What is erythema marginatum seen in?
Rheumatic fever
Give some RFs for TB
- Urban area
- ethnic minorities (+ born in TB prevalent countries)
- Living in same house as someone w/ TB
- Cramped lving conditions
- Homelessness, alcoholic, drug abuse
- Immunocompromised
- Malnourishment
- Male
- occupation: hospitals, care homes…
Give some causes of erythema nodosum
Sarcoidosis TB IBD EBV (on placement) Non-hodgkins lymphoma
What are some SEs of rifampicin?
Hepatitis + orange urine/tears
What are some SEs of isoniazid?
PERIPHERAL NEUROPATHY + heptitis
What are some SEs of pyrazinamide?
hepatitis + Gout (hyperuricaemia)
What are some SEs ethambutol?
Optic neuritis + red-green colour blindness
Give an example of a 2nd line drug Tx for TB
Macrolides - e.g. azithromycin or clarithromycin
How would you diagnose TB?
CXR
Sputum sample / bronchial lavage / other sites (e.g. lymph node biopsy) –> culture/staining + rifampicin resistance (ziel-neelson stain for acid fast bacilli + lowenstein jenson) - can now do PCR
What are the stains/culturing techniques for tb? Which is faster?
Ziel-Nelson stain for acid-fast bacilli (faster)
Lowenstein Jenson slope
How many sputum samples are needed to Dx TB?
3
What must you test a person for who has TB?
HIV, HepB/C
What is the primary infection of TB called?
Gohn focus
What is a primary focus?
Gohn focus + hillier lymphadenopathy (infected caseating lymph nodes)
How do you contact trace people for TB?
Mantoux test (tuberculin skin test) –> If +ve: IGRA (IFN gamma release assay)
If a mantoux test comes back +ve in contact tracing, what would you do? Why?
IFN-gamma testing - as may be immune/BCG
If IFN-gamma testing comes back +ve, what should you do?
Give the contact isoniazid + rifampicin
If the Mantoux test comes back -ve what should you do to the contact?
BCG vaccine
Who should be vaccinated w/ a BCG?
All infants in high prev areas (>40/100000)
Infants with parents/grandparents from high prev areas
Unvaccinated contacts of someone with pulmonary TB (with a -ve mantoux test)
Health care workers, vet workers, prison staff
What is the appearance of miliary TB on CXR?
Millet seed appearance
Describe some challenges faced by immigrants in the healthcare system
PTSD (refugees) Not Understanding the healer system Different screening programme Different vaccination programme Tropical disease (E.g. Milaria)
Describe some challenges of using an interpreter
Longer appointment Cost of interpreter decreased raport with dr (less likely to disclose important information different culture confidentiality issues