3. which of the following are know as the first stage of TB?

- primary tuberculosis - primary infection stage

Chapter 18 Patho Flashcards by Moh Husse

TB has three classifications

Primary TB also called primary infectious stage.
Postprimary TB also called reactivation, reinfections, and secondary TB.
Disseminated TB also called extrapulmonary , miliary, and tuberculosis-disseminated

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Primary TB tuberculosis

(primary infection stage)
~ 4 week period
~ initial response (of lungs) is inflammation similar
to pneumonia

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which of the following are know as the first stage of TB?

primary tuberculosis

- primary infection stage

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primary infection stage

~ a large influx of polymorphicnuclear leukocytes
and macrophages move into the infected area to
engulf - but not fully kill - the bacilli
~ this action also causes the pulmonary capillaries
to dilate, the interstitium to fill with fluid, and the
alveolar epithelium to swell from the edema fluid
~ eventually, the alveoli become consolidated

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purified protein derivative

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tubercle

~ unlike pneumonia, the lung tissue that surrounds
the infected area slowly produces a protective cell
wall
~ AKA ‘granuloma’
~ takes about 2-10 weeks to form

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Ghon nodule

name for tubercles when detected on a chest xray

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Ghon complex

as disease progresses the combination of tubercles and the involvement of the lymph nodes in the hilar region

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TB bacilli

may remain dormant for months, years, or life

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latent TB

~ patients with dormant TB do not feel sick or have
any TB related symptoms
~ they are still infected with TB but do not have
clinically active TB

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post-primary TB

~ a term used to describe the reactivation of TB
months or even years after the initial infection has
been controlled
AKA:
- reactivation TB
- reinfection TB
- secondary TB

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risk factors

~ malnourished individuals
~ institutional housing
~ people living in overcrowded conditions
~ immunosuppressed patients
~ Human Immunodeficiency Virus (HIV)
TB is leading cause of death for HIV
~ alcohol abuse

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uncontrolled TB

~ further growth of the caseous granuloma tubercle
develops
~ pt progressively experiences more severe
symptoms:
- violent coughing episodes
- greenish/ bloody sputum
- low grade fever
- anorexia
- weight loss
- extreme fatigue
- night sweats
- chest pain

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consumption

~ earlier name for TB
~ based on the gradual wasting away of the body
~ patient is highly contagious at this point

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disseminated TB

infection from TB bacilli that escape from a tubercle and travel to other sites throughout the body by means of the bloodstream or lymphatic system

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most common location

~ is the apex of the lung (↑ PaO₂)
~ other O₂ rich areas include:
- regional lymph nodes
- kidneys
- long bones
- genital tract
- brain
- meninges (spine)

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complications

~ hemoptysis
~ pneumothorax
~ bronchiectasis
~ extensive pulmonary destruction
~ malignancy
~ chronic pulmonary aspergillosis
~ mental deterioration
~ permanent retardation
~ blindness
~ deafness

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military TB

large number of bacilli are freed into the bloodstream, numerous small tubercles - about the size of a pinhead - scatter throughout the body

pathological/ structural changes

~ alveolar consolidation
~ A/c membrane destruction
~ caseous tubercles or granulomas
~ cavity formation
~ fibrosis and secondary calcification of the lung
parenchyma
~ distortion and dilation of the bronchi
~ ↑ bronchial secretions

etiology/ epidemiology

~ TB is one of the oldest diseases known to man and
remains one of the most widespread diseases in
the world
*even found in mummies from ancient Egypt
~ one of the top 3 causes of death among women
aged 15-44, worldwide
~ leading killer of HIV patients
*25% of all deaths

bacteria

in humans, TB is primarily caused by the bacteria Mycobacterium tuberculosis

transmission

~ within aerosol droplets produced by coughing,
sneezing, or laughing
~ can remain suspended in the air for several hours
after a cough or sneeze
~ may possibly be ingested in unpasteurized milk
from cattle infected with the TB pathogen
Mycobacterium Bovis

Montoux tuberculin skin test

~ most frequently used diagnostic method for TB
~ purified protein derivative (PPD)
~ results in 48/72 hours
~ an induration (wheal) of ≥10mm is considered
a positive result

acid-fast bacteria

(sputum smear)
~ Ziehl-Neelsen stain
reveals bright red acid-fast bacilli against a
blue background
~ fluorescent acid-fast stain
reveals luminescent yellow-green bacilli against
a dark brown background
this is becoming #1 choice

25. nontubeculous acid-fast mycobacteria

associated with COPD are Mycobacterium avium & Mycobacterium Kansasi

26. M. tuberculosis

~ grows very slowly | ~ up to 6 weeks for colonies to appear in culture

27. QuantiFERON-TB Gold Test

~ whole-blood test for diagnosing M. tuberculosis infection, including latent TB infection ~In 2005 the US food and Drug administration FDA approved for QFT-G test.

28. peripheral edema & venous distention

``` ~ polycythemia ~ cor pulmonale ~ distended neck veins ~ pitting edema ~ enlarged/ tender liver ```

29. chest assessment

``` ~ ↑ tactile/ vocal fremitus ~ dull percussion note ~ bronchial breath sounds ~ crackles/ wheezing ~ pleural friction rub ~ whispered pectoriloquy ```

30. hemodynamic indices

``` ~ ↑ CVP ~ ↑ RAP ~ ↑ PA ~ N PCWP ~ ↑ PVR ```

31. abnormal labs

~ positive PPD ~ positive sputum acid-fast bacillus stain test ~ positive ABF sputum culture ~ positive quantiFERON-TB Gold Test

32. chest xray

``` ~ opacity ~ Ghon nodule ~ Ghon complex ~ cavity formation ~ cavitary lesion containing an air-fluid level ~ pleural effusion ```

33. 6-month treatment protocol

``` first 2 months (induction phase) daily: ~ isoniazid (INH) ~ rifampin ~ pyrazinamide ~ ethambutol or streptomycin next 4 months, either daily or twice weekly ~ isoniazid ~ rifampin ```

34. 9-month treatment

``` months 1-2, daily: ~ isoniazid ~ rifampin months 3-9, twice weekly: ~ isoniazid ~ rifampin ```

35. isoniazid & rifampin

1st line agents prescribed for the entire 9 months

36. isoniazid

considered to be the most effective 1st-line antituberculosis agent

37. prophylactic use of isoniazid

~ often prescribed as a daily dose for 1 year to those who've been exposed to TB bacilli or who demonstrate a positive tuberculin response (even when the acid-fast sputum stain is negative)

38. resistance

when TB bacterium is resistant to one or more of these agents ≥3 more antibiotics must be added to the treatment regimen, and duration should be extended

39. Directly Observed Therapy

(DOT) a major problem with TB therapy is noncompliance on the part of the patient to take the TB medication as prescribed. therefore, ingestion of the medication must be directly observed by a responsible individual

40. Which of the following are known as the first stage of tuberculosis? 1. Reinfection tuberculosis 2. Primary tuberculosis 3. Secondary tuberculosis 4. Primary infection stage a. 2 only b. 3 only c. 1 and 3 only d. 2 and 4 only

41. What is the name of the protective wall that surrounds and encases lung tissue infected with tuberculosis? 1. Miliary tuberculosis 2. Reinfection tuberculosis 3. Granuloma 4. Tubercle a. 1 only b. 3 only c. 4 only d. 3 and 4 only

42. The tubercle bacillus is: 1. Highly aerobic 2. Acid-fast 3. Capable of surviving for months outside of the body 4. Rod-shaped a. 2 only b. 4 only c. 2 and 3 only d. 1, 2, 3, and 4 only

43. At which size wheal is a tuberculin skin test considered to be positive? a. Greater than 4 mm b. Greater than 6 mm c. Greater than 8 mm d. Greater than 10 mm

44. Which of the following is often prescribed as a prophylactic daily dose for 1 year in individuals who have been exposed to tuberculosis bacilli? a. Streptomycin b. Ethambutol c. Isoniazid d. Rifampin