Tuberculosis

Question 1

Define TB and the likely pathogen

Answer 1

Communicable infectious disease caused by Mycobacterium Tuberculosis which produces silent , progressive active disease

Question 2

Etiology of TB

Answer 2

Caused by Mycobacterium Tuberculosis =bacilli
Immunocompromised high risk
M. TB spread through micro size droplet nuclei through sneezing and coughing
Patients with laryngeal TB- increased risk when talking

Question 3

Pathophysiology tb

Answer 3

Immune system identify M. Tuberculosis
And trigger macrophages and T-lymphocyte(CD4 and CD-8). TB is phagocytoses by alveolar macrophages , trigger recruitment of T-lymphocyte , formation of granuloma to contain infections and prevent spread , leading to latent TB .patient is asymptomatic but if Immunocompromised reactivation can occur lead to active TB

Question 4

Signs and symptoms tb

Answer 4

Cough, weight loss ,night sweats, fatigue, fever
Bacteria can spread leading to extra pulmonary TB

Question 5

Describe extra pulmonary TB

Answer 5

Affects other organs and tissues
Ie
Lymph nodes-lymphadenitis
Bones and joint-skeletal TB
Genitourinary-renal TB , genital TB
CNS -meningitis
Pericardium-pericardial
Skin and soft tissue -cutaneous TB

Question 6

Diagnosis?tb

Answer 6

Sputum smear microscopy-acid -fast bacilli staining/smear
Microbiology, sputum:culture and sensitivity
GeneXPert-diagnose TB and resistance to rifampicin
Chest X ray
Clinical presentation

Question 7

Give indication for culture and DST (tb)

Answer 7

All children
Symptomatic individuals at high risk of MDR-TB ie lab workers
Patients suspected of cryogenic TB
Relapse patient
HIV positive with 2 negative smears

Question 8

Diagnosis for paediatric(tb)

Answer 8

Chest X-ray
Tuberculin skin test(TST) -purified protein derivative (PPD)
Microscopy and culture to collect sputum from child you can do induced sputum collection, saliva induction through like lemon juice

Question 9

Risk factors for TB

Answer 9

HIV status and Immunocompromised
Comorbidities-DM, alcoholism,malnutrition
Prolonged treatment with steroids
History TB
Exposure to pt with pulmonary TB
Males and being black
Children <5 years

Question 10

Risk factors for paediatric tb

Answer 10

History of recent contact with TB case
Age<3years
Malnutrition
Immune status
Time since exposure ie likely develop within 1 year

Question 11

Goal of management of TB

Answer 11

Early collection of specimen
Initiate appropriate regimen
Isolation patient with active disease
Prevent TB transmission
Restore quality of life
Resolution of symptoms

Question 12

Non pharmacological management tb

Answer 12

Isolation to prevent spread
Contact tracing
Replenishment >normal weight

Question 13

1st line management of TB

Answer 13

RIPE(HRZE)
1. HRZE for 2 months initial phase then HRE for 4 months continuation phase
H-isoniazid - 10mg/kg daily
R-rifampicin-15mg /kg daily
Z-Pyrazinamide-35mg/kg daily
E-ethambutol-20mg/kg daily
S-streptomycin -15mg/kg daily

Question 14

Management of relapse, treatment failure tb

Answer 14

1. HRZES for 2 months and , HRE for 5 months
2. 1 month HRZE and HRE 5 months

Question 15

Paediatric regimen tb

Answer 15

<30kg : 2HRZE/4 HR
>30kg 2HRZE/4HRE
Retreat: 2HRZES/5HRE

Question 16

Isoniazid is always paired with?

Answer 16

Pyridoxine vitamin B6

Question 17

Compare ethambutol and streptomycin

Answer 17

E-inhibit synthesis of bacterial cell wall
S-bind 30s ribosome prevent protein synthesis
Admin -E -oral S-IM
S/E - E -optic neuritis so regular eye exams
S-ototoxic and nephrotoxic check liver function test and ear test
R-discoloration of urine, tears, GIT upset, flulike symptoms ie fever , chills, hepatotoxicity
H- hepatotoxicity, peripheral neuropathy, rash, CNS effects ie seizures
Z-rash, git upset, hepatotoxicity, hyperuricemia(gout), arthralgia(joint pain)