TB Notes PDF

# Mycobacterium = AFB - Not stained by simple or Gram stain - Only stained by 2 N stain. - Resist Decolorization by acid or alcohol. ## Morphology - Thick rods - On blue background ## Species - M. tuberculosis = MTB - M. leprae = leprosy ## NTM - M. avium Complex - M. intracellulae - M. aviu...

# Mycobacterium = AFB - Not stained by simple or Gram stain - Only stained by 2 N stain. - Resist Decolorization by acid or alcohol. ## Morphology - Thick rods - On blue background ## Species - M. tuberculosis = MTB - M. leprae = leprosy ## NTM - M. avium Complex - M. intracellulae - M. avium - M. kansasii - M. gordonae ## AFB - Fluorochrome stain - Auramine-Rhodamine stain - **More sensitive than Z-N stain ** ## Culture - LJ medium - Egg based media - Obligate aerobe - 5-10% CO2 - **Slow grower (long G) ** - 2-4 weeks - -ve after 8 weeks ## Biochemical Reaction - **Niacin test:** MTB +ve - **Nitrate reductase:** MTB +ve - **Catalase:** MTB +ve ## You Must - **Solid medium:** 7H11, 7H12, 7H10 - **Middlebrook's medium:** 7H9 - **Fluid:** 7H12 - + Enriched + ABS + agar - + Enriched + ABS - **Selective 7H12:** - + Solid + selective 7H10 - + Fluid + selective 7H12 ## Mycoke acids - Complex lipids - Resistance to phagocytosis - Phosphatides ## Cell Wall - Wax - D: Adjuvant - T: Trehalose - I: Intermediate - C: Cord factor - R: Resistance ## Staining - Acid Fast Bacillus (AFB) - Ziehl Neelsen Stain (Z-N) - Auramine-Rhodamine Stain (AR) ## MGIT - Middlebrooks broth - Bactec radiometric assay - Fluorescence on O2 removal - 2 - 4-14 days - Palmitate (radiolabelled carbon) ## Cell wall Continued - **I Cord Factor** - Serpentine cord like structure ## Substance - M.O. - Resist Acid, Alkali, dryness - Sensitive to UV rays ## PPD - Purified protein derivative - Used in TST ## OTH - Other - Used in TST ## Cell wall (continued from previous page) - Phosphatides - **Caecostation:** Necrosis - **Acid:** ABS ### **Tuberculosis (TB)** - **LTBI (Latent TB Infection)** - **Active TB disease** - **Pulmonary TB** - **Extra Pulmonary TB** ## **Diagnosis** - **Diagnosis of Active Pul. TB** - **Diagnosis of LTBI: TST** - **Diagnosis of Active TB** - **Microscopy** - **Direct detection** - **Sputum samples** - **Morning sample** - **Deep productive cough** - **Processing** - **Direct Detection** - **De-Contamination** - **NALC - N-acetyl-L-cysteine** - **NaOH** - Concentration & centrifugation - **Sample** - **Supernatant** - **Sediment** - **Stain** - **Ziehl-Neelsen Stain** - **Ligre Lacton** - **Molecular Diagnosis** - **PCR** - **DNA** - **Bioch Rxn** - **16SrRNA** - **RT-PCR** - **Culture** - **Solid** - **7H10** - **7H11** - **Fluid** - **7H9** - **Middle brooks** - **7H12** - **7H10** - **7H11** - **7H12** - **+ve** - 1-2 weeks - **Clinical** - **Patient history** - **Physical examination** ## **TUBERCULOSIS** - **Types of TB disease** - **Pulmonary TB** - **Primary TB** - **Reactivated TB** - **Secondary TB** - **Military TB** - **Open Pulmonary TB** - **Closed Pulmonary TB** - **Miliary TB** - **TB meningitis** ## **LTBI** - **Tuberculosis skin test** - **TST** - **QFTG** - **CMI** (Cellular mediated immunity) ## **Management of TB** - **Treatment of Active TB disease** - **Treatment of LTBI** ## **Tuberculosis Continued** - **Diagnosis of Latent Tuberculosis (LTBI)** - **Tuberculosis skin test** - **TST (Tuberculin skin test)** - **PPD 0.1 ml** - **I.D** Inner aspect of the forearm. - **Waiting time:** 48-72 hrs - **Induration** - **5-10 mm** - **+ve indicates** - **Close contact of active TB disease** - **Prior TB disease** - **Severe Immuno Suppression (AIDS)** - **Risk factors (endemic area, IV drug abusers)** - **Hospital or work personnel, healthcare workers, and homeless** - **Un-vaccinated children (4 years)** - **Exposed to TB** - **False +ve results** - **BCG Vaccination** - **Infection with NTM** - **QFTG (QuantiFERON-TB Gold)** - **In-Vitro** - **Not present in BCG vaccine or NTM** - **IFN- y Production** - **Quantified by ELISA** - **16-24 hours** - **Advantages** - **One blood sample** - **Avoid false +ve** - **Disadvantages** - **Expensive** - **Not present in BCG vaccine or NTM** - **Affected by IR** - **No pt revisit** - **Test should be done before 12 hours** - **Rapid result (24 hours)** - **TST** - **+ve** - **10-14 mm** - **More than 10mm** - **+ve** - **-ve** - ** Less than 10mm** - **-ve** - **QFTG** - **+ve** - ** +ve** - **-ve** - **-ve** - **Treatment of Latent Tuberculosis (LTBI)** - **Isoniazid for 9 months**. ## **TB in Children** - **TB infection in children**. - **Primary TB infection in children** - **LTBI** - **Active TB** - **Treatment of Latent TB infection in children** - **INH for 6 months** - **Active TB treatment in children** - **INH, RIF, PZA + EMB for 6 months** - **TB in children** - **HIV infection** - **TB infection associated with the presence of the BCG scar** ## **TB in HIV positive people** - **TB infection in HIV positive**. - **Active TB** - **LTBI** - **Treatment of active TB in HIV positive** - **INH, RIF, PZA + EMB for 6 months** - **Treatment of LTBI in HIV positive patients**: - **INH for 9 months** - **INH, RIF, PZA for 6 months** - **Treatment of Latent Tuberculosis (LTBI) in pregnancy** - **INH for 9 months** - **INH, RIF, PZA for 6 months** ### **TB in Pregnant Women** - **TB infection in pregnant** - **Active TB** - **LTBI** - **Treatment of active TB in pregnant women** - **INH, RIF, PZA + EMB for 6 months** - **Treatment of LTBI in pregnant women** - **INH for 9 months** ## **TB in other situations** - **TB in children** - **TB infection in children**. - **Primary TB infection in children** - **LTBI** - **Active TB** - **Treatment of Latent TB infection in children** - **INH for 6 months** - **Active TB treatment in children**: - **INH, RIF, PZA + EMB for 6 months** - **TB in children** - **HIV infection** - **TB infection associated with the presence of the BCG scar** - **TB in HIV positive people** - **TB infection in HIV positive**. - **Active TB** - **LTBI** - **Treatment of active TB in HIV positive** - **INH, RIF, PZA + EMB for 6 months** - **Treatment of LTBI in HIV positive patients**: - **INH for 9 months** - **INH, RIF, PZA for 6 months** - **TB in pregnant** - **TB infection in pregnant** - **Active TB** - **LTBI** - **Treatment of active TB in pregnant women** - **INH, RIF, PZA + EMB for 6 months** - **Treatment of LTBI in pregnant women** - **INH for 9 months** - **TB in other situations** - **TB in children** - **TB infection in children**. - **Primary TB infection in children** - **LTBI** - **Active TB** - **Treatment of Latent TB infection in children** - **INH for 6 months** - **Active TB treatment in children**: - **INH, RIF, PZA + EMB for 6 months** - **TB in children** - **HIV infection** - **TB infection associated with the presence of the BCG scar** - **TB in HIV positive people** - **TB infection in HIV positive**. - **Active TB** - **LTBI** - **Treatment of active TB in HIV positive** - **INH, RIF, PZA + EMB for 6 months** - **Treatment of LTBI in HIV positive patients**: - **INH for 9 months** - **INH, RIF, PZA for 6 months** - **TB in pregnant** - **TB infection in pregnant** - **Active TB** - **LTBI** - **Treatment of active TB in pregnant women** - **INH, RIF, PZA + EMB for 6 months** - **Treatment of LTBI in pregnant women** - **INH for 9 months** - **Treatment of Latent Tuberculosis (LTBI) in pregnancy** - **INH for 9 months** - **INH, RIF, PZA for 6 months**