Tuberculosis

Question 1

How is TB spread?

Answer 1

Airborne (pulmonary and laryngeal TB spreads, the others not)

• someone with TB bacteria in their lungs coughs (sneezes, yells, sings)
• TB bacteria attached to aerosol droplets which can remain suspended in air for many hours, especially if there is poor air circulation
• someone else breathes these bacteria in
• usually requires prolonged close contact
• outdoors mycobacteria eliminated by UV radiation and dilution

Question 2

How is TB not spread?

Answer 2

• shaking hands
• sharing food
• touching surfaces
• sharing toothbrushes
• kissing

Question 3

What does TB usually present as?

Answer 3

• cough
• fever
• sweats (mainly at night)
• weight loss

CRP normal in 15%, ESR normal in 21%

Question 4

What is the treatment of TB?

Answer 4

• multiple drug therapy is essential
• single agent treatment leads to drug resistant organisms within 14 days
• therapy must continue for at least 6 months
• TB therapy is a job for committed specialists only
• legal requirement to notify all cases
• test for HIV, hep B and C

Question 5

What are the 4 drugs used for TB treatment?

Answer 5

• rifampicin
• isoniazid
• pyrazinamide
• ethambutol

Question 6

What side effects are caused by rifampicin?

Answer 6

• orange ‘irn bru’ urine/tears/lenses
• induces liver enzymes, prednisolone, anticonvulsants
• all hormonal contraceptive methods ineffective
• hepatitis
• rash

Question 7

What side effects are caused by isoniazid?

Answer 7

• hepatitis
• peripheral neuropathy (pyridoxine B6)
• rash

Question 8

What side effects are caused by pyrazinamide?

Answer 8

• hepatitis
• gout
• rash

Question 9

What side effects are caused by ethambutol?

Answer 9

• optic neuropathy (check visual acuity)
• rash