18 TB - Boards and Beyond

Characteristics

  • high oxygen content in upper lobe

  • mycolic acid makes mycobacterium

  • sulfatides: glycolipids on surface, allows survival inside macrophages

Infection

  • latent: wall it off

  • most people: either clear infection or go into latent phase
  • small proportion: primary TB, may resolve or become miliary (systemic, serious)
  • may reactivate decades later when immunocompromised

Primary

  • very rare to get sick from primary TB

  • kill macrophage and spill content

  • caseous necrosis: cheese like grossly
  • epithelioid: large cells that look like epithelial. Pic: giant cell

  • important: hilar, classic for TB and sarcoidosis

  • yellow in periphery
  • all results of primary exposure

Miliary TB

  • name from xray: small white lines on xray looking like millet seeds

Reactivated TB

  • primary exposure resolved, either Ghon complex or cleared or latent

Aspergilloma

  • complication of reactivation TB
  • hemoptysis if big enough

Diagnosis

  • inhalation: cough up some sputum

  • measure the hardened area, not red area

  • can't mount immune response

  • false positive

Treatment

  • DOT: pt come in to make sure not miss dosage so no resistant strains

INH

  • katG in TB that activates INH

  • numbness in extremities

Rifampin

Pyrazinamide

Ethambutol

Streptomycin