Tuberculosis

Question 1

what organism causes tuberculosis?

Answer 1

Mycobacterium tuberculosis bacteria.

Question 2

what is the shape of the bacteria causing tuberculosis?

Answer 2

mycobacterium tuberculosa - rod shaped (bacilli).

Question 3

what do the tuberculosis bacteria do on staining?

Answer 3

They don’t take up normal stain. this is called ‘acid-fast bacilli’.

Question 4

what staining is used for tuberculosis?

Answer 4

Ziehl-neelsen stain.

Question 4

what staining is used for tuberculosis?

Answer 4

Ziehl-neelsen stain.

Question 5

what do the tb bacteria stain on ziehl Neelsen staining?

Answer 5

stain red on a blue background.

Question 6

what is a typical story of a patient with TB?

Answer 6

patient coughs up sputum.
contains acid fast bacilli that strains red.
= Tuberculosis.

Question 7

what are the risk factors of TB?

Answer 7

Healthcare worker, 
close contact with TB - place or person
alcohol abuse
drug abuse 
homeless
born in a country with high TB rates 
immunocompromised (HIV)

Question 8

how is TB spread?

Answer 8

By inhaling saliva droplets. it spreads through lymphatics and blood.

Question 9

what is active TB?

Answer 9

when the disease is active in the person.

Usually forms granulomas throughout the body.

Question 10

what is latent TB?

Answer 10

When the immune system has formed capsules around the infection, so the person doesn’t have active infection but the bacteria is still there and might be reactivated.

Question 11

what is secondary TB?

Answer 11

When latent TB is reactivated.

Question 12

what is military TB?

Answer 12

when the immune system can’t control the TB leading to disseminated severe disease.

Question 13

what’s the most common type of TB?

Answer 13

Pulmonary TB - due to the bacterias high oxygen demand.

Question 14

where is common sites for extra pulmonary TB?

Answer 14

lymphatics (abscess in the neck) 
GI
pleura 
pericardium
CNS
bones 
joints
cutaneous

Question 15

what type of vaccine is the BGC?

Answer 15

Live attenuated - weakened form of the bacteria

Question 16

what does the BCG vaccine prevent against?

Answer 16

Good at - preventing severe disease.

less good at - preventing pulmonary disease.

Question 17

where is the BCG given?

Answer 17

intradermal (between epidermis and dermis).

ONLY VACCINE TO BE GIVEN INTRADERMALLY.

Question 18

Who should not be given the vaccine?

Answer 18

Immunocompromised.

Question 19

what test is used to check for previous TB infection/vaccination?

Answer 19

Manteaux test.

Question 20

what shows a positive manteau test?

Answer 20

test is read after 72hrs.

>5mm or =5mm.

Question 21

what is done if the manteau test is positive?

Answer 21

patient is tested for active disease.

Chest X-ray + cultures.

Question 22

where is the manteaux test injected into?

Answer 22

Intradermal, causes a bleb.

Question 23

what type of cultures are done when investigating TB?

Answer 23

blood culture.
sputum culture.
aspiration of lymph node culture.

Question 24

who is offered the BCG vaccine?

Answer 24

High risk: - healthcare workers - neonates born in high risk area of UK - neonates with family history of TB - neonates with family members from high risk countries - unvaccinated people <35yrs who have close contact who is positive - children and young adults who have recently come from a country at high risk

Question 25

how much TB does pulmonary TB account for?

Answer 25

70%

Question 26

What are the signs and symptoms of pulmonary TB?

Answer 26

``` GRADUALLY WORSENING. night sweats lymphadenopathy erythema nodosum (red sore lesions on shins) lethargy fever weight loss cough - which brings up sputum haemoptysis ```

Question 27

what is TB of the spine called?

Answer 27

Pott's disease.

Question 28

what does the manteaux test show?

Answer 28

- previous TB infection - previous BCG vaccine - active TB - latent TB

Question 29

what is done to confirm latent TB after manteaux test if the tests for active TB are negative?

Answer 29

interferon gamma release assays - whole blood test.

Question 30

what must be done before someone gets BCG vaccine?

Answer 30

Manteaux test - which must be negative.

Question 31

how many culture samples should be taken?

Answer 31

3.

Question 32

when should TB treatment be started?

Answer 32

As soon as possible, when waiting on culture results because thy take a long time.

Question 33

is latent TB treated?

Answer 33

Not always, only if the person is at risk of reactivation.

Question 34

what is the treatment for latent TB?

Answer 34

- isoniazid + rifampicin = 3 months OR - isoniazid alone = 6 months.

Question 35

What is the treatment for active TB?

Answer 35

- Rifampicin - 6 months - Isoniazid - 6 months - pyrazinamide - 2 months - ethambutol - 2 months.

Question 36

what are the side effects of the drugs used to treat TB?

Answer 36

- rifampicin - red pee/tears - isoniazid - peripheral neuropathy - pyrazinamide - hyperuricaemia (gout) - ethambutol - colour blindness

Question 37

which drugs have a risk of hepatotoxicity?

Answer 37

rifampicin isoniazid pyrazinamide

Question 38

what should be prescribed with RIPE drugs?

Answer 38

pyridoxine - Vitamin B6 - to reduce peripheral neuropathy.

Question 39

what drug does rifampicin reduce effectiveness of?

Answer 39

Oral contraceptive pill.

Question 40

what does military TB look like on chest X-ray?

Answer 40

Millet seeds.

Question 41

when is TB considered non-contagious?

Answer 41

After 2 weeks of medication.