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Tuberculosis Flashcards

1
Q

what us tuberculosis

A

mycobacteria infection that is spread in air

occurs in many body sites

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2
Q

what type of reaction occurs in TB

A

Delayed Type IV hypersensitivity (granulomas with necrosis)

T cell response (NOT antibody response

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3
Q

in TB is the damage to the lung due to the bacteria or the T cell response

A

T cell response

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4
Q

why can TB be described as immunity + hypersensitivity

A

immunity: enhanced macrophage killing
hypersensitivity: Type IV granulomatous inflammation, tissue necrosis and scarring

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5
Q

4 bacteria that cause TB

A

Mycobacterium tuberculosis
mycobacterium bovis
mycobacterium africanum
mycobacterium microti

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6
Q

how is mycobacterium tuberculosis presented on a. Gm stain

A

rod shaped Gm=ve bacillus

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7
Q

what people are more likely to get TB

A

immunocomprimised

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8
Q

what test is used to diagnos mycobacterium tuberculsosis

A

zeihl-Neelson

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9
Q

what opportunistic pathogens cause TB in immunocompromised individuals

A

Virus (CMV)
bacterium (mycobacterium avium intracellulare)
Fungi (aspergillus, candida pnumonocystis)
Protozoa (cryptosporodoa, toxoplasma)

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10
Q

In TB infection does/does not mean disease

A

does not
infected people can still be healthy
1/3 of people are infected

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11
Q

2 types of TB

A

active (5-10% get sick, 8 weeks to present)

latent (lies dormant in body)

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12
Q

what determines TB’s clinical outcome

A

immune response

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13
Q

what is the immune response to TB

A

1) Tb evades phagocytosis
2) Slow onset Th1 adaptive immunity: 8 week
3) enhanced effector mechanism (MTB-sepcitid CD4+ T cells, IFN-y, TNF-a)
4) granuloma (walled off infection

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14
Q

what is the characteristics of TB

A

caseous necrosis
granuloma forms, growing collection fo phagocytic cells that bacteria infects and replicates in
little oxygen so bug adapts and lies dormant then reactivated with patient is old, immunosuppressed, on steroids

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15
Q

what type if immunity occurs in TB

A

Th-1 biased immunity

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16
Q

what factors have contributed to the global TB rise

A 
HIV pandemic
Displacement & migration
Poverty 
Disruption to health infrastructure from political changes / conflict
Poorly managed TB programmes
Anti-TB dug resistance: MDR
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17
Q

risk factors for TB

A

contact with TB infected person (TB in sputum)
immigrants from Africa/India
poverty, homelessness, alcoholism
HIV

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18
Q

what happens to patients with open (contagious) TB

A

positive smear test = kept in hospital

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19
Q

how is positive TB classified

A

first exposure and up to 5 years later

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20
Q

what type of reaction occurs in primary TB

A

Delayed Type IV sensitivity reaction

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21
Q

what are the characteristics of Primary TB

A

 Small focus (ghon focus)
 Peripheray of mid zone of lung
 Large hilar nodes (granulomatous)

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22
Q

what is the most common type of TB

A

latent TB

re-infection or re-activation

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23
Q

what causes re-acivation of TB

A

Age
HIV
immunosuppressive therapy eg. steroids

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24
Q

characteristics of secondary TB

A

at apices of lung (upper lobe)
 Fibrosing + Cavitating apical lesions
 Similar to cancer
 Large increasing in size

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25
what type of TB are people with chronic kidney disease likely to suffer from
latent TB increased risk of treatment toxicity dialysis
26
what is given to reduce the risk of active infection to some people with latent TB
chemoprophlaxis
27
what people are more likely to get TB
``` people born in other countries migrate to country where it is less common (secondary TB) deprivation immunocomprimised young adults & elderly more in men silicosis ```
28
symptoms of TB
``` productive cough occasional haemoptysis night sweats fever weight loss can affect different organs pleuritic pain jaundice meningitis GI pain/bowel obstrcution spinal pain cold absess pericardiac tamponade renal failure hypoadrenalism ```
29
where is latent TB more likely to occur
it is asymptomatic wakes up in parts of lung where more oxygen
30
in patients with septic arthritis and TB symptoms what are never injected into solitary arthritic joints
steroids incase it is TB
31
what is primary lymph node TB
* Common in kids * Pneumonia associated * Extrathoracic (most common) nodes * Firm, non-tender enlargement of a cervical or supraclavicular nde * Node = necrotic, can liquefy * No abscess formation/no erythema
32
if a patient is diagnosed with TB what other test should be carried out
HIV test
33
how is TB diagnosed in examination
upper zone crackles | swollen lymph glands
34
what test is carried out to check for TB in bronchial washings
Zeihl Nelson Stain
35
how can samples be collected from TB patients
sputum bronchial washings drain pleural effusions needle in cold absess
36
what does an X-ray of a patient with TB show
``` consolidation pleural effusion thickening of mediastinum (hilarious adenopathy) cavity formation fibrosis upper lobe predominancy bulky lymph nodes scarring/shrinkage heals with calcification ```
37
what is ghon focus - seen on chest x-ray of TB patient
Small calcified nodule in upper parts of upper lobe or lower parts of upper lobes (midzone)
38
what causes the unilateral calcification as seen in patients with Tb
emphysema | pus in airways
39
what Is milary TB
person has poor immune controlled spread everywhere in lung + blood + to CNS tree in bud
40
how is milary TB usually diagnosed
blood culture bronchoalveolar lavage fluid: smear negative, culture positive lumbar puncture checks CNS involvment
41
if no sputum produced how should a sample be collected
bronchoscopy from upper Lobe
42
what test is done on samples in suspected Tb
zeihl-neelson (misses Tb 50% of time) detects mycobacterium | auramine via microscopy
43
what is the most important test on samples from suspected TB
culture drug sensitivities solid/liquid phases
44
latent TB is culture negative/positive
negative
45
what does nucleic acid amplification detect
TB mycobacterium and non TB mycobacterium high specificity identifies MDR
46
what test is carried out on the skin
Mantoux (tuberculin test) detects previous exposure to TB and BCG takes 2 days Type IV sensitivity reaction
47
what can the Mantoux test not distinguish
the type of TB
48
what would give a false negative In the Mantoux test
immunosuppressed - HIV infection sarcoidosis drugs - chemo, anti-TNFs, steroids
49
what would give a false positive in the Mantoux test
BCG vaccine | non-tuberculosis mycobacterium
50
what test is more effective at diagnosing TB than the mantoux test
IGRA take blood, 1 visit detects T cell secretion of IFN-y following exposure to M.tuberculosis specific antigens high sensitivity and specificity (does not react with BCG) detects all TB types
51
what tests for active TB
``` PCR: primary TB test answer in 90mins/2hours spit or cartage sensitivity of 3 samples (90% affective) misses 1 in 4 ```
52
other than TB detection what is else does PCR tell us
if organism is resistna two rifampicin
53
how is TB treated
BCG vaccine Anti-TNF drugs given cured in 6 months do not give patients steroids/immunosuppressants
54
what drugs are given for active TB treatment
4 drugs for 2 months: Rifampicin, Isoniazid (H), Pyrazinamide, Ethambutol 2 drugs for further 4 months: Rifampicin + Isoniazid
55
if TB is in the brain/CNS how long should treatment last
4 drugs for 2 months | 2drugs for 10 months
56
side effects of Anti-TB drugs
```  Need to stop the pill  Liver problems  Hepatitis (common)  Vomiting  nausea (most common)  Lack of appetite  Arthralgia  Cutaneous reactions  Cutaneous hypersensitivity  Retrobular neuritis (colour blindness  blindness) ```
57
side effect of Rifampicin
pink/orange urine/sweat/tears | induces cytochrome enzyme (rapid steroid breakdown eg, contraception and breakdown of opiate analgesics)
58
why is isoniazid prescribed with pyridoxine
to prevent B6 deficiency/polyneuropathy | allergic reactions with hepatitis: skin rashes/fever
59
side effects of ethambutol
optic neuritis: reversible colour blindness
60
side effects of pyrazinamide
hepatic toxicity
61
side effect of stretomycin
Irreversible damage to vestibular nerve in elderly/those with renal impairment Only used if MDR/very ill
62
what is DOTS: Directly Observed Therapy Short-Course
for people who lead chaotic lifestyles/unlikely to take medication responsible observer administers drug and observes ingestion
63
what TB is not treated in UK
latent TB due to low transmission rates, treated in USA
64
treatment for latent TB
2 drugs, 3 months: Rifampicin, Isoniazid or 1 drug 6 months: isoniazid treat prior to immunosuppressive therapy other treatments: Furoquniolones and TMC207 (bedaquilline)used if resistant to everything else
65
what is MDR-TB
multi drug resistant TB resistant to first line therapy: Rifampicin + Isoniazid common in Russia/estonia/china must stay in hospital
66
how long do patients with MDR-TB need to take medication for
2 years
67
what treatment is given to patients with Isoniazid resistance
need to take drug for another 3 years
68
what is XDR-TB
resistant to second line therapy | MDR + Fluquinolones + injecables
69
prognosis of Tb
global epidemic, kills most people as single pathogen 5-10% risk of infection HIV carry 10% extra TB risk each year
70
what is TB diagnosis confirmed by
PCR AAFB Culture
71
what people should you suspect TB in if the symptoms are present
returning travellers immunocompromised non-resolving pneumonia

RESPIRATORY (12 decks)

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