Tuberculosis Team Lecture Flashcards
Why traditionally was sunlight recommended in TB treatment in sanatoriums?
Inc patient VitD - VitD receptors found on monocytes and activated T cells, boost immune function
Direct Sunlight kills TB bacillus within hours - reduce transmission risk.
What are the different sites of he body where TB can infect?
Pulmonary (lungs)
Pleural tuberculosis
Lymph nodes
Bones
CNS - TB meningitis
Larynx
What types of TB are infectious?
Pulmonary and laryngeal only.
What populations are at higher risk of developing TB infections?
Migrant populations
Homeless
Prisoners
Parent/grandparent born in high risk country
What are the key signs and symptoms of a TB infection?
Chest pain or pain with breathing or coughing
Loss of appetite
Chills
Unintentional weight loss
Fatigue
Night sweats
Fever
Coughing up blood (late stage 6-9months into infection - shows highly contagious)
Coughing that lasts three weeks or more.
How are the symptoms of TB different to pneumonia?
TB longer duration - particularly the cough for 3 weeks or more
TB more systemic effects such as weight loss, night sweats.
What are some risk factors for TB?
Born in high-risk country - Philippines, Congo, Papua New Guinea, China
Parents or Grandparents born in high risk country (travel to visit)
Homelessness - crowding, ventilation, alcohol and drug use
Imprisonment
Time in detention centres
Refugee camps
HIV (or any immunosuppressive state, such as DM)
Smoking
Malnutrition
Severe kidney disease. (delayed diagnosis, immunosuppressed, malnutrition)
What is the incidence and prevalence of TB globally?
Over 9 million new cases anually
Around 2 million deaths per year
1/3 of the worlds population if infected with latent Mtb
One of the top three killers next to HIV and Malaria.
How does the number of TB cases vary across the UK?
Highest in London - over 2,000 - particularly Newham
Then south of england, west midlands, north east/yorkshire/hampshire
Lowest in east of england and east midlands.
What is the prevalance of TB in North of Tyne?
Highest in Newcastle Upon Tyne and Middelsborough
Lowest in Gateshead and Northumberland
Rates are increasing rapidly
Has lower rates compared to england overall
More than 70% of TB cases were born outside of the country - most commonly India, Pakistan and Eritrea.
Associated with Black African, Indian and Mixed ethnicity.
How important are social risk factors in TB?
22% of UK born cases have a social risk factor.
SRF are more likely to have pulmonary TB (infectious), less likey to complete treatment and more likely to die or be lost to follow up.
What is the relationship between HIV testing and TB?
91% of TB patients have a HIV test.
TB tests are also offered to HIV patients
Due to link between immunodeficiency, infection and poor prognosis.
What are the key features of latent TB?
TB lives but does not grow inside the body
Asymptomatic
Not infectious
Can re-activate
What are the key features of active TB?
Active and grows in the body
Symptomatic
Infectious
Cause death is untreated.
What diagnostic tests are needed for active TB?**
CXR
3x morning Sputum Samples
May if necessary use:
Often used if CXR positive but not coughing so unable to get sputum samples.
CT scan
Bronchoscopy/EBUS - take sample for acid fast bacillus smear
FNA/Surgery - take sample for acid fast bacillus smear.
What is the Quantiferon TB Gold Blood test?
Is an ELISA based interferon gamma release essay, whole blood is stimulates overnight with TB, INFgamma is measured by ELISA in the morning and quantified, if previous exposure to antigen will increase amount produced. Memory Th1 cells produce INFgamma
Requires patient blood sample.
Cannot distinguish between latent and active TB
What is the LTBI programme?
How was it affected by covid?
Programme to test and treat all newly arrived migrants in England, from high risk TB countries aged between 16-35yrs.
Stopped in April 2020, is now rerunning, but thought to contribute to rise in TB cases from 2020 onwards.
What is meant by primary tuberculosis?
The infection of an individual who has not previously been infected
Occurs usually within first 2 years after exposure
Most common in children.
What is secondary tuberculosis?
The infection of an individual who has been infected in the past, and this is a flare up (reactivation) of that latent TB
Often occurs due to factors such as reduced immunity, poor nutritional status, alcoholism, drug use or advancing age.
Small percentage may also be caused by reinfection.
What is meant by latent, cavity and military tuberculosis?
**
Latent - in granuloma, alive but not replicating.
Cavitary TB - a pathological gas filled space in the lung parenchyma or wall, caused by M.Tb caesating granuloma eroding into airway
Miliary TB - dissemintated form of TB, blood spread through lungs and body, multiple gramulomas throughout lung parenchyma, classified as pulmonary and extra-pulmonary TB.
What are the key sides effects from anti-TB drugs?
Rifampicin - jaundice
Ethambutol hydrochloride - colour blind, gout,
Pyrazinamide - gout, liver effects
Isoniazid - peripheral neuropathy, hepatitis, psychosis.
Pyridoxine - peripheral neuritis.
What is the role of TB clinical team?
Active TB case findins
Contact tracing
Direct Observed therapy
Education and training for health professionals
Input local and national decision making with UKHSA
Patient and Family Support throughout treatment.
What is shown on the x-ray?
TB - areas of black with white surrounding rim
May have areas of opacity which indicates calcification - healing of granulomas
Tend to be thin individual/low weight.
What is the guidance on contact tracing in TB?
Investigate all people in contact with pulmonary or extra pulmonary TB to identify primary source of infection
In asymptomatic cotacts younger than 65yrs consider testing for latent TN.
Consider treatment for latent infection or BCG if previously unvaccinated, contact of smera positive pulmonary or laryngeal TB, mantoux negative/IGRA negative.
