Tuberculosis

Question 1

TB

What is the bacteria that causes TB?

Answer 1

Mycobacterium tuberculosis.

Question 2

Essentials of Diagnosis:

• Fatigue, Weight loss, fever, night sweats, productive cough.
• Cough >2 to 3 weeks’ duration, lymphadenopathy. (swelling of the lymph nodes)
• Risk factors: household exposure, incarceration, drug use, travel to endemic area.
• Chest Radiograph: pulmonary opacities.
• Acid-fast bacilli on smear of sputum or sputum culture positive for Mycobacterium tuberculosis.

Answer 2

Tuberculosis

Question 3

General considerations:

• The lungs are the major site for Mycobacterium.
• Clinical manifestations of include primary, reactivation, laryngeal, endobronchial, lower lung field infection, and tuberculoma.
• Pulmonary complications of can include hemoptysis, pneumothorax, bronchiectasis, extensive pulmonary destruction, malignancy, and chronic pulmonary aspergillosis

Answer 3

Tuberculosis

Question 4

Physical Findings:

• Findings of pulmonary are not specific and usually are absent in mild or moderate disease. Early onset symptoms are to Pneumonia.
• Dullness with decreased fremitus may indicate pleural thickening or effusion.
• Crackles may be present throughout inspiration or may be heard only after a short cough (post-tussive crackles).
• Distant hollow breath sounds over cavities are called amphoric, after the sound made by blowing across the mouth of jars used in antiquity (amphorae).
• Extra pulmonary signs include clubbing and findings localized to other sites of involvement.

Answer 4

Tuberculosis

Question 5

Lab/Imaging/Other:

• Acid fast bacilli light microscopy- Require 3 consecutive morning specimens.
• Most patients with reactivation have abnormalities on chest radiography, even in the absence of respiratory symptoms.
• Sputum should represent secretions from the lower respiratory tract, and at least 5 to 10 mL is optimal for adequate diagnostic yield.

Answer 5

Tuberculosis

Question 6

Differential Diagnosis:

• Pneumonia
• Cystic Fibrosis
• Chronic Bronchitis

Answer 6

Tuberculosis

Question 7

Treatment:

• Isoniazid: Dosing: 5 mg/kg/dose (usual dose: 300 mg) once daily
• Adverse: Tingling sensation give B6 50mg daily
• Rifampin: Dose: 300 mg PO BID.

LFT are needed for monitor.

Regimens: consist of an initial 2-month phase of a 4-drug regimen, followed by a continuation phase of an additional 4 to 7 months of rifampin and isoniazid for pulmonary tuberculosis and a continuation phase of an additional 7 to 10 months of rifampin and isoniazid for tuberculous meningitis (optimal duration is not defined although continuation phase must continue for a minimum of 7 additional months).

NOTE: Adjunctive corticosteroid therapy (e.g. dexamethasone, prednisolone) tapered over 6 to 8 weeks is also recommended for tuberculous meningitis.

MEDAVAC

Answer 7

Tuberculosis

Question 8

TB

Reactive TB is found where in the lungs typically?

Answer 8

Upper Respiratory