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Old TB (Examination Chest (Auscultation (± bronchial breathing, ↓ AE,…

- - - - Plombage: insertion of polystyrene balls into thoracic cavity
      - Phrenic nerve crush: diaphragm paralysis
      - Thoracoplasty: rib removal to collapse lung
      - Apical lobectomy
  - - - LN compression of large airways
      - Traction from fibrosis
  - - - RMP: hepatitis, orange urine, enzyme induction
      - INH: peripheral sensory neuropathy, ↓PMN
      - PZA: hepatitis, arthralgia (CI: gout, porphyria)
      - EMB: optic neuritis → loss of colour vision first
    - - RMP
      - INH
- - - - Childhood or naïve TB infection
        Organism multiplies @ pleural surface → Ghon Focus
        Macros take TB to LNs
        Nodes + lung lesion = Ghon complex
        Mostly asympto: may → fever and effusion
        Cell mediated immunity / DTH controls infection in 95%
        Fibrosis of Ghon complex → calcified nodule
        (Ranke complex)
        Rarely may → 1O progressive TB (immunocomp)
    - - Resembles acute bacterial pneumonia
        Mid and lower zone consolidation, effusions, hilar LNs
        Lymphohaematogenous spread → extra-pulmonary and milliary TB
    - - Infected but no clinical or x-ray signs of active TB Non-infectious
        May persist for years
        Weakened host resistance → reactivation
    - - Usually reactivation of latent TB due to ↓ host immunity
        May be due to reinfection
        Typically develops in the upper lobes
        Hypersensitivity → tissue destruction → cavitation and formation of caseating granulomas.
  - - - Tuberculin Skin Test
        If +ve → IGRA
    - - If suggestive CXR take ≥3 sputum samples (one AM)
        May use BAL if can’t induce sputum
        Microscopy for AFB: Ziehl-Neelsen stain
        Culture: Lowenstein-Jensen media (Gold stand)
      - CXR
        
        Consolidation, cavitation, fibrosis, calcification
        
        Mainly upper lobes.
    - - Intradermal injection of purified protein derivative
        Induration measured @ 48-72h
        False +ve: BCG, other mycobacteria, prev exposure
        False –ve: HIV, sarcoid, lymphoma
    - - Pt. lymphocytes incubated c¯ M. tb specific antigens → IFN-γ production if previous exposure.
        Will not be positive if just BCG (uses M. bovis)
        E.g. Quantiferon Gold and T-spot-TB