Mycobacterium tuberculosis: Difference between revisions
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Mycobacterium tuberculosis
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= Tuberculosis (TB) = |
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== Definition == |
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* Primary vs. reactivation vs. reinfection |
* Primary vs. reactivation vs. reinfection |
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* Latent vs. active |
* Latent vs. active |
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= Epidemiology = |
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* Reinfection accounts for ~40% of active tuberculosis in endemic countries |
* Reinfection accounts for ~40% of active tuberculosis in endemic countries |
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* Latent tuberculosis in ~30% of the global population |
* Latent tuberculosis in ~30% of the global population |
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= Presentation = |
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* Primary tuberculosis is usually asymptomatic |
* Primary tuberculosis is usually asymptomatic |
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* Extra-pulmonary tuberculosis |
* Extra-pulmonary tuberculosis |
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** Pleural tuberculosis is most common |
** Pleural tuberculosis is most common |
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** Scrofula (cervical lymph node infection) next-most common |
** [[Scrofula]] (cervical lymph node infection) next-most common |
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** [[Tuberculous meningitis]] |
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** Meningitis |
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** [[Tuberculous pericarditis]] |
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** Pericarditis |
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** Renal |
** Renal tuberculosis |
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** Abdominal |
** Abdominal tuberculosis |
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** Gastrointestinal |
** Gastrointestinal tuberculosis |
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= Investigations = |
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* AM sputum for acid-fast bacilli x3 |
* AM sputum for acid-fast bacilli x3 |
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** About 75% sensitive |
** About 75% sensitive |
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= Management = |
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* Standard HREZ x2mo then HR x4mo |
* Standard HREZ x2mo then HR x4mo |
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** Improvement in symptoms |
** Improvement in symptoms |
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== IRIS == |
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== DILI == |
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* Most common complication leading to treatment interruption, with a mortality of 6-12% if drugs are not stopped |
* Most common complication leading to treatment interruption, with a mortality of 6-12% if drugs are not stopped |
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** Only rechallenge with pyrazinamide if it was a mild case |
** Only rechallenge with pyrazinamide if it was a mild case |
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== Adherence to Treatment == |
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* Refer to [http://www.letstalktb.org/ Let's Talk TB] |
* Refer to [http://www.letstalktb.org/ Let's Talk TB] |
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[[Category:TB]] |
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[[Category:Pulmonary infections]] |
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Revision as of 03:21, 15 August 2019
- Mycobacterium tuberculosis causes tuberculosis, most commonly pulmonary but can affect any organ
Classification
- Primary vs. reactivation vs. reinfection
- Latent vs. active
Epidemiology
- Reinfection accounts for ~40% of active tuberculosis in endemic countries
- Latent tuberculosis in ~30% of the global population
Presentation
- Primary tuberculosis is usually asymptomatic
- Possible presentations include mild URTI with cough and/or fever
- May be seen on CXR as infiltrate in mid-lung zones with hilar adenopathy
- Ghon complex, especially in children
- May progress in children and the immunocompromised patients
- Recent primary tuberculosis
- Immunological phenomena
- Erythema nodosum
- Phlyctenular conjunctivitis
- Immunological phenomena
- Recent or active tuberculosis
- Erythema induratum
- Reactivation tuberculosis
- Poorly-defined clinical course
- Usually reactivates in lung apices
- Active tuberculosis
- Cough and fever for more than two weeks
- Cough and HIV infection
- Extra-pulmonary tuberculosis
- Pleural tuberculosis is most common
- Scrofula (cervical lymph node infection) next-most common
- Tuberculous meningitis
- Tuberculous pericarditis
- Renal tuberculosis
- Abdominal tuberculosis
- Gastrointestinal tuberculosis
Investigations
- AM sputum for acid-fast bacilli x3
- About 70% sensitive
- ANTB (PCR)
- About 75% sensitive
Management
- Standard HREZ x2mo then HR x4mo
- Isoniazid 5mg/kg/d, max 300mg daily
- Rifampin 10mg/kg/d
- Pyrazinamide 25mg/kg/d, max 2g daily
- Ethambutol 20mg/kg/d, max 1.2g daily
- Pyridoxine
- Airborne precautions until:
- Treated for at least 2 weeks
- 3x negative sputum smears
- Collected at 8- to 24-hour intervals, including one early morning collection
- Improvement in symptoms
IRIS
DILI
- Most common complication leading to treatment interruption, with a mortality of 6-12% if drugs are not stopped
- Rif > INH > PZA
- Most patients can have the same TB drugs reintroduced without recurrence of DILI, though recurrence can be delayed
- Procedure
- Hold if ALT >120 and symptoms, if ALT >200 even without symptoms, or bili >2x ULN
- Switch to second-line meds
- Reintroduce the original drugs once AST & ALT are <2x ULN
- Only rechallenge with pyrazinamide if it was a mild case
Adherence to Treatment
- Refer to Let's Talk TB
