Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is leprosy a disease of? |
|
Definition
skin and nerves
causes peripheral neuropathy |
|
|
Term
| name a way to classify leprosy? |
|
Definition
| Ridley-Jopling classification |
|
|
Term
| Types of leprosy using ridley-jopling classification |
|
Definition
LL lepromatous lep in those with poor cell mediated immunity
Borderline lepromatous
boderline boderline
boderline tuberculoid
tuberculoid leprosy occurs in those with good cell mediated immunity |
|
|
Term
| in someone with poor cell mediated immunity which type of leprosy are they likely to have? |
|
Definition
| Lepromatous leprosy in those with poor cell mediated immunity |
|
|
Term
| in a pt with good cell mediated immunity what type of leprosy are they likely to have? |
|
Definition
| tuberculoid leprosy in those with good cell mediated immunity |
|
|
Term
| who classification of leprosy |
|
Definition
Paucibacillary < 5 lesions
Multibacillary > 5 lesions |
|
|
Term
| name two common leprosy reactions |
|
Definition
reversal recation (type I)
Erythema nodosum leprosum (type 2) |
|
|
Term
| distinguishing features of a leprosy path |
|
Definition
hypo-pigmented
anaesthetic
loss of hair
loss of sweat glands in patch
central healing
macular or papular |
|
|
Term
| what is a leonine facies? |
|
Definition
| sagging of skin beneath the eyes |
|
|
Term
|
Definition
| loss of outer edge of eye brows |
|
|
Term
| cardinal signs of leprosy |
|
Definition
hypopigmented skin path and loss of sensation
enlarged peripheral nerve with loss of function
positive skin smear |
|
|
Term
| rx duration for paucibacillary < 5 patches |
|
Definition
6 months
rifampicin + dapsone monthly plus
daily dapsone |
|
|
Term
take rifampicin and dapsone monthly
plus daily dapsone
this is the rx for? |
|
Definition
Paucibacillary leprosy
(tuberculoid leprosy pts) |
|
|
Term
|
Definition
12 months
rifampicin + dapsone +clofazimine monthly
plus clofazimine and dapson dialy |
|
|
Term
take rifamp + dapsone + clofazimine monthly
plus dapson and clofazimine dialy
what type of leprosy do you have? |
|
Definition
|
|
Term
describe type 1 reversal reaction in leprosy
what type of patients is this common in? |
|
Definition
lesions get red,hot,tender
may be oedema and nearby nerve may be painful
commonest in boderline patients
BT or BL |
|
|
Term
desrcibe type 2 erythema nodosum leprosum reaction
what type of patients is this common in? |
|
Definition
Increased igG are depositied in lesions. Found particularly in extensor surfaces. can become necrotic/ulcerated
commonest in lepromatous leprosy and borderline lepromatous pts
Treated with high dose steroids |
|
|
Term
what is type 2 ENL reaction due to?
how is it treated? |
|
Definition
due to increased circulation of IgG that are deposited in the lepromatous lesions
treated with high dose steroids |
|
|
Term
|
Definition
|
|
Term
| mycobacterium leprae properties |
|
Definition
intrcellular parasite
acid fast bacilli |
|
|
Term
| incubation period for leprosy? |
|
Definition
| typically years but can be up to a decade |
|
|
Term
| leprosy is an immunity deficiency disease. what is the significance in relation to hiv? |
|
Definition
| No increased risk of leprosy in HIV + pts |
|
|
Term
| what determines manifestation of leprosy disease? |
|
Definition
| Host immunity and dose of AFB determines manifestation of disease |
|
|
Term
| you need 2/3 cardinal signs to diagnose leprosy what are they? |
|
Definition
hypopigmented lesions
enlarged peripheral nerve
acid fast bacillia |
|
|
Term
| how does leprosy affect the eyes and mens genitals? |
|
Definition
eyes: iritis and corneal aneasthesia can cause blindless
genitals: testicular atrophy
also gynaecomastia in males |
|
|
Term
| describe lepromatous leprosy |
|
Definition
cell mediated immunity poor
there is Ab mediated response
becomes generalised
bacteria found throughout the body |
|
|
Term
| describe tuberculoid leprosy |
|
Definition
cell mediated response very good
less bacteria and few clinical features |
|
|
Term
| which types of leprosy are unstable? |
|
Definition
bordeline types
they can change with changes in immunity over time |
|
|
Term
| in which leprosy might you see a lioninan appearance? saggy skin beneath the eyes? |
|
Definition
| diffuse lepromatous leprosy |
|
|
Term
| where are skin smears taken from to dx leprosy? |
|
Definition
ear lobe or edge of lesion
note: you will not find bacilli in in skin smear of paucibacillary leprosy |
|
|
Term
| PCR from which part part of body can detect leprosy? |
|
Definition
|
|
Term
| side effect of cloazamine? |
|
Definition
|
|
Term
| if there is rifampicin resitant which drugs can you sue for leprosy? |
|
Definition
2 of the following + clofazimine
Clarithromycin
minocycline
Quinolone |
|
|
Term
| if during treatment any new nerve damage < 6 m old is detected what should you rx with? |
|
Definition
|
|
Term
|
Definition
kids BCG vaccine
single dose rifampicin to household contacts over the age of 2 years |
|
|
Term
| when can you get type I and II reactions in leprosy? |
|
Definition
| when rx starts or change in state e.g immunity increase/decreaes, infection, pregnancy |
|
|
Term
| rx for type I reactions in leprosy? |
|
Definition
|
|
Term
| rx for type 2 reactions in leprosy? |
|
Definition
| pred or thalidomie and increase dose of clofazimine for 3/12 |
|
|
Term
| WHO global leprosy strategy |
|
Definition
zero disabilities among new paediatric pts
a grade 2 disability rate of <1 case per 1 million
zero countries with legislation allowing discrimination on basis of leprosy |
|
|
Term
| average incubation period for leprosy? |
|
Definition
|
|
Term
| describe the pathology of leprosy |
|
Definition
| inflammation of the nerves as an immune response to mycobacterium leprae |
|
|
Term
| how is leprosy transmitted? |
|
Definition
close contact with armadillos
droplets from nose and mouth |
|
|
Term
| name the components of MDT to treat multibacillary leprosy |
|
Definition
rifampicin
dapsone
clofazimine |
|
|
Term
| what effect does HIV have on presentation of leprosy? |
|
Definition
| No effect on HIV and leprosy as it is the innate immune system that causes pathology |
|
|
Term
| what does the leprosy parasite have an affinity for? |
|
Definition
| myeline sheath of schwaan cells of peripheral nerves |
|
|
Term
| what is the commonest cause of peripheral neuroptahy worldwide? |
|
Definition
|
|
Term
what does ppd stand for?
what is it used to test? |
|
Definition
Purified protein derivative (boiled/mashed up Tb Ag)
we inject it intradermally to see if someone has been exposed to Tb. Works by testing cell mediated immunity. After 48-72h pts whose immune system recognise the Tb ag will have a localised reaction and this is called the heaf test |
|
|
Term
| what is the modern version of the heaf test aka? |
|
Definition
| IGRA - interferon gamma release assay. A test on monocytes. if there is exposure to TB protein then interferon gamma is released |
|
|
Term
| which part of airway does TB affect? |
|
Definition
|
|
Term
|
Definition
Yes
Exposure leads to latent and active disease |
|
|
Term
latent TB
Characteristics
Infectious? |
|
Definition
IGRA or skin test +
No symptoms
Culture -
Not infectious |
|
|
Term
| active Tb characteristics |
|
Definition
IGRA or skin test +
Signs and symptoms of TB
Culture +
Infectious! |
|
|
Term
| what is the relationship between advanced HIV, TB and IGRA test? |
|
Definition
| People with advanced HIV may have Tb but -ve IGRA. This is because their immunity is low and IGRA is a measure of cell mediated immunity |
|
|
Term
| how can Tb survive in a macrophage? |
|
Definition
| it blocks phagosome fusion with lysosome therefore controlling cell death of the phagocyte |
|
|
Term
| granuloma formation is hallmark in Tb. What are granulomas? |
|
Definition
| collections of immune cells in response to chronic (non resolving) inflammation |
|
|
Term
| what are Tb granulomas usually composed of? |
|
Definition
| Mononuclear cells e.g macrophages and T cells |
|
|
Term
| what is the aim of granulomas? |
|
Definition
| to contain infection, but they provide a niche for mycobacteria |
|
|
Term
| what is the strongest risk factor for active Tb? |
|
Definition
| depletion of CD4 helper cells |
|
|
Term
|
Definition
Inhalation.droplets generated when infected persons cough, sneeze, shout or sing
NOT by surface contact |
|
|
Term
| how long can Tb remain in the air? |
|
Definition
|
|
Term
| 4 factors TB transmission depends on? |
|
Definition
Suseptibbility - immune status
Infectiousness - no of bacilli expelled
Environment - ventilation? overcrowding
Exposure - duration, frequency |
|
|
Term
| What effect does UV light have on Tb? |
|
Definition
| tb is killed by exposure to uv light |
|
|
Term
|
Definition
sputum culture for acid fast bacilli
Fluorescent microscopy
Gene Xpert |
|
|
Term
| What does who recommend for diagnosing TB in ?MDR Tb or HIV associated tb? |
|
Definition
|
|
Term
| reasons why you might get false - skin test |
|
Definition
Immunosuppression
Severe illness
Poor technique, not injected intradermally
Normal variation (some people don't react to skin test) |
|
|
Term
| reasons why skin test might be false + |
|
Definition
previous BCG
environmental mycobacteria (skin test is not specific to TB mycobacterium) |
|
|
Term
| name some extrapulmonary Tb sites |
|
Definition
Lymphatics
Pleura
MSK
Genitourinary
Meningeal |
|
|
Term
| most common extra pulmonary Tb site? |
|
Definition
|
|
Term
| in pleural Tb which result is highly sensitive/specific for tb? |
|
Definition
| Raised adenosine deaminase |
|
|
Term
| what is the minimum duration of rx for tB? |
|
Definition
|
|
Term
|
Definition
2M RIPE
4m RI
Rifam/Isonia/Pyrazin/Ethambutol |
|
|
Term
| What does rifampicin do to liver enzymes? |
|
Definition
|
|
Term
| isoniazid can cause peripheral neuropathy. what can we give in this situation? |
|
Definition
|
|
Term
| what can isoniazid cause and what do with give to counteract this? |
|
Definition
Causes peripheral neuropathy
give B6 pyridoxine to treat it |
|
|
Term
| what side effect does ethambutol cause? |
|
Definition
Retinopathy
Eye test required before rx |
|
|
Term
| which TB med is the most common cause of drug induced liver injury? |
|
Definition
|
|
Term
| which drugs are involved in drug resistant Tb? |
|
Definition
| normally isoniazid resistance develops first followed by Rifampicin resistance |
|
|
Term
| which mutation accounts for 50-90% of Isoniazid resistant Tb strains? |
|
Definition
|
|
Term
| katG and which other mutations account for isoniazid resistant? |
|
Definition
|
|
Term
| which mutation accounts for 96% of Rifampicin resistant Tb strains? |
|
Definition
|
|
Term
| what is acquired Tb resistance? |
|
Definition
non adherance to tb meds. Erractic use or stops early.
Can be prevented |
|
|
Term
| what is primary drug resistance? |
|
Definition
| pt is adherent to therapy but were infected by someone with Tb that is already drug resistant |
|
|
Term
|
Definition
| Resistant to Rifampicin and Isoniazid |
|
|
Term
|
Definition
pre extensively drug resistant Tb
There is additional second line drug resistance to any injectable 2nd line drug or fluoroquinolone |
|
|
Term
| gold standard for diagnosis MDR-TB? |
|
Definition
Phenotypic DST culture
drug susceptibility Testing |
|
|
Term
Normal Tb rx duration 6m
What about in MDR-TB? |
|
Definition
18-20m
At least 5 drugs in intensive phase (8m)
At least 4 drugs in continuation phase (12m) |
|
|
Term
| In MDR-TB how long does the intensive and continuation phase last? |
|
Definition
intensive phase 8 months (at least 5 drugs)
continuation phase 12 months (at least 4 drugs) |
|
|
Term
|
Definition
| inhibits proton pump of mycobacterial ATP synthesis. This is required to generate energy |
|
|
Term
| List commonly used drugs in MDR-TB |
|
Definition
Quinolones
Bedaquiline
Linezolid
Clofazimine
Cycloserine |
|
|
Term
|
Definition
A reversible MAOI
Binds 70s complex of bacterial ribosomes
s/e peripheral neuropathy and myelosupression |
|
|
Term
| Side effects of Bedaquiline? |
|
Definition
QTc prolongation
long t1/2 life of 5.5 months! |
|
|
Term
|
Definition
| binds to guanine bases of bacterial DNA to inhibit bacterial proliferation |
|
|
Term
| what is the bangladesh regimen? |
|
Definition
7 drugs in the intensive phase
total rx duration is shorter 9-12months v 18-20m |
|
|
Term
|
Definition
| Asymptomatic TB where the immune system is controlling the infection |
|
|
Term
| how does latent become active TB? |
|
Definition
| weakened immune system cannot control bacteria. |
|
|
Term
| what proportion of people worldwide are infected with TB? |
|
Definition
|
|
Term
| What proportion of people with latent Tb develop active Tb? |
|
Definition
|
|
Term
| what AB are used to rx uncomplicated Tb? |
|
Definition
Rifampicin
Isoniazid
Pyrazinamide
Ethambutol
Streptomysin |
|
|
