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Malawi prep > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

which pathogen causes tuberculosis?

A

mycobacterium tuberculosis

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2
Q

how many people are infected with tb worldwide?

A

2 billion

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3
Q

do all people with tb have symptoms?

A

no: 90-95% aren’t aware they are infected

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4
Q

infected with tb but no symptoms: what is this called?

A

latent infection

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5
Q

latent tb: what are risk factors to develop active disease? (2)

A

aids, old age

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6
Q

what type of bacterium is tb: shape? aerobe/anearobe?

A

rod shaped
strictly aerobe

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7
Q

how is tb transmitted?

A

inhalation

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8
Q

how does tb survive inside a phagocyte in the alveoli?

what is the consequence?

A

after phagocytosis they prevent fusion with lysosomes

they can proliferate and cause localized infection

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9
Q

what is primary tuberculosis? what are the symptoms?

A

localized infection after exposure

asymptomatic or flu-like symptoms

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10
Q

what type of necrosis can form inside the granuloma?

A

caseous necrosis (also called ‘Ghon focus’)

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10
Q

which 2 components make up the characteristic Ghon complex of tb?

A

Ghon focus (caseous necrosis inside granulomas) + hilar lymph nodes (also caseous necrosis inside)

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10
Q

what can form inside the lungs +/-3 weeks after exposure? why is this?

A

granulomes

due to cell-mediated immunity: cells wall of the infection and prevent from spreading

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11
Q

what can you see on chest x-ray of tb?

A

primary tb: enlarged hilus, consolidation
healed primary tb: Ghon focus (round, well-defined calcific density in the periphery)
reactivated tb: consolidations upper lobes

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11
Q

what happens eventually to the granulomas, what type of tissue forms?

A

fibrosis + calcification

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12
Q

which 2 directions can TB go after granuloma formation?

A

-> tb killed of, end of disease
-> tb remains viable inside granuloma (dormant)

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13
Q

what are risk factors for dormant tb to become reactivated?

A

aids or aging

14
Q

reactivation of dormant tb from inside granuloma: where in lung does tb prefer to spread? why is this?

A

upper lobes, greater oxygenation (tb is aerobe)

15
Q

reactivation of dormant tb: after spreading to other parts of the lungs, do more or less T cells get activated this time? why is this? what is the consequence?

A

more, because of memory cells

consequence: more caseous necrosis with cavitations

16
Q

what is the consequence of cavitating necrosis? (2 things)

A

tb can now disseminate into:
1) lungs -> pneumonia
2) vasular system -> systemic miliary tb

17
Q

which system can be affected in systemic miliary tb? (6)

A
  • kidneys: pyuria (WBCs in urine)
  • lumbar vertebrae: Potts disease
  • meningitis
  • addison’s disease
  • hepatitis
  • cervical lymphadenitis
18
Q

how can you test for tb?

A
  • dermal test: mantoux test
  • blood test: IGRA (interferon gamma release assay)
19
Q

how does a mantoux test work?

A

inject component of tb in skin: if person has been infected before -> small localized reaction in 48-72h

(bump has to be of certain size to be positive test)

20
Q

what does a positive mantoux test indicate?

A

if someone has been exposed to tb

doesn’t differentiate between active and latent disease

21
Q

what are 2 benefits or IGRA testing?

A
  • only need to show up once
  • unlikely to be positive from BCG vaccine
22
Q

is there a tb vaccine?

A

yes, BCG vaccine

(in NL: BCG vaccination is offered to children if one or both parents are from a country where tb is prevalent)

23
Q

positive mantoux or IGRA: what is the next step?

A

chest x-ray to check for active disease

24
Q

what are symptoms that are indicative of active tb?

A

fever, night sweats, weight loss, coughing up blood

25
Q

what type of testing can you do during active tb?

A

sputum/BAL: culture, PCR, staining

26
Q

how do you treat latent infection of tb?

A

antibiotics: isoniazid for prolonged time (+/- 9 months)

27
Q

how do you treat active infection?

A

combination of drugs (isoniazid, rifampin, ethambutol, pyrazinamide) for months

-> non-infectieus in weeks

28
Q

which patients are the most infectieus?

A

adults with reactivated TB

29
Q

how do you prevent spreading from a patient with reactivated tb?

A

negative pressure room, FFP2 masks

30
Q

what are MDR-tb and XDR-tb?

A

multiple drug resistance tb
xtreme drug resistance tb

31
Q

what are 3 things that can make sure the tb is treated effectively?

A
  • use multiple drugs together
  • make sure specific strain is treated
  • use for prolonged time
32
Q

what is the course of tb infection: from infection to dissemination?

A
  • infection -> primary infection with mild/no symptoms
  • after 3 weeks: granuloma formation (caseous necrosis) -> latent disease
  • aids or old age -> reactivation -> cavitating necrosis -> dissemination -> pneumonia/systemic disease

Malawi prep (12 decks)

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