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Senior - ID 2 > 10 - Tuberculosis > Flashcards

10 - Tuberculosis Flashcards

1
Q

2nd leading cause of infection of the world?

A

TB

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2
Q

22 countries that account for 80% of TB?

A

Slide 4

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3
Q

Top 7 countries that account for the maj of US cases?

A 
Mexico
Philippines
Vietnam
India
China
Haiti
Guatemala

Asians are the most cases

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4
Q

Untreated fatality rate for TB?

A

50%

Social, economic and medical factors make this worse

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5
Q

Risk groups for TB?

A 
Close contact w TB
Foreign born
No medicine/income
Elderly
Long term care facilities
IV drugs
Occupational exposure
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6
Q

Who is the reservior host for M. Tuberculosis’?

A

Humans

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7
Q

How is TB spread?

A

Airborne droplet nuclei transmission

- can be fewer than 10 bacilli

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8
Q

Lab words for TB?

A

Acid-fast
Non-motile
Non-spore forming
Non-encapsulated

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9
Q

How does infection occur?

A

Airborne droplet nuclei transmisison

Deposit w/in terminal airspaces

Macrophages ingest
- transport to regional lymph n

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10
Q

What is a common concomitant infection with TB?

A

HIV

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11
Q

What makes you more likely to go from latent to active TB?

A
  • HIV - 100x more
  • DM - 3x more
  • Substance abuse (IV)
  • Recent TB (w/in 2 yrs)
  • CXR w previous TB w no Tx
  • Low body weight (<10%)
  • Immunosuppressive therapy
  • Silicosis
  • Gastroectomy
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12
Q

HIV to active TB incidence?

A

7-10% increase each year

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13
Q

HIV pts also need to worry about?

A

Extrapulmonary TB

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14
Q

S/S of TB (typical)

A

Pulmonary TB

  • productive cough
  • fever
  • wt loss
  • hemoptysis
  • chest pain
  • anorexia
  • fatigue
  • night sweats
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15
Q

Types of non-respiratory TB?

A 
TB meningitis 
Skeletal TB
Genitourinary TB
Cutaneous TB
Gastorintestinal TB

Miliary

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16
Q

Who is prone to non-respiratory TB?

A

Immunocompromised

Elderly

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17
Q

TB meningitis S/S

A

HA(intermittent or persistent)
Mental status change
Coma
Fever (low/absent)

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18
Q

Skeletal TB S/S?

A

Spine

  • Potts disease
  • back pain/stiffness
  • extremity paralysis

Arthritis

  • 1 joint
  • any joint
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19
Q

MC skeletal TB?

A

Spine

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20
Q

Genitourinary TB S/S?

A
  • flank pain
  • dysuria
  • frequency
  • epididymitis
  • scrotal mass
  • PID
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21
Q

Tb induced PID accounts for?

A

10% of sterility worldwide

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22
Q

Cutaneous TB s/s?

A

Ulcer

Wart like lesion

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23
Q

Gastrointestinal TB s/s?

A
  • Any site
  • non-healing ulcers
  • esophageal disease
  • peptic ulcer disease
  • malabsorption
  • diarrhea
  • hematochezia
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24
Q

Miliary TB s/s?

A

Widespread (hematogenous) dissemination

  • weakness/fatigue
  • wt loss
  • HA
  • fever
  • cough
  • generalized lymphadenopathy
  • hepatomegaly
  • splenomegaly
  • pancreatitis
  • multi-organ dysfunction
  • adrenal insufficiency
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25
Q

Who gets miliary tb?

A

Immunocompromised

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26
Q

Mortality rate for miliary TB?

A

Close to 100%

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27
Q

Pulmonary TB physical exam findings?

A

Abnormal breath sounds

- especially over upper lobes

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28
Q

Exgrapulmonary TB physical exam findings?

A

tissue dependent

But common ones are

  • confusion
  • neurolgic deficit
  • lymphadenopathy
  • coma
  • chorioretinitis
  • cutaneous lesion
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29
Q

Tests for TB?

A

PPD
Sputum
Biopsy
Blood cultures

30
Q

Cornerstone for Latent TB diagnosis?

A

PPD

31
Q

Sputum collection?

A

For smear and culture

  • early morning
  • 3 days in a row
32
Q

Alternates for sputum collection?

A
  • Gastric aspirate
  • Transbronchial biopsy
  • Fiberoptic bronchoscopy
  • Bronchial washings
33
Q

Blood cultures for TB?

A

QTF-G (quantiferon gold)
RNA probes
PCR
Line probe assay

34
Q

Screening labs for TB tx?

A 
CBC
Chem (AST/ALT)
Alkaling phosphate
Total bilirubin
Uric acid
Creatinine
Obtain HIV serology
35
Q

Radiology findings for primary progressive TB?

A

Central apical portion
- left lower lobe infiltrate

Pleural effusions

36
Q

CXR reactivation findings?

A

Cavity formation
Noncalcified round infiltrates
Ranke complex
Hemogenously calcified nodules/tuberculomas

37
Q

What are ranke complexes?

A

Ghon lesion - Calcified peripheral nodule

Calcified hilar nodes

38
Q

If you see homogeneously calcified nodules or tuberculomas it means?

A

Its an old disease

39
Q

What will an x ray show for miliary TB?

A

Millet seeds

40
Q

What is the empiric tx for TB?

A

6 months of 4-drug regimen

  • INH (isoniazid)
  • Pyrazinamine
  • Rifampin
  • Ethambutol
41
Q

Treatment progression of TB?

A

Start with empiric

Once the isolate is know DC ethambutol

After 2 months only INH + rifampin

42
Q

Special considerations?

A

If they are INH resistant

  • rifampin
  • pyrazinamide
  • ethambutol

X 6 months

43
Q

What type of mask do you need for TB protection?

A

N-95 particulate respirator

44
Q

Complications of pulmonary TB?

A

Relapse
Aspergilloma
Carcinoma

45
Q

Differentials for TB?

A
  • FOUO
  • histoplasmosis
  • lung abscess
  • lung cancer (non small cell)
  • other mycobacterium infection
46
Q

What is the only latent TB (LTBI) test available?

A

PPD or TST
(Mantoux test)

TST (tuberculin skin testing)

47
Q

How is PPD/TST given?

A

5 tuberculin units of PPD

Measure response in 48-72 hrs

48
Q

What is a pos PPD?

A

Size of induration is diagnostic

Not erythemia

49
Q

All pos PPD get?

A

CXR

50
Q

A PPD larger than 5mm is pos for:

A
  • close contacts to TB
  • HIV
  • organ transplants
  • long term steroids
  • fibrotic lesions on CXR
    (Not granulomas)

SHE SAID TO STARR THIS SLIDE

51
Q

A PPD larger than 10mm is pos for:

A

High risk pts
Recent converters
Kids <4 yrs w adult TB exposure
Residents/employees of high risk facilities (prisons, hospitals, military)

52
Q

Who are “high risk” pts (10mm is pos)

A
  • DM
  • Hematologic malignancies
  • head/neck carcinoma
  • jejunoileal bypass
  • IV drug use
  • HIV pos
  • ESRD
  • silicosis
  • malnutrition
  • gastrectomy
53
Q

What is a “recent converter”?

A

10mm increase in past 2 yrs

Recent immigrants from high prevalence country

54
Q

Normal “pos PPD”

?

A

> /= 15mm

55
Q

What will cause false positives?

A

Infection w other mycobacterium

Vaccination w bacille calmett-guerin
- BCG (given in other countries)

56
Q

BCG is effective in?

A

Effective in kids but not in adults

57
Q

What about false neg?

A

10-25% of pts with TB are negative on PPD

58
Q

How long do we wait to check PPD?

A

72hrs

59
Q

Who gets LFT’s when on INH?

A

Everybody every month

60
Q

What is two step testing?

A

A complicated way to test that avoids using QTF-G for confirmation

Its on slide 45

61
Q

What is the LBTI prevention therapy?

A

Isoniazid (INH, Lanizaid) 300mg PO x 9 months

CDC recommend

62
Q

What should be added to INH therapy?

A

Pyridoxine PO QD

To prevent peripheral neuropathy

63
Q

What is the alternate drug for LTBI tx?

A

rifampin

If they are INH resistant or unable to tolerate INH

64
Q

What is the new MMWR tx for LTBI?

A

LTBI DOT tx

  • INH
  • rifampentinn (priftin)

Weekly x 3 mo DOT

65
Q

TB tx options and regimens?

A

Slide 48

66
Q

Though we should do AST/ALT on all TB pts in the military who else is high risk and needs liver tests?

A
  • 35yrs
  • other drugs
  • ETOH
  • chronic liver
  • hx of peripheral neuropathies
  • conditions predisposing to neuropathy
  • pregnancy
  • IV drug users

Get monthly AST/ALT

67
Q

INH side effects?

A

Hepatocellular disease
Peripheral neuropathy
Interactions w phenytoin
- increases concentrations of both

68
Q

Rifampin s/e?

A

Thrombocytopenia
Accelerated clearance of drugs
Decrease effectiveness of OCP

69
Q

Ethambutol SE?

A

Change in visual acuity

70
Q

Pyrazinamide SE?

A

Hyperuricemia
- asymptomatic hyperuricemia

NOT an indication for discontinuing

71
Q

with age comes skills

A

Its called multi-tasking

I can laugh, cough, sneeze and pee all at the same

Senior - ID 2 (6 decks)

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