Tuberculosis

incomplete-TODO: tb in pregnancy?!

You must be familiar with the principles of management of TB not just the pharmacological aspects listed below.

Specifically you should be familiar with:

  • The “initial phase” management involving 4 drugs, including their names - see [[TB antibiotic regimes]]
  • The implications of pregnancy and breastfeeding
  • The importance of hepatic and renal function checks
  • Details of individual drugs in terms of dosages, side-effects etc is NOT required
A social disease; cause of death of people with HIV
Etiology Mycobacterium tuberculosis.
Epidemiology
Symptoms: Classically, weight loss, fever, night sweats (yes, all B symptoms!)
Pulmonary TB: persistent productive cough
But any organ can be affected:
- lymphatic: lymphadenopathy
- skeletal: bone/joint pain
- renal: sterile pyuria
Diagnosis and investigations - Mantoux (not TB-specific) or Quantiferon = delayed hypersensitivity to MTB
- GeneXpert = real-time PCR, sensitivity++. Speciation, RPOB status (i.e. rifampicin resistance)
- Sputum sample + stain for MC&S
- CXR: diffuse opacities (miliary TB), lobar consolidation, hilar lymphadenopathy, pleural effusions
- Consider HIV testing - this is an indicator condition
Management See below

management

Needs referral to 2o care

public health aspects

  • Notifiable disease!
  • for active pulmonary TB, only considered non-contagious after 2 weeks of treatment

TB antibiotic regimes

vaccination

#curriculum #pathology #incomplete