Tuberculosis

Answer Explanation:

• The correct answer is “Is rising in incidence in the UK”. This is because there has been a steady increase in the number of tuberculosis cases in the UK, especially in urban areas. This is due to a number of factors including increased immigration from countries where tuberculosis is endemic, increased homelessness and drug use, and the spread of drug-resistant strains of tuberculosis.

Overview of Pulmonary Tuberculosis:

Etiology:

• Pulmonary tuberculosis is primarily caused by Mycobacterium tuberculosis, not Mycobacterium bovis. Mycobacterium bovis is more commonly associated with tuberculosis in cattle, although it can occasionally cause disease in humans.

Pathophysiology:

• The bacteria are inhaled and can settle in the lung tissue, causing a local inflammatory response. Over time, this can lead to the formation of granulomas, areas of inflamed tissue which can eventually become necrotic and calcify.

Location:

• Pulmonary tuberculosis typically affects the upper lobes of the lungs, not the bases. This is due to the higher oxygen tension in the upper lobes, which is favourable for the growth of Mycobacterium tuberculosis.

Treatment:

• Treatment for pulmonary tuberculosis usually involves a combination of antibiotics including rifampicin, isoniazid, pyrazinamide, and ethambutol for a period of 6 months, not 1 year. Penicillin is not effective against Mycobacterium tuberculosis due to the bacterium’s unique cell wall structure.

Answer Explanation:

• The correct answer is Pyrazinamide. This is because Pyrazinamide is a first-line antitubercular agent used in the treatment of tuberculosis.
• Ciprofloxacin, Co-trimoxazole, Imipenem, and Clarithromycin are not first-line agents for the treatment of tuberculosis. They may be used in cases of drug-resistant tuberculosis or in specific clinical scenarios, but they are not the first choice.

Overview of Tuberculosis:

Definition:

• Tuberculosis (TB) is a bacterial infection caused by Mycobacterium tuberculosis. It primarily affects the lungs (pulmonary TB) but can also affect other parts of the body (extrapulmonary TB).

Epidemiology:

• TB is a global health problem, with a higher prevalence in developing countries. It is spread through airborne droplets when individuals with the disease cough or sneeze.

Clinical Features:

• Common symptoms include a persistent cough, fever, night sweats, and weight loss. In cases of extrapulmonary TB, symptoms will depend on the organ system involved.

Diagnosis:

• Diagnosis is typically made through a combination of clinical suspicion, imaging (such as a chest X-ray), and microbiological confirmation (sputum culture or molecular testing).

Treatment:

• Treatment involves a combination of first-line antitubercular agents, typically including Pyrazinamide, Isoniazid, Rifampicin, and Ethambutol.
• Treatment duration is usually 6 months but may be extended in cases of drug-resistant TB or complicated disease.