can grow and multiply. This causes the macrophages to die and release bacterial cells that can infect further macrophages. Cell mediated response and granuloma is formed and prevents them from spreading. In some cases bacterias are killed and lesions become calcified. in other cases caseous necrosis, fibrosis and cavitation apices. Progression pneumonitis to cavitation. Intrabronchial spread to other parts of lungs. - 12Why patients with TB require treatment with multiple drugsMultiple antibiotics are necessary to prevent the emergence of drug resistance in the bacteria.
- 13What is typical treatment regime for TBRifampicin, isoniazid, ethambutol and pyrazinamide initial for 2 months and then rifampicin and isoniazid for further 4 months.
- 14Side effects of rifampicinHepatitis, rash, GI upset, flu like symptoms,
Drug interactions with OCP (oral contraceptive pill)/ prednisolone. - 15Side effects of Isoniazidrash
Peripheral neuropathy (damage to peripheral nerves, causes weakness, numbness and pain, usually in hands, feet)
hepatitis - 16Side effects of EthambutolOptic neuropathy ( colour vision is the first to deteriorate)
- 17Side effects of pyrazinamideHepatitis,
facial flushing,
rash,
arthralgia (pain in joint),
nausea and anorexia
High uric acid - 18Process of directly observed therapyA problem with treatment arises when patients stop taking the drugs as soon as they feel better, because of inconvenience or to save money and may lead to recurrence of illness in the individual and the emergence of drug resistant strains
of M. tuberculosis. Directly Observed Treatment, Short Course (DOTS) uses a health worker to make sure that each patient takes their complete course of drugs. - 19Explain the origin of multi drug resistant TB and problems associated with its treatment?A problem with treatment arises when patients stop taking the drugs as soon as they feel better, because of inconvenience or to save money. This is mainly seen in patients in poorer countries or those of low socio-economic status in developed nations. Badly supervised, incomplete or incorrect treatment programmes may lead to recurrence of illness in the individual and the emergence of drug resistant strains of M. tuberculosis. Examination of the bacteria isolated from relapsed cases shows that 52 % are resistant to one or more drugs.
- 20why Contact tracing is essential?Contact screening may identify asymptomatic TB.Chemoprophylaxis may prevent disease progression. Prophylaxis entails one to two anti-TB drugs for shorter period than for symptomatic disease.
- 21Mantoux test or Tuberculin skin testTB antigen is injected intra-dermally and cell mediated response at 48-72 hours is recorded. A +ve test indicates immunity, previous exposure or BCG. A strong +ve test probably means active TB.
<5mm -- negative, >15mm almost always likely to be TB. 6mm-15mm-- depends. False -ve test in immunosuppression ( military TB, Sarcoid, AIDS, lymphoma. - 22Process of TB notificationRegistered medical practitioners have a statutory duty to notify the 'proper officer' at their local council or local health protection team (HPT) of suspected cases of notifiable diseases. They must:
Complete a notification form immediately on diagnosis of a suspected notifiable disease. They should not wait for laboratory confirmation of a suspected infection or contamination before notification. Send the form securely to the proper officer within three days, or notify them verbally within 24 hours if the case is urgent. - 23List the people in contact with a person with TB who should be traced.Close contacts' are people who have had prolonged, frequent or intense contact with a person with infectious TB. For example, these could include 'household contacts' – those who share a bedroom, kitchen, bathroom or sitting room with the index case. Close contacts may also include boyfriends or girlfriends and frequent visitors to the home of the index case. Depending in the circumstances, occasionally coworkers are classed as 'close contacts although they are more usually classed as 'social contacts'.
- 24Indications for immunisation against tuberculosisChildren ( up to 16 ) living in the area of high incidence of TB or with a parent or grandparent born in the country of high incidence.
Individuals at occupational risk - healthcare worker, lab staff, veterinary staff, prison staff, staff of care homes and hostels. - 25Describe the BCG vaccine ( Bacillus calmette Guerin)The BCG vaccine contains a live strain of a bacterium closely related to the one that causes TB in humans. The bacterium has been weakened (attenuated), so that it stimulates the immune system but does not cause disease in healthy people. The bacterium used for the vaccine is called Mycobacterium bovis, which causes TB in animals such as cows and badgers.
- 26Where does TB infection normally started?Intact respiratory mucosa is very resistant to invasion by microorganisms. Infection therefore begins in the terminal air spaces right at the periphery of lungs, usually just beneath the pleural surface.
- 27Pathology of TBIn the majority of infected individuals (95%) this dissemination remains entirely asymptomatic. After a few week T cell mediated immunity is established.
Macrophages (APC) activate mycobacteria specific CD4+ T helper cells via MHC class II. The Th1 T heller cells produce interferon gamma , this cytokine is a powerful activator of macrophages, promoting increased level of intracellular killing. - 28How granuloma is formed in TB?Activated macrophages aggregate around mycobacteria to form granulomas. The centre of the lesion becomes necrotic with an appearance like soft cheese (caseous necrosis) and most of the bacteria die. A few bacilli, however, survive in a dormant form and cause reactivation of TB.
- 29What is Ghon complex?Calcified scar in the lung parenchyma and the hilar lymph nodes, together this is referred to as the Ghon complex.
- 30What Active TB is?Infection with M. tuberculosis where mycobacteria are growing and causing symptoms and signs of disease.
-- A small minority of people are unable to contain the initial infection due to an inadequate T cells immune response : progress immediately to active TB.
--reactivation of Latent TB: immunocompromised - 31Most common sites of extra-pulmonary TB?Lymph nodes (mainly cervical and supraclavicular)
and
kidneys
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- Respiratory medicine Fichas sobre Pulmonary Tuberculosis, creado por Rahul sharma el 04/08/2016.
- Creado por
- Rahul sharma
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