INFECTIOUS DISEASES > Tuberculosis (TB) > Flashcards

Tuberculosis (TB) Flashcards

(18 cards)

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1
Q

What pathogen causes it?

A

Mycobacterium tuberculosis

Also called M.bovis

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2
Q

How is it transmitted?

Where does it tend to spread more?

A

Via air droplets in the air - just like COVID

Overcrowding
Prisons

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3
Q

Pathophysiology - Primary infection:

Primary infection:

  • What are tubercles?
  • These tubercles can become caseating. What does this mean?
  • Where does the infection usually spread to?

Pathophysiology - Latent TB:

  • Not everyone has an active infection. How would you know someone has latent (asymptomatic) TB?
  • What percentage of people have a reactivation with latent TB?
  • What causes a reactivation?
A

Tubercles are nodules that contain caseous necrosis, which forms in the lungs as a result of an infection with Mycobacterium tuberculosis in the patients with tuberculosis. Granulomas form in the infected tissue and undergo necrosis in the centre. Tubercles are also known as tuberculous nodules, or tuberculomas.

Lymph nodes

Latent TB is where you’ve been infected with the TB bacteria, but do not have any symptoms of active infection.

They have a positive skin/blood test.
The immune system deals with it by forming granulomas preventing bacteria growth and spread

5-10 %

Immunosuppression
Physical stress

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4
Q

Clinical features:

Are the symptoms chronic or acute?
What type on onset does it have?

What systemic S+S do they have? - 5

Pulmonary TB:

  • What type of cough do they have?
  • What other features may have have wit the cough?
  • What 4 other lung diseases may they progress to having?
A

CHRONIC - THIS IS NOT A NEW INFECTION - IT HAS AN INSIDIOUS ONSET

Low-grade fever 
Anorexia 
Weight loss 
Malaise 
Night sweats

Dry then productive

Haemoptysis
Pleurisy

Pneumonia
Pleural effusion
Lobar collapse
Bronchiectasis

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5
Q

Clinical features:

Tuberculous lymphadenitis:

  • What is it?
  • Is it painful?
  • Where does it happen?

GI TB:

  • Where does most disease happen?
  • What GI symptoms do they have?
  • Why is bowel obstruction common?
A

Painless enlargement of cervical or supraclavicular lymph nodes

Ileocaecel region

Abdo pain
Vomiting

The most common complication of abdominal tuberculosis is obstruction due to NARROWING of the lumen by hyperplastic caecal tuberculosis, by strictures of the small intestine or by inflammatory adhesions.

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6
Q

Clinical features:

Spinal TB:

  • They have pain and tenderness in the spine. How long does this happen for?
  • When may patients actually present?
  • What may it lead to?
  • This whole clinical picture is called ____ disease. Fill the gap?

Genitourinary TB:

  • What sort of symptoms do they have?
  • Why is it important to know about?

Cardiac TB:
- What cardiac pathology does it cause via inflammation?

A

Weeks to months - slow insidious progression

When deformity neurological symptoms develop

Bony destruction
Vertebral collapse
Soft tissue abscess

Pott's disease 
----------
Chronic, intermittent or silent!!
- Dysuria 
- Loin/back pain 
- Haematuria

It is the second most common TB presentation in the UK.

===
Pericarditis

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7
Q

Clinical features:

CNS TB:

  • How does it spread?
  • What does it form in the brain?
  • What neurological symptoms do they have?

Skin TB:

  • It forms something called lupus vulgaris. What is it?
  • What colour are the nodules?
  • How do they feel?
  • Where do they tend to appear? - 2
  • They also get erythema nodosum. What is it?
A

The blood

Tuberculomas

Neurological deficit
Confusion 
Seizures 
Headache 
Meningism 
====
Peristent progressive cutantous TB

Red-brown

Rough

Face and shin

Erythema nodosum is a type of panniculitis, an inflammatory disorder affecting subcutaneous fat. It presents as tender red nodules on the anterior shins.

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8
Q

Clinical features:

Military TB - SEVERE MANIFESTATION:

  • Why is it called military?
  • What does it look like on XR?
  • How does it spread to the rest of the body?
A

Because it is due to the formation of discrete foci (2mm) of granulomatous tissue throughout the lung

Dissemination throughout the body including meningeal involvement.

The blood - haematogenous

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9
Q

Risk factors:

What continents are at risk of TB?

Knowing TB is spread by air droplets, what may increase someone risk?

A

Africa
South Asia

Being homeless
Living in cramped housing
Contact with infected individuals

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10
Q

Investigations - Latent TB - Screening:

Who should TB tests be offered to?

Tuberculin skin testing (TST):

  • What is another name for it?
  • How is it done?
  • How do you know you have a positive test?

Interferon-gamma release assays (IGRAS):

  • How does this test for TB?
  • This test is more specific than above!

What is a limitation of the above tests?

A

There will be an induration (bump) around the site

Close contacts
Immunocompromised
Health workers
High-risk populations

Mantoux test

Tuberculin is injected into the dermal layer of the skin

It measures interferon-gamma which is released from T-cells reacting to TB antigens

They can’t distinguish between active and latent TB.

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11
Q

Investigations - Active TB:

CXR - Primary Infection:

  • What do you see?
  • Where does it usually happen?
  • What is a Ghon focus and where does it typically happen?
  • What extra-parenchymal features may you see?
  • These features may resolve following a successful immune response. What will they leave?

CXR - Secondary Infection:
- They may have air-filled spaces in the apices. What type of lesion is this called?

CXR - Military TB:

  • What do you see throughout the lung fields?
  • Why is it called military?
A

Calcified nodes

Fibronodular/linear opacities in the upper lobe

A Ghon focus is a primary lesion usually subpleural, often in the mid to lower zones, caused by Mycobacterium bacilli (tuberculosis) developed in the lung of a nonimmune host (usually a child).

Ipsilateral hilar lymphadenopathy
Effusion

Cavitating lesions
—

Diffuse shadows throughout lung fields

Due to there being more nodules which can’t easily be counted t

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12
Q

Investigations - Active TB:

Getting samples:

  • How many sputum samples are needed?
  • What time of the day does a 1 of them have to come from?
  • What fluid can be nebulised to induce sputum production?
  • What can be done in children?

Extrapulmonary - What else can be aspirated or biopsied?

A

3

Early morning - the rest can be spontaneous

Nebulised saline

Bronchoalbeolar lavage of gastric lavage

Lymph nodes
Ascites 
Organs 
Pus 
Urine 
CSF
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13
Q

Investigations - Active TB:

Sputum smear:

  • AFB smear is done to it. What does this stand for?
  • Why is this used?
  • This is not that sensitive. What can be done which is more sensitive?

NAAT:

  • What does this stand for?
  • How does it work?
  • Why is it used?
A

Acid-fast bacilli (AFB)

Doesn’t come up on normal staining

Culture - used to assess drug sensitivity

Nucleic acid amplification test

Detects DNA of M.tuberculosis in sputum by DNA or RNA amplification

It allows for rapid diagnosis before culture

Can also detect drug sensitivity

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14
Q

Investigations - Both:

What chronic infection is screened for which could be a possible cause?

Basic bloods that should be done to assess the baseline before starting Rx- 3

A

FBC
LFT
U&E

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15
Q

Management - Active TB:

Who Rx them?

Infection control:

  • Who should be notified?
  • Who needs to be screened?
  • Where does the patient need to be put in?

Drug Rx:

  • Should Rx be started before or after culture?
  • How long are they given drugs for?

Mneumonic for drugs - RIPE - what does it stand for?

A

Quarantined in a single room for the first 2 wks of Rx

A specialist TB clinician

Public health authorities

Close contacts

Before if clinical suspicion is high

6 months in total

Rifampicin
Isoniazid
Pyrazinamide
Ethambutol

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16
Q

Management - Active TB:

How much longer are they on drugs if they have CNS involvement?

What should be added to reduce inflammation in meningeal and pericardial disease?

Direct observed therapy (DOT) can be used to increase adherance. Who is this done in?

Study These Flashcards
A

6 more months (4-10 months)

Steroids

Homeless
Drug/alcohol abuse
Prison 
Psychiatric 
Cognitive disorders
17
Q

Management - Latent TB:

Not all need to be treated.

Who are at increased risk of progression to active disease?

THE SAME DRUGS ARE USED FOR ACTIVE

R+I combo is used for 3 months. I can also be used on it’s own for 6 months. What does R and I stand for?

Study These Flashcards
A 
HIV
Transplantation 
Chemotherapy
DM
CKD
<5 yrs old 
Immigrants in high incidence countries

Isoniazid
Rifampicin

18
Q

Prevention:

What vaccine is given?

Who should be screened?

Study These Flashcards
A

BCG vaccine

Close contacts
Immunocompromised
Health workers
High-risk populations

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