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Questions and Answers
What is the minimum duration of antituberculous drug treatment for most cases?
What is the minimum duration of antituberculous drug treatment for most cases?
What should be confirmed before initiating antituberculous drug therapy?
What should be confirmed before initiating antituberculous drug therapy?
Which finding indicates that CSF-PCR for TB is required in a patient with symptoms of meningitis?
Which finding indicates that CSF-PCR for TB is required in a patient with symptoms of meningitis?
Which treatment should be initiated immediately for a patient with bacterial meningitis suspected?
Which treatment should be initiated immediately for a patient with bacterial meningitis suspected?
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What monitoring is crucial during the treatment of tuberculosis?
What monitoring is crucial during the treatment of tuberculosis?
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What indicates a potential false-positive reaction in the Tuberculin skin test (TST)?
What indicates a potential false-positive reaction in the Tuberculin skin test (TST)?
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Which factor is NOT a cause of false-negative reactions in the Tuberculin test?
Which factor is NOT a cause of false-negative reactions in the Tuberculin test?
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What is the recommended duration of treatment for most sites of tuberculosis infection?
What is the recommended duration of treatment for most sites of tuberculosis infection?
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What treatment duration is specifically required for TB meningitis?
What treatment duration is specifically required for TB meningitis?
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Which of the following is a major concern regarding tuberculosis treatment?
Which of the following is a major concern regarding tuberculosis treatment?
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Which laboratory test is used to confirm the presence of pulmonary TB?
Which laboratory test is used to confirm the presence of pulmonary TB?
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What is NOT a method to diagnose tuberculosis?
What is NOT a method to diagnose tuberculosis?
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Which of the following is considered a first-line drug in the treatment of tuberculosis?
Which of the following is considered a first-line drug in the treatment of tuberculosis?
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What is the maximum daily dosage of Isoniazide for an adult patient weighing 70 kg?
What is the maximum daily dosage of Isoniazide for an adult patient weighing 70 kg?
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Which of the following is a contraindication for administering Rifampicin?
Which of the following is a contraindication for administering Rifampicin?
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What is indicated by the presence of inflammatory cells that are rich in lymphocytes in the fluid obtained from paracentesis?
What is indicated by the presence of inflammatory cells that are rich in lymphocytes in the fluid obtained from paracentesis?
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Which complication is associated with tuberculoma?
Which complication is associated with tuberculoma?
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How often should Pyrazinamide be administered to patients with renal failure?
How often should Pyrazinamide be administered to patients with renal failure?
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What is a major precaution when prescribing Ethambutol?
What is a major precaution when prescribing Ethambutol?
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What is a common symptom of genito-urinary tuberculosis?
What is a common symptom of genito-urinary tuberculosis?
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What could be a consequence of salpingo-oophoritis in adult females caused by tuberculosis?
What could be a consequence of salpingo-oophoritis in adult females caused by tuberculosis?
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Which class of drugs includes levofloxacin and moxifloxacin used in MDR TB treatment?
Which class of drugs includes levofloxacin and moxifloxacin used in MDR TB treatment?
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What should Pyridoxine be given to prevent when treating with Isoniazide?
What should Pyridoxine be given to prevent when treating with Isoniazide?
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Which of the following symptoms would most likely indicate TB pericarditis?
Which of the following symptoms would most likely indicate TB pericarditis?
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Which of the following conditions is a contraindication for Pyrazinamide?
Which of the following conditions is a contraindication for Pyrazinamide?
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What is a severe consequence of pericardial effusion due to tuberculosis?
What is a severe consequence of pericardial effusion due to tuberculosis?
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In the context of genito-urinary tuberculosis, how may the infection spread beyond the kidneys?
In the context of genito-urinary tuberculosis, how may the infection spread beyond the kidneys?
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Which statement is accurate regarding extra-pulmonary tuberculosis?
Which statement is accurate regarding extra-pulmonary tuberculosis?
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What anatomical area is primarily affected by the most significant fluid deposition described in the ultrasonography findings?
What anatomical area is primarily affected by the most significant fluid deposition described in the ultrasonography findings?
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What symptoms are indicative of constriction in a patient?
What symptoms are indicative of constriction in a patient?
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Which lymph node chains are typically involved in TB lymphadenitis?
Which lymph node chains are typically involved in TB lymphadenitis?
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What is a common complication of untreated Pott’s Disease?
What is a common complication of untreated Pott’s Disease?
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Which demographic is most vulnerable to miliary TB?
Which demographic is most vulnerable to miliary TB?
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What imaging technique is recommended according to the site of suspected TB?
What imaging technique is recommended according to the site of suspected TB?
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What condition is characterized by direct extension from an underlying TB infection to the skin?
What condition is characterized by direct extension from an underlying TB infection to the skin?
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What type of TB infection is primarily monoarticular?
What type of TB infection is primarily monoarticular?
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Which lab finding is typically expected in cases of chronic illness related to TB?
Which lab finding is typically expected in cases of chronic illness related to TB?
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Which of the following is NOT a common symptom of extrapulmonary TB?
Which of the following is NOT a common symptom of extrapulmonary TB?
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What is the most common method of spreading extrapulmonary TB?
What is the most common method of spreading extrapulmonary TB?
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What is the most likely diagnosis for the female patient in the case study?
What is the most likely diagnosis for the female patient in the case study?
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Which of the following diagnostic tests is most likely to confirm a diagnosis of tuberculous peritonitis?
Which of the following diagnostic tests is most likely to confirm a diagnosis of tuberculous peritonitis?
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What is the recommended treatment duration for extrapulmonary TB?
What is the recommended treatment duration for extrapulmonary TB?
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Which of the following is NOT a factor that may influence the treatment duration for extrapulmonary TB?
Which of the following is NOT a factor that may influence the treatment duration for extrapulmonary TB?
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What is the role of serology in diagnosing extrapulmonary TB?
What is the role of serology in diagnosing extrapulmonary TB?
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What is the most important factor in determining the duration of treatment for latent TB?
What is the most important factor in determining the duration of treatment for latent TB?
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Study Notes
Extrapulmonary Tuberculosis
- Extrapulmonary TB is tuberculosis that occurs outside the lungs.
- Dissemination of the infection can be hematogenous or from adjacent organs.
- Symptoms vary based on affected site. Common symptoms include fever, malaise, and weight loss.
- Diagnosis involves culture, serology tests.
- Treatment typically includes multiple drugs for more than 6 months.
Intended Learning Outcomes
- Students will be able to identify different sites of extrapulmonary TB.
- Students will understand the clinical presentation of extrapulmonary TB.
- Students will know different diagnostic tests for extrapulmonary TB.
- Students will define latent TB and different treatment options for latent and extrapulmonary TB.
Case Study
- A 36-year-old woman with diabetes was admitted with abdominal tenderness and ascites.
- No other notable symptoms were present in the patient.
- Vital signs were within normal range (temperature 36.3°C, blood pressure 120/70mmHg, and heart rate 82/min)).
- Physical examination revealed ascites.
Laboratory Results
- No anemia, white blood cell elevation, or thrombocyte abnormalities were present.
- Peripheral blood smear was normal.
- Renal, hepatic, and electrolyte function were normal.
- C-reactive protein (CRP) was 39 mg/L (normal range 0-5 mg/L).
- Erythrocyte sedimentation rate (ESR) was 42 mm/h (normal range 0-20 mm/h).
Chest X-Ray and Abdominal Ultrasonography
- Chest X-ray was normal.
- Abdominal ultrasound showed abdominal free fluid, septations in fluid accumulation, and multiple implants in the peritoneal surfaces of the hepatic diaphragm and right paracolic area, with the largest implant measuring 16mm.
Paracentesis Results
- Paracentesis fluid was sent for pathology testing.
- Inflammatory cells were present, mostly lymphocytes.
- No malignant cells were found.
- Serum albumin gradient was <1.1, indicating the fluid was exudative.
- Brucella and viral markers were negative.
Tuberculin Testing and Microscopic Examination
- Tuberculin skin test was positive.
- Tuberculosis quantiferon PCR in blood was positive.
- Ascitic fluid direct microscopic examination showed no tuberculosis bacilli and acid-fast stain was negative.
Abdominal CT and MRI
- Abdominal CT scan showed fluid accumulation, hepatic peritoneal surface nodular lesions, increased reticular density in the omental area, and mesentery lymph nodes.
- Adenosine deaminase (ADA) level was 62 units/L.
- Abdominal MRI showed nodular opacities in the peritoneal area and ascites.
Trucut Biopsy
- Trucut biopsy of peritoneal surface nodules revealed granulomas with histiocytic cells.
Treatment
- Six months of multi-drug therapy for tuberculosis was initiated.
- The patient responded well, and the ascites resolved.
Sites of Extrapulmonary Tuberculosis
- Gastrointestinal TB
- Liver TB
- TB peritonitis
- CNS tuberculosis
- Genitourinary TB
- TB pericarditis
- TB lymphadenitis
- Cutaneous TB
- TB of bone and joints
- Miliary TB
TB Peritonitis
- Peritoneal infection from abdominal lymph nodes or salpingo-oophoritis.
- Common in alcoholics with cirrhosis.
Gastrointestinal Tuberculosis
- Caused by Mycobacterium bovis or Mycobacterium tuberculosis.
- Common sites are the jejuno-ileal and ileocecal regions.
- Symptoms may include inflammation, pain, diarrhea, obstruction, and bleeding, and may mimic appendicitis.
Tuberculosis of the Liver
- Result of direct spread or miliary tuberculosis.
- Obstructive jaundice can occur if the gall bladder is involved.
Tuberculous Meningitis
- Chronic, potentially life-threatening form of tuberculosis.
- Very common in children under five years old in areas with high TB prevalence.
- Symptoms include low-grade fever, headache, nausea and drowsiness which can progress to stupor or coma; with positive Kernig and Brudzinski signs.
Complications of Meningitis
- Basal meningeal adhesions
- Blood vessel thrombosis (leading to stroke and hemiparesis).
- Obstruction of cerebrospinal fluid (CSF) flow, leading to increased intracranial pressure, hydrocephalus, and potentially seizures
- Tuberculoma (brain lesion) development
Tuberculoma
- Focal neurological signs, seizures and risk of rupture with secondary meningitis.
Genitourinary Tuberculosis
- Renal manifestations can resemble pyelonephritis; pyuria without typical urinary pathogens (sterile pyuria).
- Affects the bladder, prostate, seminal vesicles, or epididymis in men.
- Inflammation can extend to the perinephric space and cause a cold abscess on the thigh.
- Salpingo-oophoritis (infection of the fallopian tubes and ovaries) can lead to pelvic pain, scarring, infertility, or ectopic pregnancy.
TB Pericarditis
- Rare, typically occurs in the third to fifth decades of life..
- It can develop from mediastinal lymph node foci or pleural tuberculosis.
- Symptoms may include pericardial friction rub, chest pain, or fever. Pericardial tamponade can also occur.
TB Pericarditis Types
- Effusion: compressive symptoms of tamponade (dyspnea, neck vein distention, paradoxical pulse, muffled heart sounds, potential hypotension)
- Effusion/constriction: combination of infusion and restrictive types
- Constriction: high jugular venous pressure (JVP), hepatomegaly (HM), ascites, and edema (associated with restrictive symptoms)
TB Lymphadenitis (Scrofula)
- Usually involves posterior cervical and supraclavicular lymph nodes.
- Likely due to contagious spread from intrathoracic lymphatics or infection of tonsils/adenoids.
- Mediastinal lymph nodes frequently enlarge as part of primary pulmonary TB.
- Characterized by painless, unilateral lymph node enlargement (1+ lymph nodes, often matted).
- Untreated cases can develop necrosis, liquefaction, cold abscesses, and potential sinus formation.
Cutaneous Tuberculosis (Scrofuloderma)
- Direct extension from an underlying TB focus on lymph node, bone or joint.
- May appear as ulcers, and sinus tracts on the overlying skin
- Can also be as a result of immune reaction to the infection.
Tuberculosis of Bone and Joints
- Common in areas with high TB prevalence
- Typically occurs in older individuals
- Axial skeletal involvement is frequently observed more than peripheral joint involvement • Pott's disease: spinal TB, vertebrae collapse with risk of spinal cord compression and paraplegia • Arthritis is usually monoarticular
- LL> UL involvement
Miliary Tuberculosis
- Usually found in children <4 years old, immunocompromised, and elderly patients.
Diagnosis
- Complete Blood Count (CBC): lymphocytosis, anemia of chronic illness
- Erythrocyte Sedimentation Rate (ESR): high
- Imaging: based on the site involved
- Fluid sampling and cytology or tissue biopsy when indicated
Tuberculosis Testing
- Chemical analysis and cytology (fluids): low glucose, high protein and lymphocytosis
- Acid-fast staining, microscopic analysis, mycobacterial culture, fluid and tissue samples
- Nucleic acid-based testing
- Chest X-Ray: for the exclusion or confirmation of pulmonary TB
- Tuberculin skin testing (TST)
- Interferon-gamma release assay (IGRA)
Tuberculin Test
-
False-positive reactions:
- BCG vaccination history
- Infection with non-tuberculous mycobacteria
- Reactions exceeding 15mm are less likely due to vaccination or environmental mycobacterium exposure
- False-negative reactions:
- Cutaneous anergy
- Recent TB infection (<8-10 weeks)
- Very old TB infection (years)
- Very young age (<6 months)
- Recent live-virus vaccination (like measles, smallpox)
- Overwhelming TB disease
Treatment
- Antituberculous drugs
- Surgery (drain abscesses, correct obstruction)
- Nutrition
Multi-drug Resistant Tuberculosis (MDR-TB)
- INH-resistant or rifampicin-resistant TB
- Requires different protocols with 2nd, 3rd (or 4th) line drugs instead of 1st line drugs.
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Description
Test your knowledge on the treatment and diagnosis of tuberculosis. This quiz covers various aspects including drug duration, necessary evaluations, and diagnostic methods for TB. Challenge yourself with questions about treatment protocols and laboratory tests.
