Tuberculosis

Tuberculosis

1. Anatomy

2. Risk factors

   • Close contact
   • Immigration from endemic area
   • Children less than 5 years
   • Diabetes
   • Malnourished people

3. Stages

   • Primary
     • Mostly asymptomatic, some have flu-like symptoms
     • Cell mediated immunity (3 weeks)
     • Ghon complex (gown focus + lymph node)
   • Secondary
     • Reactivation of dormant TB
   • Systemic military TB
     • Kidneys (sterile pyuria, WBC in the urine)
     • Meningitis
     • Pott's disease (lumbar vertebra)
     • Addison's disease (adrenal glands)
     • Hepatits (liver)
     • Lymphadenitis in the neck (scrofula)

4. Radiology

   • Tree in a bud

5. Treatment and management

   • 4 drugs for 2 months, 2 drugs for 4 months
     • Rifampin (inhibits RNA synthesis)
     • Isoniazid (inhibits cell wall synthesis
     • Pyrazinamide (unclear exact target)
     • Ethambutol (inhibits cell wall synthesis
       • Optic neuropathy as an adverse effect

6. Prognosis

   • patients with treated TB can expect to do well with minimal or no sequele
   • Poor : in anemic states, smokers, late presentation of the disease

7. Signs&symptoms

   • Cough
     • Mechanism
       • Stimulation of mechano-or chemoreceptors
         • Afferent impulses to cough center (medulla)
           • Efferent impulses via vagus, phrenic, intercostal nerves
             • Increased contraction of muscles --> noisy expiration (cough)
     • Types
       • Productive
         • presence of excessive sputum, expectorants are useful
           • Sputum color
             • Mucoid (clear and white)
               • normally of little consequence and suggest that no infection is there
             • Yellow, green or brown
               • indicates infection, probably caused by a bacterial infection, such as bronchitis or pneumonia
             • Hemoptysis
               • Blood in the sputum, rusted (pneumonia), pink but thin and frothy (LVF), dark red (carcinoma)
       • Non-productive
         • serving no useful purpose, increased discomfort to the patient
   • Clubbing
     • Other Causes
       • Cyanotic heart diseases
       • Cystic fibrosis
       • Lung cancer
       • Ulcerative colitis
       • Lung abscess
         • Infective endocarditis

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