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→pericardial
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==History==
*Died from or infected by Tb
*cardiac tamponade
*sequele - carcified pericardium
*very pauci-bacillary and bacterial investigation from pericardiocentesis is very much less sensitive
====intestinal====
*can mimic Crohn's disease
*Gene Xpert
**Xpert MTB/RIF
**can detect drug resistantresistance to rifampicin
====histopathology====
*cannot distinguish between latent/active/used be treated
==Treatment&Management==
*needs prolonged Tx
*needs multiple drugs
**Z - pyra'''z'''inamide
*2HERZ2RHZE+4HE4RH*2HERZ2RHZE+4(HERH)3₃
===side effects===
*fever - Z
*lupus - H
*drug interaction related to CYP interaction 450P - R**carbamazepine**oral contraceptive**methadone ===interrupted Tx===*interrupted during intensive phase**interrupted for > 14 days - re-Tx from the beggining**interrupted for < 14 days - continue*during continuing phase ===spinal/bone TB===*needs 9 months ===TB meningitis===*needs 12 months*2RHZE+10RH ===latent TB===*some options ==Management=====paradoxical reaction===*inflammation after commencing Tx*problematic in CNS, pericardial*co-Tx with steroids**CNS/meningitis,tuberculoma - dexamethasone**pericardial - predonisolone ===Directoly Observed Treatment, short course (DOTs)===*in high risk stuation*in homeless/chaotic social circumstance*in poor adherence/treatment failure *Dr. Karlos Stybro ===TB in pregnancy===*RHZE are safe*supplementation with VitB6 (pyridoxine) recommended**hyperemesis gravidarum ===TB in breastfeeding===*no contraindication*rule out TB in baby ===hepatotoxicity===*any GI complaint may represent hepatotoxicity*suspend all TB drugs until lab test revealed*risk**co-infection HIV, hepB/C**other chronic liver disease**alcohol**advanced age*early - 2- 3wks, R,H; good prognosis*late - after 1mo, E; bad prognosis
==Drug-resistant==
===mono-resistant===
*H-resistant approx. 7%
*primary resistance
**infected by resistant TB
*secondary resistance
**
===multi-resistant MDR===
*resistant to H and R
*risk
**previous Tx
**household contact with MDR
**HIV
*resistance to R is a marker of MDR
**90% of R-resistance strains are also resistant to H → GeneXpert
===extensively resistant XDR===
*MDR + fluoroquinolone-resistant and at least one additional group A drug
===pre-extensively resistant pre-XDR===
*MDR + fluoroquinolone-resistant
