Primary Tuberculosis Overview

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Questions and Answers

What characterizes primary tuberculosis?

  • TB that has become chronic
  • TB detected later in adulthood
  • TB revealed for the first time (correct)
  • TB detected only in children

In primary tuberculosis, where is the localization of inflammation most commonly observed?

  • Pleura
  • Peripheral lymph nodes
  • Lung tissue (correct)
  • Intrathoracic lymph nodes

What components make up the primary tuberculosis complex?

  • Focus in lungs and pleural effusion
  • Focus in the abdominal cavity
  • Focus in lung, specific lymphangitis and tuberculosis of regional lymph nodes (correct)
  • Only lung infiltration

Which site is most commonly affected by tuberculosis in peripheral lymph nodes?

<p>Neck region (C)</p> Signup and view all the answers

What does the concept of exogenic superinfection refer to?

<p>Introduction of TB bacteria from outside into a previously non-infected organism (D)</p> Signup and view all the answers

How is endogenic reinfection defined?

<p>Activation of a previously hidden TB focus (C)</p> Signup and view all the answers

In disseminated pulmonary tuberculosis, which method of infection spread is not involved?

<p>Lymphagenic (A)</p> Signup and view all the answers

In hematogenic disseminated pulmonary tuberculosis, the localization of the infection typically occurs in which vessels?

<p>Venules (D)</p> Signup and view all the answers

Proliferation of survived MBT in alveolar macrophages of airways after inspiration of sputum particles corresponds to which stage of infection?

<p>3rd stage of infection (D)</p> Signup and view all the answers

Which stage of infection corresponds to swallowing MBT by alveolar macrophages in a non-immunized organism?

<p>3rd stage of infection (C)</p> Signup and view all the answers

The development of a nonnegative response to TST after infection represents which stage?

<p>4th stage of infection (C)</p> Signup and view all the answers

Reactivation of a TB focus in lung tissue with caseous necrosis suggests which stage of infection?

<p>4th stage of infection (B)</p> Signup and view all the answers

What does the expectoration of sputum contaminated by MBT and subsequent infection of another person indicate?

<p>3rd stage of infection (B)</p> Signup and view all the answers

Which type of hypersensitivity is the basis of TB inflammation?

<p>Delayed-type hypersensitivity (D)</p> Signup and view all the answers

In latent TB infection, which condition describes the infectious process?

<p>Presence of MBT without clinical symptoms (C)</p> Signup and view all the answers

What is the epidemiologic parameter of infection in TB?

<p>% of nonnegative response to TST excluding post-BCG allergy (B)</p> Signup and view all the answers

Which clinical form of TB typically presents on a Chest X-ray resembling pneumonia?

<p>Infiltrative TB (A)</p> Signup and view all the answers

What clinical form of TB is characterized by the predominance of exudative inflammation in the lung?

<p>Infiltrative TB (B)</p> Signup and view all the answers

Which form of TB is associated with a predominance of productive-proliferative inflammation in the lung?

<p>Tuberculomas of lung (C)</p> Signup and view all the answers

Which clinical form of TB typically results from ineffective chemotherapy courses?

<p>Infiltrative TB (D)</p> Signup and view all the answers

Which form of TB is characterized by the prevalence of caseous necrosis in the lung?

<p>Caseous pneumonia (A)</p> Signup and view all the answers

Which clinical form of TB usually has a gradual onset?

<p>Disseminated TB (B)</p> Signup and view all the answers

Which clinical form of TB is most frequently associated with an acute onset?

<p>Infiltrative TB (D)</p> Signup and view all the answers

Which clinical form of TB typically shows a shadow with a definitive low border and an indefinite upper border on imaging?

<p>Peristsissuritis (D)</p> Signup and view all the answers

What is the main thermo-stable component of tuberculin?

<p>Antigen CFP10 (A)</p> Signup and view all the answers

What does tuberculin act as in relation to M.tuberculosis?

<p>A hapten that produces sensibilization (B)</p> Signup and view all the answers

After contamination with M.tuberculosis, how long does it typically take for the host body to react to the injection of Tuberculin?

<p>After 2-3 weeks (B)</p> Signup and view all the answers

What type of hypersensitivity is the basis of the skin response to the injection of tuberculin?

<p>Delayed type of hypersensitivity (B)</p> Signup and view all the answers

What is the most common indication for a Tuberculin Skin Test (TST)?

<p>Detection of primary TB infection (D)</p> Signup and view all the answers

For active diagnosis of TB, how frequently is the TST carried out in Russia?

<p>Every 6 months (D)</p> Signup and view all the answers

How much PPD-S is included in a dosage of 0.1 ml?

<p>5 TE (D)</p> Signup and view all the answers

What defines polyresistance in mycobacterium tuberculosis (MBT)?

<p>Resistance to two or more anti-tuberculosis drugs without resistance to Isoniazid &amp; Rifampicin (A)</p> Signup and view all the answers

What percentage of new tuberculosis cases in Russia is associated with multidrug-resistant tuberculosis (MDR)?

<p>15-20% (A)</p> Signup and view all the answers

What limits the successful treatment of new tuberculosis cases during the initial phase of chemotherapy?

<p>Slow growth of MBT on culture media (C)</p> Signup and view all the answers

Which method is used to detect genetic mutants of mycobacterium tuberculosis with resistance to antituberculous drugs?

<p>PCR (C)</p> Signup and view all the answers

What is the definition of acquired (secondary) resistance in mycobacterium tuberculosis?

<p>Drug resistance developed during tuberculosis treatment (C)</p> Signup and view all the answers

In how many weeks can resistance of mycobacterium tuberculosis develop when inadequately chosen anti-tuberculous drugs are used?

<p>2-3 weeks (D)</p> Signup and view all the answers

How long does multidrug-resistant tuberculosis (MDR-TB) increase the course of antituberculous treatment?

<p>10-12 months (D)</p> Signup and view all the answers

What location is favored for secondary tuberculosis as seen on a chest X-ray?

<p>Lower lobe of the lung (B)</p> Signup and view all the answers

Which type of tuberculosis is more likely to present with a rapid progression of symptoms?

<p>Disseminated TB (D)</p> Signup and view all the answers

Which type of TB is most associated with cachexia?

<p>Disseminated TB (D)</p> Signup and view all the answers

Expectoration of more than 100 ml of sputum is typically seen in which type of TB?

<p>Infiltrative TB (A)</p> Signup and view all the answers

Which of the following conditions is more likely to cause dyspnea?

<p>Disseminated TB (B)</p> Signup and view all the answers

In comparison to infiltrative pneumonia, caseous pneumonia is more characterized by which condition?

<p>Acute onset (C)</p> Signup and view all the answers

In the presence of caseous pneumonia, the shift of the mediastinum is associated with which phenomenon?

<p>Apneumatosis due to purulent sputum (B)</p> Signup and view all the answers

The presence of two hyperinflated caverns in the left lung with a mediastinum shift suggests which type of TB?

<p>Fibrous-cavernous TB (C)</p> Signup and view all the answers

Which type of dissemination is characterized by bilateral foci that are 1-2 mm in size?

<p>Miliary TB (C)</p> Signup and view all the answers

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Flashcards

Primary TB

The first time TB is detected in an individual.

Primary TB inflammation localization

The typical site of inflammation in primary TB is in the lymph nodes surrounding the lungs.

Primary Tuberculosis Complex

The combination of the initial focus of TB infection in the lungs and the involvement of nearby lymph nodes.

Paraspecific reactions in TB

In children and teenagers, a somewhat unusual reaction that occurs with TB infection, presenting with enlarged lymph nodes in several parts of the body.

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TB in peripheral lymph nodes

The most common location for TB infection to spread to in peripheral lymph nodes is the neck.

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Exogenic super infection

The spread of TB bacteria from the outside world into someone who is already infected.

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Endogenic reinfection

The reactivation of a dormant TB infection within the body.

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Hematogenic disseminated pulmonary TB

The spread of TB throughout the body using the bloodstream.

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1st stage of TB infection

The initial encounter of a previously uninfected individual with Mycobacterium tuberculosis. This stage involves the bacteria entering the lungs, multiplying within alveolar macrophages, and triggering an immune response.

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2nd stage of TB infection

The Mycobacterium tuberculosis (MTB) bacteria proliferate within the host's lung tissue. This leads to the formation of the primary tuberculosis complex, including the Ghon focus and regional lymph node involvement.

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3rd stage of TB infection

The body mounts an immune response to the MTB infection. This immune response leads to a positive tuberculin skin test (TST) result, indicating exposure to the bacteria.

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4th stage of TB infection

The TB bacteria become dormant and remain in a latent state within the host. This stage is characterized by no active disease and minimal symptoms. However, the potential for reactivation remains.

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5th stage of TB infection

The dormant bacteria reactivate and cause active tuberculosis disease. This stage involves symptoms like coughing, fever, and weight loss.

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Delayed-type hypersensitivity

A type of immune response characterized by a delayed reaction. It involves T cells recognizing and destroying infected cells. This is the primary mechanism behind the immune response to TB.

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Infection rate in TB epidemiology

This refers to the percentage of individuals in a population who have a positive tuberculin skin test (TST) result. It indicates the proportion of people who have been exposed to MTB.

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Risk of developing active TB

It is a measure of the likelihood of individuals with a latent TB infection developing active tuberculosis disease.

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What is tuberculin?

Tuberculin is a preparation derived from the bacteria Mycobacterium tuberculosis. It is mainly used to detect past or present Mycobacterium tuberculosis infection.

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What type of antigen is tuberculin?

Tuberculin is a hapten, meaning it's an incomplete antigen that doesn't trigger an immune response on its own. It needs to bind to a carrier molecule to become immunogenic.

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Tuberculin as an allergen

Tuberculin is also an allergen. It can cause a localized allergic reaction in individuals who have been previously exposed to Mycobacterium tuberculosis. This reaction is usually observed in the skin after injection of tuberculin.

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What is the tuberculin skin test (TST)?

The tuberculin skin test (TST) is a common diagnostic tool for detecting latent tuberculosis infection. It involves injecting a small amount of tuberculin into the skin and observing the reaction 48-72 hours later.

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What is the basis of the skin response to tuberculin?

The basis for the skin response to tuberculin injection is a delayed type hypersensitivity (DTH). This response is mediated by T-lymphocytes specifically recognizing Mycobacterium tuberculosis antigens.

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For what is the TST most commonly used?

The TST is primarily used for identifying individuals who have been infected with Mycobacterium tuberculosis. The test doesn't indicate active disease, but rather exposure to the bacteria.

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How often is the TST performed in Russia?

In Russia, the TST is routinely performed every 6 months to detect latent TB infection.

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What are the standard doses of tuberculin?

The standard dose of tuberculin for TST is measured in tuberculin units (TU). A 0.1 ml injection of PPD-S contains 5 TU, while a 0.1 ml injection of PPD-L contains 2 TU.

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Polyresistance (combined) TB

A type of tuberculosis (TB) where the bacteria have become resistant to two or more anti-tuberculosis drugs, excluding Isoniazid and Rifampicin.

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Multidrug Resistant (MDR) TB

A type of tuberculosis (TB) where the bacteria have developed resistance to Isoniazid and Rifampicin, the two most important TB drugs.

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MDR-TB Prevalence in Russia

The occurrence of new tuberculosis (TB) cases with MDR-TB in Russia is significant at a rate of 15-20%.

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Acquired (secondary) resistance

Acquired resistance occurs when a patient develops resistance to anti-tuberculosis drugs during the treatment course.

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PCR for Drug Resistance Detection in MTB

A method to detect genetic mutations in Mycobacterium tuberculosis (MTB) responsible for drug resistance.

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Time Frame for Drug Resistance Development

The development of drug resistance in MTB commonly occurs after 4-6 months of treatment with inappropriate or insufficiently chosen anti-tuberculosis medications.

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Secondary TB Localization

The preferred location for secondary TB infections, also known as pulmonary TB.

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Primary TB Localization

The typical location for primary tuberculosis (TB) infections.

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Disseminated TB

A type of TB with a slow onset and is often seen in people who have had a latent infection.

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Fibrous-cavernous TB

A form of TB that progresses slowly over time, often showing characteristics like the formation of cavities in the lungs.

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Cloud-like Infiltrate

A type of TB characterized by the appearance of a cloud-like shadow on a chest X-ray, often seen in the lower lobes of the lungs.

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Infiltrative TB

This type of TB is associated with inflammation and consolidation of the lung tissue, giving a pneumonia-like appearance on chest X-ray.

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Exudative TB

A specific type of TB where the predominant inflammation in the lungs is characterized by an exudative pattern.

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Productive-proliferative TB

This form of TB is characterized by a predominance of productive-proliferative inflammation, leading to the formation of granulomas and caseous necrosis in the lung tissue.

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Caseous TB

This type of TB can be a result of ineffective chemotherapy and is characterized by a predominance of caseous necrosis in the lung tissue.

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Cachexia

This is a severe symptom of TB, where the body starts to waste away due to severe weight loss, loss of appetite, and weakness.

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Caseous pneumonia

This type of TB produces large amounts of sputum. When someone coughs, they produce more than 100ml of phlegm.

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Dyspnea

This is a symptom where it's difficult to breathe. Shortness of breath is more commonly seen in disseminated TB.

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Caseous pneumonia

This is a serious TB infection, where a large part of the lung is filled with cheese-like, decaying matter.

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Atelectasis

This is a lung condition where the lung collapses. The collapsed lung can be caused by many things, but one is pressure from the chest cavity caused by TB.

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Miliary TB

A very serious form of TB where the bacteria spread throughout the body through the bloodstream.

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Hematogenic Disseminated TB

This is a specific type of TB where the bacteria spread in the body through the bloodstream, but only through the veins. This is very serious as it can affect many organs.

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Study Notes

Tuberculosis History

  • Tuberculosis (TB) is an infectious disease primarily caused by Mycobacterium tuberculosis, with a predilection for lung localization.
  • The most ancient recognition of TB likely involved cases of infiltrative TB or TB of peripheral lymph nodes.
  • Hippocrates provided an early, systemic description of TB's clinical and epidemiological features.
  • Aristotle first proposed the infectious nature of TB.
  • Avicenna contributed to the understanding of the clinical manifestations of TB.
  • Jacob Monget first described miliary tuberculosis.
  • The term "tuberculosis" was initially proposed by Girolamo Fracastorius.
  • The famous Russian surgeon Pirogov is linked to the development of surgical treatment methods for TB (and description of specific necrosis cases).
  • Koch improved the staining method for M.tuberculosis.
  • Calmette and Guerin (also known as C.G) developed a vaccine for TB prevention.

Tuberculosis Etiology and Pathogenesis

  • Mycobacterium tuberculosis is a bacteria.
  • The primary cause of TB in humans is M. tuberculosis.
  • Mycobacterial modifications initially occur due to chemotherapy.
  • M. tuberculosis has different forms.
  • Koch bacilli can transform into L-forms or virus-like forms.
  • TB development is influenced by several factors, including genetic mutations, treatment inadequacies, and treatment interruptions.

Tuberculosis: Diagnostic Features

  • The Ziehl-Neelsen method uses acid-fast staining properties of TB to distinguish M. tuberculosis from other bacteria.
  • The method involves multiple steps, including staining with carbol-fuchsin, acid-alcohol decolorization, counterstaining, and methylene blue.
  • Diagnostic methods of TB include sputum analysis, imaging (e.g., X-ray), and tests like TST and IGRA.

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