- Airborne - Ingestion of unpasteurized milk (M. Bovis) - Inborne

- clearance of the organism - rapid progressive disease (primary disease) - active disease many years after the infection - chronic or latent infection

Tuberculosis Flashcards by Sabaowy .j

How many people gets infected with TB each year?

100 000 000

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How many new TB cases is there?

8 800 000 new cases of TB (140/100 000)

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How many of the new cases of TB are smear positive?

4 000 000

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How many people die from TB?

1 700 000 peopl (100 000 children) die from TB

- 200 people/hour die with TB

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How many children are orphans as a result of paerental deaths caused by TB?

9 mln

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LTI =

Latent TB Infection

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What is Latent TB Infection (LTI)?

Subclinical infection without clinical, bacteriological or radiological signs or symptoms of disease.
Positive TST

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What is Tuberculosis?

Clinically, bacteriologically and/or radiographically confirmed disease

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What is chemoprophylaxis used for?

Chemoprophylaxis: treatment of infection with M. Tuberculosis to prevent progression to active TB

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What is preventive chemotherapy?

Preventive chemotherapy: treatment of individuals at risk of aquiring TB who are not infected

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Etiology - Mycobacterium tuberculosis complex:

Mycobacterium africanum
Mycobacterium bovis
Mycobacterium EAI ( East African-Indian)
Beijing
Haarlem
LAM (Latin-American and Mediterranea)
CAS (Central and Middle Eastern Asia)
European X family
European T family

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Transmission of TB:

Airborne
Ingestion of unpasteurized milk (M. Bovis)
Inborne

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Pathogenesis of TB

clearance of the organism
rapid progressive disease (primary disease)
active disease many years after the infection
chronic or latent infection

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Risk factors of TB INFECTION:

household contact
profession-due contact
alcoholics, drug addicts, homeless people
immigrants from high prevalence countries

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Risk factors for developing TB DISEASE:

immunosupression (iatrogenic, HIV)
malnutrition
age <5yrs
neoplastic disease
chronic disease: DM, chronic kidney failure
stomach resection

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What are the clinical features of primary infection:

local inflammation with granuloma formation
lymphadenopathy (hilar, mediastinal)
lobar collapse due to bronchial compression (may lead to bronchestasis)
pleural effusion (lymphocytic exudate with high protein but low glucose concentration)
erythema nodosum
in children manifestation may be scarce and non-specific

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What are the clinical features in latent infection:

no clinical features
immunological record:
- tuberculin skin test
- interferon gamma release test

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Post primary tuberculosis:

direct progression of primary infection
hematogenous spread
reactivation pf primary disease
exogenous reinfection

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What is the pulmonary symptoms of post-primary tuberculosis?

cough
sputum
hemoptysis
chest pain
dyspnoea

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What are the general symptoms of post-primary tuberculosis?

fever
night sweats
weight loss

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What are the clinical signs of pulmonary TB?

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reduced breath sounds and consolidation
wheezing in bronchial narrowing
signs of extrapulmonary involvment

What is so special about TB in children?

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higher risk of severe primary progressive disease after infection
higher proportion of disseminated and extrapulmonary disease
unreliable symptoms and signs
bacteriological examination difficult

3-8 weeks after primary infection of TB in children:

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TST response

- erythema nodosum

1-3 months after primary infection of TB in children:

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hematogenous spread (meningitis and miliary in infants)

3-7 months after primary infection of TB in children:

- bronchial disease(<5 years) | - pleural effusion (>5 years)

1-3 years after primary infection of TB in children:

- osteo-articular disease - calcification - adult-type disease

What is special about patients with HIV and TB?

- higher frequency of extrapulmonary TB - higher frequency of atypical localisation - greater frequency of general symptoms - shorter duration of symptoms before diagnosis

Diagnostic materials:

- gastric aspirate - bronchial washings - cerebrospinal fluid - pleural fluid - urine - sputum (more useful in adults) - other body fluids

Diagnostic tests:

- AFB smears - Culture: solid media up to 10 weeks, liquid media up to 6 weeks - PCR

What is the gold standard to confirm tuberculosis?

Culture

TST =

Tuberculin Skin Test

The tuberculin skin test (TST):

Can not differentiate between latent and active disease. | Tool available for diagnosis of TB infection

IGRA =

Interferon Gamma Release Assay

Interferon gamma release assay (IGRA):

Cell mediated immunity - circulating lymphocytes are extracted from the venous blood nad exposed to antigens of M. Tuberculosis and after 6-24hrs the production of interferon gamma ins measured

Serology-

Blood tests to measure the humoral response to M. tuberculosis

What does the interpetation of TST depend on?

- diameter of the induration | - person’s risk of being infected with TB and risk of progression to disease if infected

Diameter of induration of _> 5mm is considered positive in:

- HIV-infected children | - severly malnourished childreen (with clinical evidence of marasmus or kwashiorkor)

Diameter of induration of _> 10mm is considered positive in:

- all other children (whether or not they have recieved BCG vaccination)

Positive TST:

- active TB disease - latent TB infection - recent exposure to M. tuberculosis - exposure to enviromental mycobacteria - BCG-vaccination

Causes of false positive TST results:

- incorrect interpetation of test - BCG vaccine - infection with nontuberculous mycobacteria

IGRA pros and cons:

- good tool in diagnostics of latent TB - unlike TST, IGRA is negative in healthy vaccinated individuals - may be false negative in active TB - not enough experience in hcildren <5 years

Basic principles of treatment:

- combination of antibiotoics * rapid killing of mycobacteria • interrruption of the chain transmission - long duration of treatment * sterilization of lesions • prevention of relapse

First line TB drugs:

- Rifampicin - Isoniazid - Pyrazinamide - Ethambutol - Streptomycin

Rational treatment standard:

- intensive phase (2 months) • rapid killing - continuation phase (4-6 months) • sterilization

DOT =

Direct Observed Therapy

Direct Observed Therapy (DOT):

Recommended by WHO for all cases, at least in the intesive phase

DOTS =

Directly Observed Therapy Short-Course

What is the BCG vaccine?

BCG vaccine is a live vaccine prepared from attenuated strains of M. bovis

What is the BCG vaccine used to for?

BCG vaccine is used to prevent disseminated and other life-threatening infections of M. tuberculosis in infants and young children. - is used in more than 100 countries

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Tuberculosis Flashcards

(50 cards)