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Disease & prevention > Case 2 > Flashcards

Case 2 Flashcards

1
Q

What is TB?

A

bacteiral disease that attacks lungs but can also attack other parts of body including kidneys, spine & brain

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2
Q

What is TB caused by?

A

Myobacterium TB and bacteria which grows very slowly

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3
Q

What are the general symptoms of TB?

A
  • Chills and fever
  • night sweats
  • losing weight without trying
  • loss of appetite
  • weakness or fatigue
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4
Q

What are the symptoms of latent TB?

A

None, it is latent

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5
Q

What do the symptoms of TB depend on?

A

Where TB is growing in body

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6
Q

What are the symptoms of pulmonary TB?

A

Pulmonary in lungs & most common form
* Prolonged coughing
* Producing sputum
* Cough up blood
* chest pain
* shortness of breath

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7
Q

*What are the symptoms of extrapulmonary TB?

A

extrapulmonary = Outside lungs
Symptoms depend on site
E.g. TB can start in intstines

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8
Q

What is active tb?

A

Active TB is divided into closed and open tb
TB bacteria are active (multiplying in your body) and spread to other organs causing symptoms

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9
Q

What is closed tb?

A

brain, kidney, spine, intestine and not contagious

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10
Q

What is open tb?

A

When TB bacteria is:
- active and multiplying in the lungs
- show symptoms
- only OPEN TB IS CONTAGIOUS!

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11
Q

*What is latent TB?

A
  • not multiplying and no symptoms but is somewhere in the body
  • usually positive skin test or blood test
  • latent can become active if no treatment for latent TB
  • weak immune system (e.g. cancer, hiv, etc) at higher risk of tb becoming active. e.g. if develop cancer & receive chemo maybe latent becomes active
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12
Q

What is miliary TB?

A

when inflammation focus ruptures into the blood stream = spread of bacteria thru entire body

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13
Q

*What happens when TB enters the body?

A
  • When a person breathes in TB bacteria, bacteria can settle in lungs & begin to grow.
  • Then they can move through blood to other parts of body, such as the kidney, spine, and brain.
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14
Q

What are the risk factors for TB?

A
  • Weakened immune system (HIV, diabetes, pregnancy, etc)
  • Travelling or living in certain areas
  • Substance abuse: IV drug use or alcohol abuse = weakened immune system
  • Tobacco use
  • Refugee camps
  • Healthcare workers
  • People recently infected with. theTB bacteria
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15
Q

What are the risk factors for becoming infected as a result of (airborne) exposure?

A
  • Severity of illness in index case (latent, active)
  • Closeness of contact
  • Duration of exposure
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16
Q

What is the TB disease model?

A
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17
Q

How can you diagnose TB?

A
  • Blood test
  • Skin test
  • Interferon Gamma Release Assay (IGRA)
  • X-ray
  • Sputum microscopy
  • Bacteria culture
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18
Q

How do you test for closed TB?

A

Skin test or blood test

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19
Q

What is the tuberculosis skin test?

A
  • Injecting protein extracts of the tb bacteria in the skin
  • If person infected, proteins recognised by immune system = local inflammatory response (induration & redness)
  • Also used for tracing of people who have been infected with tb bacteria (latent TB)
  • induration measured 2-3 days later
  • hard, raised, red bump = tb
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20
Q

What are some problems with the skin test?

A
  • Can get false positives (vaccinated with BCG vaccine)
  • false negatives (when immune system is supressed)
  • Doesn’t specify type of tb or if its active, only if you’ve ever been infected (throughout whole life)
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21
Q

Why can someone get a false negative with the tb skin test?

A

If person’s immune system is suppressed (e.g. aids), then immune cells that should alarm the body that something is wrong is killed by. theAIDS virus and so the immune system will not be activated and you don’t get a response.

22
Q

What is the IGRA test?

A
  • Uses blood samples & measures t-cell response to tb antigens
  • specific for tb
  • distinguishes tb infection from BCG
  • distinguishes between family members of bacteria
23
Q

What is the sputum microscopy?

A
  • using a microscope to determine whether abnormal cells are present in sputum samples
  • can also test for drug-resistant strains of tb
  • but has low sensitivity so a lot of patients with TB will not be found with this test
24
Q

Explain the bacteria culture test

A
  • info on type of bacteria & sensitivity for treatment
  • takes 4-8 weeks coz slow growing bacteria
25
Q

What is the most common medicine for tb?

A

Rifampicin & isoniazid

26
Q

*What is the treatment for TB?

is this correct?

A
  • medication
  • if you are non-resistant to the medication = 4-6 months treatment or 6-12??
  • if are resistant to medication = 20-30 months
  • latent tb = 3-4 months
27
Q

What does the treatment of TB depend on?

A

Length of treatment & amount of medication depends on:
* age
* overall health
* possible drug resistance
* form of TB (latent or active)
* infection location in body.
* access to healthcare
* if at risk

28
Q

What is treatment of tb aimed at?

A
  • curing individual patients
  • reduction of spread of bacteria
  • prevention of resistance against tb drugs
  • reduction of risk of activation of tb (latent tb)
29
Q

What is chemoprophylaxis for tb?

A

Prevention of disease after exposure to TB
* in children after contact with a contagious patient
* recent infection (TST conversion) -> if sure negative but then all of a sudden positive
* coincidental positive TB skin test finding

Tuberculosis chemoprophylaxis is a therapeutic measure for the prevention of infection by Mycobacterium tuberculosis or to avoid development of the disease in individuals already infected with it.

tst = tb skin test

30
Q

Why does treatment of. tbwith medication take so long?

A
  • because tb bacteria grows very slowly.
  • drugs interact with a diving cell so only if the cell is diving is it vulnerable to certain drugs.
  • Cells take 18-24 hr to divide.
31
Q

What are the problems with TB treatment?

A

many serious side effects:
* e.g. hepaitis, nervous/eye disorders
* interaction with other drugs (e.g. oral contraceptives or anti-epileptics)
* interaction with alcohol use

32
Q

Why is TB treatment a problem for methadone and alcohol users?

A
  • because these are risk groups to have TB (alcohol /drug addicts)
  • being addicted means immune system is worse & also they come into contact with people who are likely to be infected with tb.
  • TB medication cannot drink so if addicted to alcohol probably will drink = incompletion of medication = resistance, hepatitis, etc.
33
Q

What are some other causes of inadequate treatment?

A
  • Multiple drugs
  • duration of treatment
  • size of tablets
34
Q

What are causes of inadequate treatment for the patient?

A
  • co-morbidity, addiction, poor social circumstances
  • Symptoms disappear often within a few weeks so some people might think to stop medication, uncessery to continue
35
Q

What are causes of inadequate treatment abroad (3rd world / Eastern Europe)?

A
  • costs of drugs
  • logistical problems (have to make sure person gets drugs for 6-9 months which can be problem)
36
Q

*How do bacteria become drug-resistant?

is this correct?

A
  • Mutations in their genes allow some bacteria to survive these antibiotics, and they pass these genes along to their descendants
  • Every cell division will cause some small error in DNA during copying & some erros may make bacterium less vulnerable to drugs.
37
Q

Why are multiple drugs used simultaneously?

A
  • If use drugs with different modes of operation e.g. 1 blocks glucose so bacteria doesn’t get nutrients it needs other drug will interfere with cell division or inhibit growth, etc.
  • Different drugs = unlikely that the TB bacteria will be able to develop resistance against all 4 drugs.
  • Generally goes 1 by 1 so if not killed by 1 drug, hopefully killed by other 3 drugs.
38
Q

What are the different mechanisms of actions of drugs?

A
  • Some drugs inhibit growth but don’t kill bacteria
  • other drugs kill bacteria
39
Q

*What is MDR and XDR tb?

A
40
Q

When does one receive a tb vaccination?

A
  • living/coming from countries with high prevalence
  • not recommended for people already with weakened immune system (coz living bacteria) or who have had tb in. thepast
41
Q

What is the prevalence of TB bacteria?

A
  • prevalent. inlow & middle income countries.
42
Q

Why is prevalence of LTBI so high in elderly and low in young people?

A
  • weaker immune system
  • latent tb doesn’t mean infected recently.
  • when born in 1920, tb was prevalent in nl so at the. ageof 10-15 years, was very likley that elderly could have been in contact with someone with tb.
  • after 80 years it could still be present => old people dying.
43
Q

What happens when you get infected with TB (contact tracing)?

A
  • Doctors identify who is infected
  • close contact, work, etc.
  • outbreak management - stone in. thepond principle = you infect everyone around you (ripple effect)
44
Q

Explain how the ripple effect works with tb

A
  • you infect everyone aroun dyou
  • first investigation of contacts closest and longest contact with index-case e.g. family
  • if # of infected more than expected = expansion to next circle (see image)
  • by DNA fingerprinting, source. ofinfection can be identified.
45
Q

What are the best methods for prventing tb?

A
  • vaccination
  • imrpoved living/sanitary conditions
  • screening
46
Q

Who do we need to screen for tb?

A
  • risk groups (people with HIV/aids)
  • people who work: in high tb prevalent areas / with people with tb
  • migrants from high prevalent areas
  • IV drug users
  • prisoners
  • contact with infected individuals
47
Q

Why do we have the notifiable disease system in NL?

A
  • can detect early
  • monitor trends
  • response planning (if outbreak, decide plan of action)
  • see the effect of the interventions
  • eradicating disease
  • to protect certain risk groups in different geographic areas (e.g. the bible belt in NL)
48
Q

What does surveillance supply information about?

A
  • estimate of the health condtiion of a population - information to set priorities
  • a starting point to choose your health targets
  • what diseases to tackle, which expisures to tackle?
  • measures to evalute interventions, programs or outcomes
  • information to conduct research –> to find new risk factors, new treatments, new strategies to fight the disease.
49
Q

What are 3 common challenges of TB according to the ECDC?

A
  1. Identifying all TB cases at an earlier stafe 00<> .health care professionals don’t necessarily think about TB as a potential infection
  2. ensuring patients to complete thewir treatments (medications) –> essential to cure the patient
  3. prevent multi-drug resistance (MDR) and extensively drug-resistant (XDR) TB.
50
Q

What is multi-drug resistant TB (MDR-TB)?

A

Multidrug-resistant TB (MDR TB) is caused by TB germs that are resistant to at least two of the most important TB medicines: isoniazid and rifampin.

51
Q

What is extensively drug-resistant TB (XDR-TB)?

A
  • A more serious form of MDR TB is XDR TB.
  • XDR TB is a rare type of TB that is resistant to nearly all medicines used to treat TB disease.

Disease & prevention (10 decks)

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