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Q1: Microbiology and transmission (2 min)
- Mycobacterium tuberculosis complex; acid-fast bacilli (Ziehl–Neelsen/fluorochrome)
- Airborne droplet nuclei; only active pulmonary TB is contagious[2]
- Primary infection vs reactivation (post-primary) patterns
Q2: Diagnosis algorithm (3 min)
- Suggestive: chronic cough, fever, night sweats, weight loss, upper lobe cavitation
- Xpert MTB/RIF: Boehme — 98.2% smear-positive / 72.5% smear-negative culture-positive on one direct test; less than 2 hours; also detects rifampicin resistance
- Smear microscopy, liquid culture + DST; HIV test all patients[9]
Q3: Drug-susceptible regimen with doses (3 min)
- WHO 2HRZE/4HR for new pulmonary TB[22]
- ATS: 2 months INH+RIF+PZA+EMB then 4 months INH+RIF; INH 5 mg/kg typically 300 mg, RIF 10 mg/kg typically 600 mg; pyridoxine 25–50 mg/day if neuropathy-risk[9]
- Stop hepatotoxic drugs if ALT ≥3× ULN with symptoms or ≥5× without[9]
Q4: Extrapulmonary and TBM (3 min)
- Lymph node, pleural, bone/joint, genitourinary, miliary, pericardial, CNS
- TBM: lymphocytic CSF, high protein, low glucose; ATS 2 + 7–10 months (optimal duration not defined) + dexamethasone/prednisolone 6–8 weeks; Thwaites RR death 0.69[9][5]
- Miliary: haematogenous; choroidal tubercles; high mortality if delayed
Q5: Drug resistance (2 min)
- pre-XDR = MDR/RR + any fluoroquinolone; XDR = MDR/RR + any FQ + at least one additional Group A drug (LFX, MFX, bedaquiline, linezolid) — WHO 2021[23]
- Never add one drug to a failing regimen
- WHO 6-month BPaLM (linezolid 600 mg) for eligible MDR/RR ≥14 years; BPaL if FQ-resistant[22]
Q6: HIV co-infection and LTBI (2 min)
- Always test HIV; atypical CXR and disseminated disease more common
- ART timing: balance IRIS vs mortality benefit — follow current HIV-TB tables (do not invent a DTG milligram from ATS 2016)
- LTBI preferred: 3HP, 4R, or 3HR (NTCA/CDC 2020)[12]
Q7: Prevention, burden, India programme pearls (2 min)
- WHO GTB 2025: 10.7 million incident / 1.23 million deaths in 2024; India 25%; DS success 88%; among top 10 causes of death and leading infectious-agent killer (2021 ranking: 10th overall, second after COVID-19)[21]
- NTEP notification, free drugs, contact tracing, airborne precautions
- BCG: mainly life-threatening TB in infants and young children (Pai)[2]
References7ShowHide
- [2]Pai M, Behr MA, Dowdy D, et al. Tuberculosis Nat Rev Dis Primers, 2016.PMID 27784885
- [5]Thwaites GE, Nguyen DB, Nguyen HD, et al. Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults N Engl J Med, 2004.PMID 15496623
- [9]Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis Clin Infect Dis, 2016.PMID 27516382
- [12]Sterling TR, Njie G, Zenner D, et al. Guidelines for the Treatment of Latent Tuberculosis Infection: NTCA and CDC, 2020 MMWR Recomm Rep, 2020.PMID 32053584
- [21]World Health Organization Global tuberculosis report 2025 World Health Organization, 2025.Source
- [22]World Health Organization WHO consolidated guidelines on tuberculosis. Module 4: treatment and care World Health Organization, 2025.Source
- [23]World Health Organization WHO announces updated definitions of extensively drug-resistant tuberculosis World Health Organization, 2021.Source