Tuberculosis

Question 1

TB general and risk factors

Answer 1

Mycobacterium Tuberculosis infection, normally affects the lungs however may lay latent for sometime.

Rx: poverty, alcohol, tobacco, immunosuppression, contact with TB

Question 2

Clinical features of TB?

Answer 2

Pulmonary
- silent of cough, sputum, malaise, weight loss, night sweats, pleurisy, haemoptysis, pleural effusion (SOB), superimposed pulmonary infection

Milliary
- Haematogenous spread. non-specific or overwhelming signs. Nodular opacities on CXR, retinal TB

Genitourinary
- dysuria, freq, loin pain, haematuria, sterile pyuria

Bone
- vertebral collaps and pott’s vertebra (Most common extra pulmonary manifestation

Meningitis

• prodrome: fever, HA, V, abdo pain, drowsy, meningism, delirium over 1-3 weeks
• CN palsies and papilloedema

Question 3

Diagnosis of TB

Answer 3

Latent TB:

• Mantoux (skin testing) = positive/immunity, stong positive/likely infected –>QFG
• QuantiFERON Gold

Active TB

• CXR - consolidation, cavitation, fibrosis, calcification
• Sputum sample x3
• PCR

Active non-resp TB
- sample of sputum, pleura and pleural fluid, urine, ascities, peritoneum, bone marrow and even CSF (culture for up to 12 weeks)

Question 4

Management of TB

Answer 4

before Tx

• stress importance of compliance
• test colour vision and VA
• FBC, UEC, LFT

Drugs: MANY SIDE EFFECTS

• Rifampicin - raised LFT, orange discol of urine/tears
• Isoniazid - raised LFT, nephropathy
• Pyrazinamide - hepatitis, arthralgia
• Ethambutol - optic neurits