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Tuberkulos (TBC)

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Definition:
Infektion med bakterier som tillhör Mycobacterium tuberculosis-komplexet (M. tuberkulosis, M. bovis och M. africanum). Tuberkulos kan manifesteras i många organ, men tuberkulos i lungorna är vanligast och epidemiologiskt viktigast, eftersom det är dessa fall som är smittsamma.
Förekomst:
Incidensen i Sverige 2016 var 7,3 fall per 100 000 invånare och år, och det totala antalet fall var 734, varav 115 var smittade i Sverige.
Symtom:
Klassiska symtom på lungtuberkulos: Hosta >3 veckor, ofta produktiv (ibland med blodtillblandning), viktminskning, nedsatt allmäntillstånd ,feber och nattsvettningar. Tuberkulös lymfadenit utgör cirka 20 %.
Kliniska fynd:
Biljud vid lungauskultation på grund av pneumoni och pleurautgjutning, men auskultationen kan också vara helt normal även vid utbredda röntgenfynd. Vissa kan ha förstorade lymfkörtlar på halsen.
Diagnostik:
Direkt mikroskopi, odling och/eller PCR i sputum/bronkialsköljvätska + lungröntgen. Diagnosen latent tuberkulos ställs med tuberkulintest, eventuellt IGRA + lungröntgen.
Behandling:
Primära antituberkulösa medel är Isoniazid, rifampicin, pyrazinamid och etambutol. DOT – direkt observerad terapi vid misstanke om dålig följsamhet.
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  • Gerdt Riise, docent och överläkare, Avdelningen för lungmedicin, Sahlgrenska universitetssjukhuset, Göteborg
  • Anna Nager, med dr och specialist i allmänmedicin, Karolinska institutet