Tuberculosis

Question 1

Tuberculosis

Mycobacterium tuberculosis.

Transmission: air-borne particles

• Replication occurs within alveolar macrophages, and spread of infection occurs locally to regional lymph nodes (hilar)
• Widespread infection with multiple organ involvement is called miliary tuberculosis

Testing:

• Mantoux tuberculin skin test (TST) – PPD purified protein derivative
• Interferon gamma release assay (IGRA)
• Positive PPD
  
  • Checked for clinically active disease
  • In the absence of active disease treat with 9 months of isoniazid

Answer 1

Treatment: 4-drug regimen

1. isoniazid (hepatotoxicity)
2. rifampin
3. ethambutol
4. pyrazinamide

54% AIDS pt die from TB. 5-10% normal population

Question 2

Dental Management

If receiving INH (isoniazid) therapy for 6 months, treat as normal Pt

Otherwise defer tx, med consult

Answer 2

Oral Complications

Ulcer on dorsal tongue: painful, deep, irregular

Mucosal lesions: granular, nodular, leukoplakic (palate, lips, BM, gingiva)

Osteomyelitis

Scrofula: enlarged, painful cervical, submandibular lymph nodes with abscess and drainage

Lung Lesion

Ghon Complex: a calcified focus of infection and an associated lymph node seen on radiograph in TB