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WEEK 18:

Respiratory tract infections - TB:

QuestionAnswer
mycobacterium tuberculosis structure and staining modified peptidoglycan layer with mycolic acid waxy coat (lipids), and has a poor gram stain due to high lipid content (lipids are less permeable to gram stain) so acid fast stain (Zeihl-Neelsen stain) is needed to colourise TB for light microscopy
mycobacterium tuberculosis slow growing obligate aerobes (NEED O2) and facultative intracellular bacteria (invades macrophages and dendritic cells)
pathogenesis of active primary TB affects upper lobes creating a ghon focus (caseous necrosis) and ghon complex (a ghon focus in lymph nodes) which usually resolves but can produce calcified granuloma/ area of scar tissue and may be an area leading to secondary (reactivated) TB
pathogenesis of secondary (reactivation) of TB reactivated of primary TB site, common in immunocompromised and is treated with monoclonal antibodies
definition of latent disease of TB persistent immune response to stimulation by mycobacterium tuberculosis antigens with no evidence of clinically active TB
clinical course of TB cell mediated immunity occurs 2-8 weeks after infection (associated with tuberculin skin test). Activated T lymphocytes and macrophages form caseating granulomas that limit spread and replication where most patients are asymptomatic with latent infection
clinical findings of TB (7) cough, SOB, haemoptysis, chest pain, fever, and especially drenching night sweats, and weight loss
diagnosis of TB (2) suspected in anyone with high risk of developing TB and has general symptoms eg night sweats
post complications of pulmonary TB can lead to post TB bronchiectasis, COPD, aspergillomas (fungus), post TB corpulmonale (respiratory failure) and death
complications of active extrapulmonary TB miliary spread in lungs due to invasion into bronchus/ lymphatics via pulmonary veins
most serious complication of TB CNS disease
how to investigate TB chest radiograph and screening (mantoux test), staining and cultures
active TB will show what on a chest radiograph consolidation (opacity in upper/ mid lobes), cavitating lesions with or without calcification
latent TB will show what on a chest radiograph nodules and fibrotic changes
Mantoux test tuberculin (cell envelop protein) injected intradermally and skin is inspected for signs of local skin reaction eg swelling after 2-3 days. Test is considered positive at an induration (thickening/hardening) of 5mm or more
what happens if patients assessed has no evidence for active infection (based on symptoms and xray) still be treated for latent TB infection to prevent progression into active disease, using 3 months of isoniazid with pyridoxine and rifampicin or 6 months of isoniazid with pyridoxine
drug regimens for patients with latent TB infection 3 months of isoniazid with pyridoxine and rifampicin or 6 months of isoniazid with pyridoxine
bronchoalveolar lavage best for staining and culture of tissues/CSF/ urine samples to investigate presence of TB
sputum cultures category 3 pathogen and must be handled in category 3 lab
how long does it take for cultures to grow 2-8 weeks
antibiotic sensitivity testing importance find out what the pathogen causing TB is resistant to so we know what to treat them with
Bacillus Calmette Guerin (BCG) vaccine offers limited protection against TB (and leprosy)
MDR-TB multi drug resistant TB (strain of TB resistant to two first line drugs -isoniazid and rifampicin)
XDR-TB extensively drug resistant TB (multidrug resistant TB with additional resistance to any fluroquinolone and also any one of the three specialist second line injectable agents)
TB type of hypersensitivity delayed type
Created by: kablooey
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