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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
===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
