Tuberculosis (TB) Basics
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What is the approximate number of people who die from tuberculosis every week?

  • 5,000
  • 35,000 (correct)
  • 15,000
  • 50,000

    • What percentage of tuberculosis cases involve the central nervous system, lymphatic system, genitourinary systems, bones, and joints?

  • 15% (correct)
  • 5%
  • 10%
  • 20%

    • What is the primary way that M. tuberculosis is transmitted?

  • Direct contact with an infected person
  • Through contaminated food and water
  • Through insect vectors
  • Through the air, via aerosol droplets (correct)

    • What is the outcome of TB infection in individuals with a healthy immune response?

    <p>The bacteria are contained, but not eliminated</p> Signup and view all the answers

    What is the name of the bacteria that causes tuberculosis?

    <p>M. tuberculosis</p> Signup and view all the answers

    What is the primary risk factor for developing tuberculosis?

    <p>Poverty</p> Signup and view all the answers

    What is the result of a granuloma failing to contain bacteria?

    <p>Immediate lymphatic or hematogenous spread</p> Signup and view all the answers

    What is the annual dose of BCG vaccine administered globally?

    <p>100 million</p> Signup and view all the answers

    What is the purpose of adding antibiotics or malachite green to the medium in Lowenstein-Jensen culture?

    <p>To inhibit the growth of other bacteria</p> Signup and view all the answers

    What is the goal of preventive vaccination in TB control?

    <p>To prevent establishment of infection and development of disease</p> Signup and view all the answers

    What is the duration of first-line oral anti-TB drugs treatment for new and previously untreated cases?

    <p>6 months</p> Signup and view all the answers

    What is the role of the immune response in TB transmission?

    <p>It is required for transmission</p> Signup and view all the answers

    What is the definition of XDR-TB?

    <p>Resistant to rifampicin, isoniazid, any fluoroquinolone, and at least one of the three injectable second-line drugs</p> Signup and view all the answers

    What is the number of potentially active drugs required for MDR-TB treatment?

    <p>At least 4</p> Signup and view all the answers

    What is the function of radiology in TB diagnosis?

    <p>To detect granulomatous lesions</p> Signup and view all the answers

    What is the effect of steroids on sputum clearance in TB patients?

    <p>They increase the rate of sputum clearance</p> Signup and view all the answers

    What is the purpose of the first-line oral anti-TB drug pyrazinamide?

    <p>To treat new and previously untreated TB cases</p> Signup and view all the answers

    What is the name of the vaccine derived from M. bovis?

    <p>BCG</p> Signup and view all the answers

    What is the name of the new drug used to treat MDR-TB?

    <p>All of the above</p> Signup and view all the answers

    What is the percentage of MDR/RR-TB in new TB cases?

    <p>Variable among countries</p> Signup and view all the answers

    What is the duration required for culturing M. tuberculosis on Lowenstein-Jensen medium?

    <p>6 weeks</p> Signup and view all the answers

    What percentage of infected individuals do not develop clinical disease?

    <p>95%</p> Signup and view all the answers

    How often are the recommendations for DR TB treatment updated?

    <p>Every year</p> Signup and view all the answers

    What is the primary antibiotic used to treat leprosy?

    <p>Dapsone</p> Signup and view all the answers

    What is unique about the transmission of leprosy?

    <p>The exact mode of transmission is still unknown</p> Signup and view all the answers

    What is the characteristic of the host response in tuberculoid leprosy?

    <p>Strong cellular immune response, low antibody</p> Signup and view all the answers

    What is the effect of poor host resistance in lepromatous leprosy?

    <p>Formation of foam cell granulomas</p> Signup and view all the answers

    What is the current treatment approach for lepromatous leprosy?

    <p>Multidrug therapy</p> Signup and view all the answers

    What is the significance of the 9-banded armadillo in leprosy research?

    <p>It is used as a model organism for leprosy research</p> Signup and view all the answers

    What is the effect of leprosy on the nervous system?

    <p>It leads to paralysis and anaesthesia</p> Signup and view all the answers

    What is the primary characteristic of mycobacteria that distinguishes them from other bacteria?

    <p>Presence of lipid in their cell wall</p> Signup and view all the answers

    What is the main difference between fast and slow growers in mycobacteria?

    <p>Growth rate on plates</p> Signup and view all the answers

    Which of the following mycobacteria is a pathogen of fish and frogs?

    <p>M.marinum</p> Signup and view all the answers

    What is the purpose of the Ziehl Neelson stain in mycobacteria identification?

    <p>To identify mycobacteria as acid-fast</p> Signup and view all the answers

    What is the primary mode of transmission of M.tuberculosis?

    <p>Through inhalation of infected droplets</p> Signup and view all the answers

    What is the primary characteristic of M.leprae?

    <p>It is a slow grower</p> Signup and view all the answers

    Which of the following mycobacteria is closely related to M.tuberculosis?

    <p>M.bovis</p> Signup and view all the answers

    What is the primary limitation of vaccination as a control strategy for mycobacterial diseases?

    <p>Variable efficacy against different strains</p> Signup and view all the answers

    Mycobacterium avium-intracellulare-scofulaceum complex is an animal pathogen and opportunist of humans.

    <p>True</p> Signup and view all the answers

    All mycobacteria are slow growers.

    <p>False</p> Signup and view all the answers

    Mycobacterium ulcerans causes Buruli ulcer in humans.

    <p>True</p> Signup and view all the answers

    Ziehl Neelson stain is used to identify all types of bacteria.

    <p>False</p> Signup and view all the answers

    Mycobacterium marinum causes disease in fish and frogs.

    <p>True</p> Signup and view all the answers

    Mycobacterium bovis is not related to M. tuberculosis.

    <p>False</p> Signup and view all the answers

    All saprophytic mycobacteria are fast growers.

    <p>True</p> Signup and view all the answers

    Mycobacterium leprae is not a human pathogen.

    <p>False</p> Signup and view all the answers

    The bacteria M.paratuberculosis is a human pathogen.

    <p>False</p> Signup and view all the answers

    Two billion people are infected with HIV.

    <p>False</p> Signup and view all the answers

    Tuberculosis is a disease of wealth.

    <p>False</p> Signup and view all the answers

    In most cases, tuberculosis is a pulmonary infection that spreads to other parts of the body.

    <p>True</p> Signup and view all the answers

    The bacteria M.ulcerans is a pathogen of fish and frogs.

    <p>False</p> Signup and view all the answers

    The outcome of TB infection is always death.

    <p>False</p> Signup and view all the answers

    The immune response is required for transmission of TB

    <p>False</p> Signup and view all the answers

    The granulomatous response always contains bacteria

    <p>False</p> Signup and view all the answers

    Tuberculosis can only be diagnosed through radiology

    <p>False</p> Signup and view all the answers

    The primary goal of antibiotic treatment in TB is to prevent transmission

    <p>False</p> Signup and view all the answers

    The BCG vaccine is derived from M. tuberculosis

    <p>False</p> Signup and view all the answers

    Steroids decrease the rate of sputum clearance in TB patients

    <p>False</p> Signup and view all the answers

    Granuloma always remains walled off for years to decades

    <p>False</p> Signup and view all the answers

    The clinical syndrome of TB only requires a partially intact immune response

    <p>False</p> Signup and view all the answers

    The BCG vaccine has been proven to be 100% effective in preventing tuberculosis in humans.

    <p>False</p> Signup and view all the answers

    The first-line oral anti-TB drugs are given to previously treated cases for 6 months.

    <p>False</p> Signup and view all the answers

    XDR-TB is resistant to at least rifampicin and isoniazid, but not to fluoroquinolone.

    <p>False</p> Signup and view all the answers

    The treatment regimen for MDR-TB requires at least 3 potentially active drugs.

    <p>False</p> Signup and view all the answers

    The World Health Organization updates the recommendations for DR TB treatment every 5 years.

    <p>False</p> Signup and view all the answers

    Bedaquiline is a repurposed drug used to treat MDR-TB.

    <p>False</p> Signup and view all the answers

    The BCG vaccine is derived from M. tuberculosis.

    <p>False</p> Signup and view all the answers

    Multi-drug treatment is required for tuberculosis because of the bacteria's ability to mutate and develop resistance.

    <p>True</p> Signup and view all the answers

    Globally, the success rate in treating MDR TB is more than 70%.

    <p>False</p> Signup and view all the answers

    Leprosy is always limited to the tropics.

    <p>False</p> Signup and view all the answers

    The bacteria Mycobacterium leprae can be grown in cell cultures.

    <p>False</p> Signup and view all the answers

    Dapsone is no longer used to treat leprosy due to its high resistance.

    <p>False</p> Signup and view all the answers

    The host response in lepromatous leprosy is characterized by a strong cellular immune response.

    <p>False</p> Signup and view all the answers

    Leprosy disease can be spread through epidemic fashion.

    <p>False</p> Signup and view all the answers

    BCG vaccine is not effective in treating leprosy.

    <p>False</p> Signup and view all the answers

    The primary characteristic of leprosy is the formation of tuberculoid granulomas.

    <p>False</p> Signup and view all the answers

    Study Notes

    Tuberculosis (TB)

    • Global emergency: 35,000 deaths per week, 2 billion people infected, high incidence in HIV-infected individuals
    • Disease of poverty
    • Clinical manifestations:
      • General: fever, weight loss, weakness, persistent cough
      • Pulmonary infection: impairment of lung tissue, may spread to other parts of the body
      • Other affected areas: central nervous system, lymphatic system, genitourinary system, bones and joints, disseminated (miliary TB)

    Transmission, Protection, and Pathogenesis

    • Aerosol travels to alveoli of lungs, engulfed by alveolar macrophages
    • Host immune response:
      • Activated: clears or contains bacteria
      • Unactivated: bacteria survive and replicate in macrophages, attract immune cells, damage tissue, and form granulomatous tubercle
    • Outcome of TB infection:
      • Containment or clearance
      • Disease progression
      • Transmission

    Mycobacteria

    • Unicellular, branched rods, Gram-positive, complex cell wall with sugars, proteins, and lipids
    • Acid-fast staining with Ziehl-Neelsen stain
    • Grouping:
      • Fast growers (1-2 days): M. phlei, M. smegmatis
      • Slow growers (several weeks): M. tuberculosis, M. bovis, M. avium-intracellulare-scofulaceum complex

    TB Control and Treatment

    • Diagnosis:
      • Radiology
      • Microscopy of sputum for acid-fast rods
      • Culture of sputum samples
      • PCR
      • Immunological – T-cell response to TB antigens
    • Vaccination:
      • Bacille Calmette-Guérin (BCG) – derived from M. bovis, avirulent, safe, inexpensive, and effective in experimental models
      • Debated effectiveness in humans
    • Antibiotic treatment:
      • First-line oral anti-TB drugs: isoniazid, rifampicin, ethambutol, pyrazinamide
      • Multi-drug treatment required due to resistance

    AMR and Tuberculosis

    • MDR-TB: resistant to at least rifampicin and isoniazid
    • XDR-TB: resistant to rifampicin, isoniazid, any fluoroquinolone, and at least one of the three injectable second-line drugs
    • Treatment regimen for MDR-TB: at least 4 potentially active drugs
    • New drugs: bedaquiline, delamanid, linezolid
    • Repurposed drugs: late-generation fluoroquinolone, injectable aminoglycoside, first-line drug with known susceptibility

    Leprosy

    • Causative agent: Mycobacterium leprae
    • Non-cultivatable, but grows in 9-banded armadillos and mouse footpads
    • Intracellular parasite, grows in macrophages and other cells
    • Transmission unknown, but not epidemic
    • Disease manifestations:
      • Tuberculoid: few bacilli, mild disease, strong cellular immune response
      • Lepromatous: severe disease, massive bacilli, poor cellular immune response
    • Control of leprosy: vaccination with BCG, multidrug therapy with dapsone, clofazamine, and rifampicin

    Tuberculosis (TB)

    • Global emergency: 35,000 deaths per week, 2 billion people infected, high incidence in HIV-infected individuals
    • Disease of poverty
    • Clinical manifestations:
      • General: fever, weight loss, weakness, persistent cough
      • Pulmonary infection: impairment of lung tissue, may spread to other parts of the body
      • Other affected areas: central nervous system, lymphatic system, genitourinary system, bones and joints, disseminated (miliary TB)

    Transmission, Protection, and Pathogenesis

    • Aerosol travels to alveoli of lungs, engulfed by alveolar macrophages
    • Host immune response:
      • Activated: clears or contains bacteria
      • Unactivated: bacteria survive and replicate in macrophages, attract immune cells, damage tissue, and form granulomatous tubercle
    • Outcome of TB infection:
      • Containment or clearance
      • Disease progression
      • Transmission

    Mycobacteria

    • Unicellular, branched rods, Gram-positive, complex cell wall with sugars, proteins, and lipids
    • Acid-fast staining with Ziehl-Neelsen stain
    • Grouping:
      • Fast growers (1-2 days): M. phlei, M. smegmatis
      • Slow growers (several weeks): M. tuberculosis, M. bovis, M. avium-intracellulare-scofulaceum complex

    TB Control and Treatment

    • Diagnosis:
      • Radiology
      • Microscopy of sputum for acid-fast rods
      • Culture of sputum samples
      • PCR
      • Immunological – T-cell response to TB antigens
    • Vaccination:
      • Bacille Calmette-Guérin (BCG) – derived from M. bovis, avirulent, safe, inexpensive, and effective in experimental models
      • Debated effectiveness in humans
    • Antibiotic treatment:
      • First-line oral anti-TB drugs: isoniazid, rifampicin, ethambutol, pyrazinamide
      • Multi-drug treatment required due to resistance

    AMR and Tuberculosis

    • MDR-TB: resistant to at least rifampicin and isoniazid
    • XDR-TB: resistant to rifampicin, isoniazid, any fluoroquinolone, and at least one of the three injectable second-line drugs
    • Treatment regimen for MDR-TB: at least 4 potentially active drugs
    • New drugs: bedaquiline, delamanid, linezolid
    • Repurposed drugs: late-generation fluoroquinolone, injectable aminoglycoside, first-line drug with known susceptibility

    Leprosy

    • Causative agent: Mycobacterium leprae
    • Non-cultivatable, but grows in 9-banded armadillos and mouse footpads
    • Intracellular parasite, grows in macrophages and other cells
    • Transmission unknown, but not epidemic
    • Disease manifestations:
      • Tuberculoid: few bacilli, mild disease, strong cellular immune response
      • Lepromatous: severe disease, massive bacilli, poor cellular immune response
    • Control of leprosy: vaccination with BCG, multidrug therapy with dapsone, clofazamine, and rifampicin

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