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Tuberculosis

Tuberculosis is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • Tuberculosis (TB) is an infectious disease with protean manifestations, causing significant global morbidity and mortality.

Mechanism
  • Infectious droplet nuclei are inhaled through the respiratory tract.
  • Bacteria are dispersed through coughing, sneezing, speaking, singing.
  • Primary TB/latent TB infection (LTBI):
    • Initial infection occurs when organisms enter the alveoli, become engulfed by macrophages, and spread via regional lymph nodes to the bloodstream.
    • Patients are usually asymptomatic.
    • May be progressive/fatal in immunocompromised hosts.
    • Positive reaction to purified protein derivative (PPD) indicates past exposure or infection.
    • Negative PPD does not rule out active TB.
    • May progress to active TB (5–10%).
  • Reactivation TB:
    • LTBI becomes active TB.
    • Systemic (15%) and pulmonary (85%) symptoms.
  • TB affects about one-third of the world's population (90 million new cases in the past decade worldwide, with about 30 million deaths).
  • Centers for Disease Control and Prevention (CDC) statistics from 2011 show TB in US at an all-time low.
  • TB rates in US have continued to decline since 1993.
  • Increase in US foreign-born cases
  • Still an estimated 10–15 million people are infected in US alone.

Etiology

  • Infection with Mycobacterium tuberculosis, a slow-growing, aerobic, acid-fast bacillus resulting in disease.
  • Humans are the only known reservoir.
  • Recent TB epidemics:
    • HIV-infected patients
    • Multidrug-resistant TB (MDR-TB)
    • Extensively drug-resistant TB (XDR-TB):
      • High mortality, few effective drugs

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Citation

Rosen, Peter, et al., editors. "Tuberculosis." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307620/all/Tuberculosis.
Tuberculosis. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307620/all/Tuberculosis. Accessed April 26, 2019.
Tuberculosis. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307620/all/Tuberculosis
Tuberculosis [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307620/all/Tuberculosis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Tuberculosis ID - 307620 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307620/all/Tuberculosis PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -