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You are here: Home / 09. Medical/Surgical / infectious disease / Tuberculosis (Consumption)

Tuberculosis (Consumption)

July 14, 2011 by CrashMaster

M. Bovis, M. Africanum, M. Tuberculosis

Stage I-macrophage ingests

Stage II-reproduction leads to lysis, repeat, to tubercle, transmitted to lymph nodes, kidneys, long bones, meninges, apical portions of lungs

Stage III-2-3 weeks.  Cd4 kill Tb forming granulomas.  Can survive in the granuloma.  Walled off by epitheloid cells.

Stage IV-Reactivation-Erosion of bronchial walls.  In the immunocompetent 5% will progress in the first three years then another 5% later in life.

Cough, sputum, night sweats, weight loss

 

Complication-pneumo, empyema, endobronchial spread, superinfection of cavities (aspergillus), massive hemoptysis,

Radiology

C-XR:  primary infiltrate shows increased hilar or mediastinal nodes, Ghon focus is a healed calcified scar.  If associated c large hilum then Ranke Complex. Post-primary upper lung infiltrate or consolidation+-cavitation.  Irregular angular lesions c strands extending towards hilum.

Detection of TB with normal chest radiograph (Chest 1999;115:445) Only 1 out of 518 patients was smear + and cxr neg, though 22 were cx + (non-infectious)

Dx c sputum or bronch

PPD + 3-8 weeks after infection .1 cc dose

Extrapulmonary

Lymphadenitis (Scrofula)-most commonly cervical, discrete rubbery mass,  Excise and ripe

 

 

Pleural effusion or empyema

Spinal (Pott’s)-back pn or stiffness.  Also hip or knee

Renal-sterile pyuria, can spread to reproductive tract

Miliary-usually can see on XR

Meningitis-malaise, HA, fever,  One LP only 37% sensitive

Intracranial TB

GI-anywhere in the tract

Peritonitis-exudative c lymphocytes

Massive Hemoptysis

 

Rx:  can begin rx immediately as it will not affect the testing

Rifampin, INH, Pyrazinamide, Ethambutol (Streptomycin, Levaquin)

 

INH Overdose leads to seizures.  Treat c pyridoxine gram for gram or 5g empiric

 

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Filed Under: infectious disease, pulmonology


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