193.4 📌 章末速蚘

  • M. tuberculosis — slow-growing AFB, intracellular, airborne
  • 党球 leading single infectious killer (1.3M deaths/yr)
  • Risk activation: HIV, DM, CKD, anti-TNF, transplant, malnutrition
  • Pulmonary: reactivation upper-lobe cavitary, productive cough, hemoptysis, night sweats, weight loss
  • EPTB: scrofula (cervical LN), pleural (ADA), GU (sterile pyuria), Pott (spine), TB meningitis, pericardial
  • Dx: GeneXpert MTB/RIF (1-2 hr) + AFB + culture; IGRA for LTBI
  • Treatment:
    • Drug-sensitive: 6-month RIPE OR 2024 WHO 4-month regimen (rifapentine + moxifloxacin + INH + PZA)
    • MDR/Pre-XDR/XDR: BPaL/BPaLM × 6 mo (game changer)
    • CNS: 9-12 mo + steroid
  • LTBI: 3HP (INH + rifapentine weekly × 12), 4R, or 9H
  • BCG: efficacy child TB meningitis/miliary; not adult pulmonary
  • 盧醫垫 hint: DM + 老 + 慢性 cough / weight loss → suspect TB; rifampin + 糖藥 / DOAC / ART 郜有 interaction