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Tuberculosis (Signs (Pulmonary TB (Weight loss, Night sweats, Malaise,…
Tuberculosis
Signs
Genitourinary TB
Dysuria, frequency, haematuria
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Treatment
Active
Rifampicin, isoniazid, pyrazinamide and ethambutol for first 2 months
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Side Effects
Isoniazid: raised LFTs, low WCC, neuropathy
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Rifampicin: raised LFT, low platelet count, orange discolouration of urine
Pyrazinamide: hepatitis, arthralgia
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Epidemiology
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UK incidence is 12 per 100,000
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Pathophysiology
Active Infection
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There is infiltration with neutrophil granulocytes. These are replaced by macrophages which engulf the bacilli and produce typical granulomatous lesions: central areas of caseation surrounded by epithelioid cells and Langhan's giant cells
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Latent TB
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This is infection without the disease due to persistent immune system containment (granuloma prevents bacteria growth and spread)
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Risk factors for reactivation: new infection, HIV, organ transplantation, immunosuppression, illicit drug use, malnutrition, haemodialysis
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Investigations
Active TB
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Nucleic acid amplification test: direct detection of m.tuberculosis in sputum by DNA or RNA amplification
Chest X-ray: Fibronodular opacities in upper, middle or lower lobe, calcification
Extra-Pulmonary TB
Biopsy of lymph nodes, pleura, bone, GI/GU tract
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Latent TB
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Tuberculin skin testing = Mantoux test. TB antigen is injected intradermally and cell mediated response at 48-72h is recorded