{"id":5165,"date":"2011-07-14T20:24:03","date_gmt":"2011-07-14T20:24:03","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5165.htm\/"},"modified":"2013-02-14T19:37:36","modified_gmt":"2013-02-15T00:37:36","slug":"tuberculosis","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/tuberculosis.htm\/","title":{"rendered":"Tuberculosis (Consumption)"},"content":{"rendered":"

M. Bovis, M. Africanum, M. Tuberculosis<\/p>\n

Stage I-macrophage ingests<\/p>\n

Stage II-reproduction leads to lysis, repeat, to tubercle, transmitted to lymph nodes, kidneys, long bones, meninges, apical portions of lungs<\/p>\n

Stage III-2-3 weeks.\u00a0 Cd4 kill Tb forming granulomas.\u00a0 Can survive in the granuloma.\u00a0 Walled off by epitheloid cells.<\/p>\n

Stage IV-Reactivation-Erosion of bronchial walls.\u00a0 In the immunocompetent 5% will progress in the first three years then another 5% later in life.<\/p>\n

Cough, sputum, night sweats, weight loss<\/p>\n

 <\/p>\n

Complication-pneumo, empyema, endobronchial spread, superinfection of cavities (aspergillus), massive hemoptysis,<\/p>\n

<\/span>Radiology<\/span><\/h2>\n

C-XR:\u00a0 primary infiltrate shows increased hilar or mediastinal nodes, Ghon focus is a healed calcified scar.\u00a0 If associated c large hilum then Ranke Complex. Post-primary upper lung infiltrate or consolidation+-cavitation.\u00a0 Irregular angular lesions c strands extending towards hilum.<\/p>\n

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)<\/p>\n

Dx c sputum or bronch<\/p>\n

PPD + 3-8 weeks after infection .1 cc dose<\/p>\n

<\/span>Extrapulmonary<\/span><\/h2>\n

Lymphadenitis (Scrofula)<\/strong>-most commonly cervical, discrete rubbery mass,\u00a0 Excise and ripe<\/p>\n

\"\"<\/a><\/p>\n

 <\/p>\n

 <\/p>\n

Pleural effusion or empyema<\/p>\n

Spinal (Pott\u0092s)-back pn or stiffness.\u00a0 Also hip or knee<\/p>\n

Renal-sterile pyuria, can spread to reproductive tract<\/p>\n

Miliary-usually can see on XR<\/p>\n

Meningitis-malaise, HA, fever,\u00a0 One LP only 37% sensitive<\/p>\n

Intracranial TB<\/p>\n

GI-anywhere in the tract<\/p>\n

Peritonitis-exudative c lymphocytes<\/p>\n

Massive Hemoptysis<\/p>\n

 <\/p>\n

Rx:\u00a0 can begin rx immediately as it will not affect the testing<\/p>\n

Rifampin, INH, Pyrazinamide, Ethambutol (Streptomycin, Levaquin)<\/p>\n

 <\/p>\n

INH Overdose leads to seizures.\u00a0 Treat c pyridoxine gram for gram or 5g empiric<\/p>\n

 <\/p>\n

|\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":"

Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[23,32],"tags":[],"yoast_head":"\nTuberculosis (Consumption) - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/tuberculosis.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/tuberculosis.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/tuberculosis.htm\/\",\"name\":\"Tuberculosis (Consumption) - 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