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CR - TB (i) (Symptoms (chronic (wks-months) (unlike pneumonia which is…
CR - TB (i)
Symptoms
chronic (wks-months)
unlike pneumonia which is acute (important to establish timeline as both TB + pneumonia look similar on CXR)
non-specific cough (dry or productive, sputum could be any colour)
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dDx: lung, cancer, lymphoma, sarcoidosis
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Tx
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resistance
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XRD TB
resistant to rifampicin, isoniazid + 3+ classes of 2nd line agents
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signs
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erythema nodosum (inflamm of subcut fat, tender red nodules on an shins)
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investigations
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Mantoux test
aka tuberculin skin test, purified protein derivative test
inject 0.1 ml of 2TU PPD tuberculin intradermally, forming a wheel 6-10 mm in diameter
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measure induration area (increased fibrous issue, palpable, raised, hardened) in mm
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false +ves: BCG recipients (low specificity), non TB mycobacteria
false -ves: anergy (low sensitivity in immunocompromised), infected v recently, exposed when v young (under 6 months), liver virus vaccine, overwhelming TB disease
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transmission
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coughing, sneezing, speaking, singing
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