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Tuberculosis (TB) (Risk Factors (Ageing, Malnutrition, IVDU, Homelessness,…
Tuberculosis (TB)
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Diagnosis
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Culture - liquid/broth culture, solid culture on Lowenstein-Jensen slopes or Middlebrook agar
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Lumbar puncture and CSF examination - in all cases of military TB, due to high rate of spread to meninges
CXR
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Patchy or nodular shadows in the upper zones with loss of volume, and fibrosis with or without cavitation
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Treatment
RIPE for 6 month (12 months for CNS) - Rifampicin, Isoniazid, Pyrazinamide, Ethambutol
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To aid compliance there are special clinics called DOTS where they give medication under supervision
If histology & clinical picture are consistent with TB then start treatment without waiting for culture results and continue even if these are negative
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Pathophysiology
Primary tuberculosis
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Macrophages present the antigen to the T lymphocytes with the development of a cellular immune response
Once inhaled into the lung, alveolar macrophages ingest the bacteria
A delayed hypersensitivity-type reaction occurs, resulting in tissue necrosis and formation of a granuloma
Latent tuberculosis
In the majority of people who are infected, the immune system contains the infection and the patient develops cell-mediated immunity memory to the bacteria
The outcome of exposure is dictated by a number of factors, including the host's immune response
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However, NOT ALL INFECTED actually develop ACTIVE DISEASE
Other types of TB - GI TB, TB of bone and spine, Military TB - widespread systemic TB, CNS TB, Pericardial TB, TB of skin
Clinical Presentation
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Pulmonary TB
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Associated with - consolidation, pleural effusion, pulmonary collapse caused by compression of a lobar bronchus by enlarged nodes
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Extrapulmonary TB
Abdominal TB - ascites, abdominal lymph nodes, ill malabsorption
GU TB - epididymitis, frequency, dysuria & haematuria
Bone - pain or swelling of joint, Potts disease - spinal cord/vertebral TB
CNS TB - bacilli in CSF & on meninges, meningeal inflammation produces thick exudate, which leads to strangulation of cranial nerves and raised ICP
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