Name 10 pulmonary complications of Tb
- Massive haemoptysis!
- pleural effusion !
- cor pulmonale ( rhf caused by lungs)
- fibrosis! / emphysema
- cavitations!
- atypical mycobacterium infection
- aspergilloma!
- lung /pleural calcification
- obstructive airways disease
- bronchiectasis!
- bronchopleural fistula
Name 7 non pulmonary complications of Tb
- Lymphadenitis!
- pleural effusion!
- genitourinary
- Meningo encephalitis!
- Disseminated Tb to other organs
- pericardial effusion
- Empyema necessitans
- laryngitis
- enteritis!
- Anorectal disease!
- amyloïdosis
- Poncet’s polyarthritis (immune mediated )!
Name 5 side effects rifampicin
- Anorexia, nausea, abdominal pain
- orange/red coloured urine!
- jaundice/hepatotoxicity / hepatitis / DILI ! (stop drugs and rechallenge in hospital)
- skin itch, rash!
- thrombocytopenia / purpura (stop and refer)
Name 3 side effects isoniazid
- Peripheral neuropathy (add pyridoxine B6)
- jaundice / DILI / hepatitis
- rash, skin itching
Name 3 side effects pyrazinamide
- Joint pains / gout
- jaundice / DILI /hepatitis
- rash, skin itch
Name side effects ethambutol
- Visual impairment / loss (stop immediately, do not rechallenge )
If DILI occurs after starting Tb treatment and need to stop treatment, before rechallenging, which “liver friendly” regimen is started in mean time. (3)
- moxifloxacin
- Ethambutol
- streptomycin
MES
How re -challenge Tb drugs following DILI? (10)
- Stop Tb treatment and all hepatotoxic drugs, stop arvs if in liver failure
- do INR / ptt/ LFT / bili
- start liver friendly regimen (MES): moxifloxacin, ethambutol, streptomycin
- repeat LFT and total bilirubin after 2-3 days
- if Alt < 100 iu/l and total bilirubin normal, start rechallenge.
- day 1: rifampicin
- day 3: check alt
- day 4-6: add isoniazid
- day 7: check alt
- day 8: pyrazinamide
- day 10: check alt
- monitor alt weekly for 4 weeks
Define Tb treatment failure (2)
Positive sputum smear/culture after 5 months
Or
MDR regardless of smear result
Define MDR Tb
Resistance to both isoniazid and rifampicin
Define xDR Tb
Mdr +
resistance to any fluoroquindone +
at least one of the following second line injectables: (cak) capreomycin, amikacin, kanamycin
Treatment MDR tb?
KEMPT
- kanamycin
- ethambutol
- moxifloxacin
- pyrazinamide
- terizidone
Treat for 18 months and until sputum negative. Then an extra 24 months,
What is Tb spine called
Potts disease (spondylitis)
Presentation Potts disease? (5)
- Back pain spinal or radicular
- 50% have neurologic abnormalities - spinal cord compression from cold abscess
- C spine less likely, mostly thoracic spine
- gibbus = sharply angled curvature of spine due to vertebral collapse
- kyphosis
Diagnosis Tb pleural effusion? (6)
- Lymphocyte/neutrophil ratio > 0,75
- adenosine deaminase ADA >50 IU / L
- lysozyme > 15 mg/dl
- < 5% mesothelial cells
- positive afb/culture
- exudative
Rifafour pill count?
71 kg or more = 5 tablets
55 - 70 kg = 4
38-54 kg = 3
Treatment TB meningitis?
9 months!
Ripe + streptomycin
+ steroid - cortisol!
How monitor TB treatment
Sputum spear at 2 and 5 months
When is tuberculin skin test positive
5 or more mm
