18 TB

Overview

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Characteristics

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• high oxygen content in upper lobe

• mycolic acid makes mycobacterium

• sulfatides: glycolipids on surface, allows survival inside macrophages

Infection

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• latent: wall it off

• most people: either clear infection or go into latent phase

• small proportion: primary TB, may resolve or become miliary (systemic, serious)

• may reactivate decades later when immunocompromised

Primary

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• very rare to get sick from primary TB

• kill macrophage and spill content

• caseous necrosis: cheese like grossly

• epithelioid: large cells that look like epithelial. Pic: giant cell

• important: hilar, classic for TB and sarcoidosis

• yellow in periphery

• all results of primary exposure

Miliary TB

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• name from xray: small white lines on xray looking like millet seeds

Reactivated TB

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• primary exposure resolved, either Ghon complex or cleared or latent

Aspergilloma

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• complication of reactivation TB

• hemoptysis if big enough

Diagnosis

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• inhalation: cough up some sputum

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• measure the hardened area, not red area

• can't mount immune response

• false positive

Treatment

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• DOT: pt come in to make sure not miss dosage so no resistant strains

INH

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• katG in TB that activates INH

• numbness in extremities

Rifampin

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Pyrazinamide

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Ethambutol

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Streptomycin

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