Tuberculosis Mycobacterium tuberculosis

• Facts:
  MCC of Fever of Unknown Origin (FUO)
  
• History / PE:
  Extended duration ( > 3 weeks ) of symptoms
  Hemoptysis
  Weight loss, fatigue
  Night sweats, fever
• Diagnosis:
  Sputum acid-fast stain ("red snappers")
  Mycobacterial sputum culture (gold standard)
• Treatment:
  Active TB
  
  INH (peripheral neuritis and hepatitis )
  Pyrazinamide
  Rifampin (turns body fluids orange)
  Ethambutol ( optic neuritis ) for two months, THEN
  
  INH and rifampin for four months
  
  Latent TB
  
  INH X 9 months
  
  ***Add vitamin B6 (pyridoxine) with INH to prevent peripheral neuritis***
• Complications:
  Primary adrenal insufficiency
  Constrictive pericarditis (pericardial fibrosis and diastolic dysfunction )
• Pneumonic:
  Drugs for TB (RIPE )
  
  R ifampin
  I NH
  P yrazinamide
  E thambutol
• Notes:
  Positive PPD > 5 mm induration
  HIV or immunocompromised
  
  Positive PPD > 10 mm induration
  High risk individuals
  
  Positive PPD > 15 mm induration
  Everyone else
  
• Risk Factors:
  Homelessness
  Crowded working conditions (eg. prison)