In Part 2, Dr. Jess Pelletier speaks with Dr. Moses Kitakule about tuberculosis (TB) complications, including pulmonary and extrapulmonary emergencies and serious side effects of anti-TB medications.

Take-Home Points:

• There are a number of life-threatening pulmonary emergencies that can occur in active or latent TB patients due to structural lung changes, and we need to be ready to manage them
• Extrapulmonary TB can impact any organ system, but some of the most dangerous emergencies to be aware of include:
  • Cardiac
    • Cardiac tamponade 2/2 pericarditis with effusion
    • Myocarditis/sudden cardiac death
    • Increased risk of coronary artery disease/acute coronary syndrome
    • Aortitis
  • Neurologic
    • Meningitis
    • Tuberculomas
    • Spinal tuberculous arachnoiditis
    • Increased risk of ischemic stroke
  • Hematologic
    • Decreased cell lines, TTP, coagulopathy
  • GI
    • Bowel obstruction/perforation
    • Peritonitis
    • Tuberculous appendicitis
  • Osteoarticular
    • Osteomyelitis
    • Septic arthritis
• First-line anti-TB drugs can be quite toxic, with the most concerning emergencies including seizures, hepatoxicity, hematologic emergencies, life-threatening rashes, optic neuritis, and pneumonitis

You can view the full show notes and references here: https://docs.google.com/document/d/1ubGVR3i9lab1MM7NgXMjeORhQ-jFQt6C51R-9xI1VW4/edit?usp=sharing

In this episode, Dr. Jess Pelletier speaks with Dr. Emmanuel Effa about typhoid fever.

Take-Home Points:

• Typhoid fever is endemic in settings with water and sanitation issues
• In other places, it is more commonly imported from overseas when people visit endemic areas
• Typically, infected people present with varying degrees of fever, fatigue, headaches, abdominal pains and constipation/diarrhea. It can run a severe course that leads to death
• Diagnosis is based on clinical features and cultures of bone marrow, blood, stool or urine
• Treatment is guided by local protocols dependent on antimicrobial sensitivity patterns
• Vaccines are available and are reasonably effective.
• Overall, promoting access to safe water ensuring adequate sanitation; promoting hygiene among food handlers and typhoid vaccination are effective in preventing typhoid fever

You can view the full show notes and references here: https://docs.google.com/document/d/15yGRZV8UpQEKcFIwSFnCOGEl1uE77wlFP3T7tpm-YFc/edit?usp=sharing

In Part 1, Dr. Jess Pelletier speaks with Dr. Moses Kitakule about tuberculosis: epidemiology, pathophysiology, and diagnosis.

Take-Home Points:

• TB is a pathogen impacting only humans which infects about ⅓ of the globe
• Most cases of TB are latent and asymptomatic, but TB can reactivate at any time, particularly if a host becomes immunocompromised or highly exposed to TB
• Patients with active pulmonary TB may have fevers, night sweats, weight loss, cough lasting more than 3 weeks, hemoptysis, dyspnea, or fatigue, but older adults and those with immune compromise may be asymptomatic or present atypically
• Imaging abnormalities on chest x-ray, POCUS, or CT should be seen in active TB (but not always in immunocompromised hosts)
• Diagnostic testing in the ED should involve sending sputum AFB smear and culture, as well as a NAAT, which may help make the diagnosis more rapidly
• Miliary TB patients may need targeted testing of other body fluids
• Protecting staff and other patients is critical

You can view the full show notes and references here: https://docs.google.com/document/d/1xrs7Yy5bAtSp8F2Esale44DKY3gRkiVwQiioQjAoNHI/edit?usp=sharing