- Caseating granulomatous infection due to mycobacterium tuberculosis in the lung
- TB is a notifiable disease and contact tracing is important
Patients at risk
- Those from developing countries (including contacts)
- Immunosuppressed patients
- HIV, steroids, malignancy
- Alcoholics/homeless people/people living in overcrowded conditions
Clinical features
- May be none
- Malaise and lethargy
- Anorexia/weight loss
- Fever
- Cough
- Haemoptysis
Signs of
- Pleural effusion
- Pneumonia
- Fibrosis
Investigations
- Chest X-ray
- Affects upper zones particularly
- +/- calcification
- +/- cavitation
- Sputum microscopy (Ziehl-Nielsen stain) and culture
- Lung tissue microscopy and culture: bronchoscopy and washings for lung/pleural biopsies
Management
- 6 months of combination of antibiotics, usually
- - Rifampicin and isoniazid
- - + Pyrazinamide for first 2 months +
- Add ethambutol if risk of drug resistance is increased
- Compliance is vital
- Multi-resistant TB does occur, particularly in HIV, and may require more antibiotics (according to sensitivities) over a longer period
Side-effects of anti-TB drugs
- Rifampicin
- Liver dysfunction
- Discolouration of body fluids
- Reduced effectiveness of oral contraceptives and other drugs
- Isoniazid
- High doses cause polyneuropathy
- Pyridoxine is added to prevent this
- Pyrazinamide
- Liver dysfunction
- Ethambutol
- Retrobulbar neuritis (patients need ophthalmology monitoring)
- Streptomycin
- Vestibular nerve damage
Other mycobacteria
- Mycobacterium kansasii
- Less severe than Mycobacterium tuberculosis (normally)
- Particularly middle-aged men
- COPD and working in dusty conditions (e.g. miners)
- Mycobacterium avium intracellulare (MAI)
- Immunosuppressed patients (e.g. HIV)
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