Drugs For Tuberculosis Flashcards
Mycobacteria:
( aerobic or anaerobic?) , bacillary type bacteria that grow like _____ (___) and belong to the genus ___________ (Mycobacteriaceae)
Aerobic
fungus; Myco
Actinobacteria
Mycobacteria
They have (thinner or thicker?) cell wall than many other bacteria.
Their cell wall is _____, ______phobic and contain _______ as well as large amount of ________ which is responsible for their __________
.
Thicker
waxy; hydro; peptidoglycan
mycolic acid
acid fastness.
Mycobacteria consist of many species and many pathogens including those that cause _________ and ______
leprosy and tuberculosis.
Mycobacteria infections (MI) Types:
•
– (a) __________ (_____) caused by ________
– (b)___________ (_____)
Tuberculosis (TB)
M. tuberculosis
Non-tuberculous MI
NTB
Mycobacteria infections (MI) Types:
Non-tuberculous MI (NTB):
_________
___________
Leprosy
Atypical MI
Atypical MI:
Those that cause _____ disease
Those that cause ___ disease
lung
skin
Atypical MI:
Those that cause lung disease: Mycobacterium ___________ and Mycobacterium ___________
avium-intracellulare and kansasii
Atypical MI:
Those that cause skin disease: M. ________ , M. _______, M. _____, M. ______ and M. _______
marinum; ulcerans; chelonae
fortuitum
abscessus
Manifestation
– TB: originates as ______ infections which spread to the ______, laryngeal, pharyngeal, ____,_____, and _______ spaces.
lung
cervical lymph nodes
oral, aural and ocular
Manifestation
– NTB: originates in ______,______,______, and ________
cervical lymph nodes, aural and ocular spaces.
Diagnosis:l of mycobacterium
(I) ______ and ______ tests to identify the specific type of bacteria present in the lungs
(ii)_______ to image the lungs
(iii)________ to view the lung’s airways
Blood and sputum
CT scans
Bronchoscopy
Mycobacteria infections (MI) Management:
– (a) Tuberculous: _______ anti-tuberculous chemotherapy
Systemic
Mycobacteria infections (MI) Management:
– (b) Non-tuberculous MI: ______ + ______ + ____ until _____ culture is negative for _________
Azithromycin
ethambutol
rifampin
monthly; year
Mycobacteria infections (MI)
Transmission:
TB: transmitted via _____ of infected aerosols generated by active TB patients when he _________________________
inhalation
coughs, sneezes, laughs, spits or talks
Tuberculosis :Types
_______ TB
________TB
___________(MDR-TB)
____________________ (XDR-TB)
___________ tuberculosis
Latent
Active
Multidrug resistant tuberculosis
Extensively multidrug resistant tuberculosis
Extra-pulmonary
Tuberculosis (TB)
Latent TB: Occurs when the bacteria is _____________________. And _____________.
in the body without the person developing symptoms
cannot infect others.
Tuberculosis (TB)
Active TB: Occurs when the bacteria is ___________________.
Person with active TB can _________
in the body and the person is having symptoms
infect others.
Tuberculosis (TB)
Multidrug resistant tuberculosis (MDR-TB): TB that is ________________________ ( ______ and ________ ).
resistant to the two most potent first line drugs
isoniazid and rifampin
Tuberculosis (TB)
Extensively multidrug resistant tuberculosis (XDR-TB): TB infection that is _________________ and, at least, _______________________ ( _____,_______,______), and any of the __________ .
resistant to rifampin, isoniazid
one of the three injectable second-line drugs
Amikacin, kanamycin or capreomycin
fluoroquinolones
Tuberculosis (TB)
Extra-pulmonary tuberculosis:
Tuberculosis _________ is called extra-pulmonary tuberculosis
not affecting the lungs
Signs and symptoms tuberculosis
o Latent TB: A person with latent TB will have ___ symptoms, and ____ damage will show on a chest X-ray
However, a _______ or _______ will indicate that they have TB infection
no; no
blood test or skin prick test
Signs and symptoms tuberculosis
o Active TB:
•a _______ lasting at least _______
•coughing ______ which may have _____ in it
•loss of appetite and weight, fatigue and being unwell
•swelling in the ____, fever, _______ , chest pain and chills.
persistent cough; 3 weeks
phlegm; blood
neck; night sweats
Signs and symptoms tuberculosis
Symptoms of ACTIVE TB typically ______ over time, but they can also _______ and ________
worsen
spontaneously go away and return.
Mycobacteria infection
Epidemiology: In 2019, Estimated __________ active TB global cases with _______ deaths were reported. And Nigeria (4.4%) ranked ______ behind ____ (26%), Indonesia (8.5%), China (8.4%), Philippines (6.0%) and Pakistan (5.7%) - (WHO, 2020).
10 million
1.4 million
6th; India
Tuberculosis : Prevention
•Getting a ______ and _________ early
•___________________________ until there is no longer a risk of infection
•wearing a _____, covering the _____, and _______ rooms
diagnosis and treatment
Staying away from other people
mask; mouth; ventilating
Tuberculosis : Prevention
TB vaccination: In some countries, children receive an anti-TB vaccination {the ___________ vaccine — as part of a regular immunization program}.
bacillus Calmette–Guérin (BCG)
Tuberculosis: Complications
_______: Without treatment
Death
Tuberculosis: Complications
Disseminated infection: If it spreads throughout the body, the infection can cause problems with the _______ system and _______ function.
cardiovascular
metabolic
Tuberculosis: Complications
_______: TB can also lead to this, a potentially life threatening form of infection.
Sepsis
Tuberculosis: Complications
________
__________
__________
Death
Disseminated infection
Sepsis
TB can be fatal
T/F
T
TB can lead to sepsis
T/F
T
Antituberculous drugs
First line agents :
List all 5
Isoniazid, Rifamycin, pyrazinamide, ethambutol and streptomycin.
Antituberculous drugs
Second line agents: are used when there is _________,_________, or __________ to _________
there is intolerance, drug resistance or contraindication to the first line agents.
Rifamycin (______,________ or _________ )
rifampin, rifabutin or rifapentine
Antituberculous drugs
Second line drugs: They include _______, Clofazimine, _______, Delamanid, ______,_________ (levofloxacin or moxifloxacin), Linezolid, ________ acid, Pretomanid, Thioacetazone and Injectable-only agents (______,_______, and ———— ), _______ plus _________
Bedaquiline
Cycloserine
Ethionamide
Fluoroquinolones
Para-aminosalicylic
Amikacin, kanamycin and capreomycin
Carbapenems; clavulanate
Isoniazid is a prodrug
T/F
T
Anti-TB. Drugs
Isoniazid: A synthetic derivative of _______
– Mechanism of action: Appears to ______________________, major components of the mycobacterial cell wall.
nicotinic acid
block the synthesis of mycolic acids
Isoniazid
Uses: Used with ______ for latent TB. And combined with ______,________ and either ———— or ________ for active TB.
Nothing
rifampicin, pyrazinamide and either ethambutol or streptomycin
Isoniazid
Adverse effects:
________ due to ______ depletion
___________ due to raised ______ and ____
nausea and vomiting
Blood ________
Peripheral neuritis; pyridoxine
Hepatotoxicity; ALT and AST
dyscrasia
Isoniazid is recommended in pregnancy.
T/F
F
Not recommended in pregnancy.
Antituberculous drugs
Rifampicin:
– Mechanism of action: It _________________
inhibits RNA synthesis
Antituberculous drugs
Rifampicin:
– Uses: ________, Mycobacterium ______,_______, and ________disease.
Tuberculosis
avium complex, leprosy, and Legionnaires’
Rifampicin:
– Adverse effects:
•Nausea, vomiting, diarrhea, and loss of appetite.
•It often turns _____,_____,_____ into a ______ or _______.
_____ problems or ______ reactions may occur
urine, sweat, and tears
red or orange color
Liver; allergic
Rifampin May be used in pregnancy.
T/F
T
Antituberculous drugs
Pyrazinamide:
– Mechanism of action: ________
Unknown
Antituberculous drugs
Pyrazinamide:
– Uses: used with _______,________ and either __________ or __________ for active TB.
rifampicin, isoniazid, and either streptomycin or ethambutol
Pyrazinamide can be used for latent TB.
T/F
F
Not recommended for latent TB.
Antituberculous drugs
Pyrazinamide:
– Adverse effects:
•Common: nausea, loss of appetite, _______ and _____ pains, and _____.
•Rare and more serious side effects: ______, _____ toxicity, and sensitivity to _______.
muscle and joint ; rash
Gout; liver ; sunlight
pyrazinamide is safe in pregnancy
T/F
F
Safety in pregnancy unclear.
Antituberculous drugs
Ethambutol:
– Mechanism of action: interfers with __________
bacteria metabolic process.
Antituberculous drugs
Ethambutol:
– Uses: used with ______,______, and —— for active TB.
rifampicin, isoniazid, and pyrazinamide
Ethambutol is Not recommended for latent TB
T
Antituberculous drugs
Ethambutol:
– Adverse effects:
Common: ______ problem, ____ pain, nausea, headaches, and feeling tired.
Rare and more serious side effects: _____ problems and ____ reactions.
vision; joint
liver; allergic
Ethanbutol May be used in pregnancy.
T/F
T
Streptomycin:
Class: First line antituberculous drug except in ____.
Mechanism of action: blocks the ability of ________ to _______, which results in bacterial death.
US
30S ribosomal subunits; make proteins
Streptomycin:
Uses: used with ____,_____,______ for active TB.
rifampicin, isoniazid, and pyrazinamide
Streptomycin is recommended for latent TB.
T/F
F
Not recommended for latent TB
__________ first line drug is Also for Mycobacterium avium complex, endocarditis, brucellosis, Burkholderi infection, plague tularemia, and rat bite fever.
Streptomycin
Streptomycin is administered by _______ or _____.
i/m or i/v injection
Streptomycin is Contraindicated in pregnancy.
T/F
T
Streptomycin
Adverse effects:
Common: vertigo, vomiting, numbness of the face, fever, and rash
Rare and more serious side effects: Causes _______ in neonates if used during pregnancy
deafness
Standard treatment for active TB:
(Short or Long?) course treatment:
______(along with ______) + _____ + _______ + _______ for ————-
then
________ and ______ alone for a further ______
Short
isoniazid; pyridoxal phosphate
rifampicin; pyrazinamide; ethambutol; two months
isoniazid and rifampicin ; four months
Standard treatment for latent TB:
3 ways
•_______ to ______ of daily ______ alone or
•_____ months of weekly (____ doses total) of ______/______ combination or
•_____,______, and _______ for ____ months, followed by _____ and ______ for _____ months.
_______ need not be used
Six to nine months; isoniazid
Three; 12; isoniazid/rifapentine
Isoniazid, rifampicin, and pyrazinamide; two ; isoniazid and rifampicin; four
Ethambutol
Standard Treatment of tuberculosis is Not for child < __yrs, _____ and people living with _____.
2
pregnancy
HIV
Choosing right type of antibiotic and length of treatment will depend on:
the person’s ____ and overall health whether they have _____ or _____ TB , the ____ of the infection, and whether the strain of TB is _______
age
latent or active
location; drug resistant
Multidrug resistant tuberculosis (MDR-TB):
They are treated with _______ antituberculous drugs including bedaquiline, delamanid, linezolid and pretomanid.
second line
Extensively multidrug resistant tuberculosis (XDR-TB): Treated with effective _________
second line drugs.
In sub-Saharan Africa about ___ of all people with ______ are infected with M. tuberculosis
Half
HIV
TB is the main AIDS-defining illness.
T/F
T
Mycobacteria are (obligate or facultative ?) (aerobes or anaerobes?)
Obligate
Aerobes
M. Tuberculosis is spore forming
T/F
F
M. Tuberculosis is motile
T/F
F
Transmission of M. Tuberculosis
The tiny droplets dry (slowly or rapidly?) ; the smallest (<____µm) may ____________________ and may reach the terminal air passages when inhaled.
Rapidly
5–10
remain suspended in the air for several hours
Pathogenesis of M.tuberculosis
Inhalation of droplet nuclei
_______ by ___________
________ within _____ for ______
(Primary pulmonary tuberculosis)
Engulfed; alveolar macrophages
Replicate; macrophages; 2-3 weeks
Pathogenesis of M. Tuberculosis
In ____% of cases, infection is _________, _______ disease
________ become (active or dormant ?) and sealed off by _______
(latent tuberculosis infection – LTBI)
95; contained
no apparent
Granuloma
Dormant; scar tissue
Pathogenesis of M.tuberculosis
Surviving bacilli may be ___________
_______ of ________ and surrounding tissue
Bacilli spread through _______ from _____ to other parts of the lung
(reactivation tuberculosis)
reactivated years later
Erosion of granuloma
air passages; cavities
Pathogenesis of M.tuberculosis
Spread beyond the pulmonary system – direct, ________, _______, swallowing of _______
(extrapulmonary tuberculosis)
haematogenous
Lymphatic
sputum
______ + ______ = Ghon complex
Ghon focus
Lymph node
PULMONARY TUBERCULOSIS
Primary pulmonary TB
______ are asymptomatic
Symptoms (mild or severe?) , including ___-grade fever
Radiography –_____ lymphadenopathy, __________ lung field pulmonary infiltrates
⅔
Mild, low
hilar
mid and lower
Postprimary (reactivation) TB
90% of TB cases in (children or adults?)
_____, cough, ____,________
Chest pain, dyspnea, haemoptysis
Adults
Fever; weight loss, night sweats
Postprimary (reactivation) TB
CXR- ____________ lung infiltrates, cavities with air-fluid levels, nodules, effusions, hilar adenopathy
Apical-posterior
____ % of patients with active post primary primary TB have normal CXR
5
EXTRAPULMONARY TUBERCULOSIS
Can present in any organ system
Common presentations:
1) Tuberculous _________
2)______ Tuberculosis
3)____ involvement
4)______ tuberculosis
5)_______ tuberculosis
lymphadenitis
Pleural
CNS
skeletal
Miliary
EXTRAPULMONARY TUBERCULOSIS
Can present in any organ system
Common presentations:
1) Tuberculous lymphadenitis
_____% of cases
(Acute or Chronic?) , ___lateral (tender or non-tender?) lymphadenopathy: ______ and _______ lymph nodes.
Also mediastinal and axillary
40
Chronic; uni; non-tender
cervical and supraclavicular
EXTRAPULMONARY TUBERCULOSIS
2) Pleural tuberculosis
___% of cases
Pleuritic ______, ________ cough
P/E: _____ to percussion, ____eased breath sounds
CXR- ___lateral pleural effusion
Pleural fluid analysis – lymphocyte predominance, low glucose, low pH (<7.2), protein concen (4 – 6g/dl)
4; chest pain
non-productive
Dullness; Decr
uni
EXTRAPULMONARY TUBERCULOSIS
3) CNS involvement: ___% of cases
TB meningitis
_______– 2 to 3 weeks of malaise, headache, ___ grade fever
_______ phase – fever, ___ rigidity, altered _______
______ phase – stupor, _____, ____, death
I
Prodrome; low
Meningitic; nuchal; mental status
Paralytic; coma; seizure
EXTRAPULMONARY TUBERCULOSIS
3) CNS involvement: I% of cases
CNS tuberculoma
__________ in the brain
______ neurological symptoms, signs of ____________
Caseous foci
Focal
raised intracranial pressure
EXTRAPULMONARY TUBERCULOSIS
4) Skeletal tuberculosis
Most commonly ________ (_____ disease)
thoracolumbar spine; Pott’s
EXTRAPULMONARY TUBERCULOSIS
5) Miliary tuberculosis
______ or _______ spread
Other sites are:
- peritoneum
- pericardium
Lymphatic or haematogenous
Diagnosis – latent infection
Established by:
Positive result on either ___ Test or _____
Skin; blood
Diagnosis – latent infection
__________-Skin or
_______________- Blood,
In (presence or absence?) of features of active TB
Tuberculin Skin Test (TST); Interferon gamma release assay (IGRA)
Absence
Tuberculin skin test/ Mantoux test
Intradermal 0.1ml of 5 Tuberculin units of ____________ into the _____ (_____) surface of the forearm
Purified Protein Derivative (PPD)
volar; palmar
PPD invokes a _____________ reaction
Diameter of induration is measured after _______
Induration of _____ mm is interpreted as positive depending on clinical risk factors
delayed hypersensitivity
48 – 72 hours
5 – 15
Interferon gamma release assay (IGRA)
______ based tests of ________ or ______ which measure ____ release after _____ stimulation by M. tuberculosis.
ELISA
whole blood or mononuclear cells
IFN-gamma
T-cell
Clinical specimens – pulmonary TB
spontaneously expectorated sputum ( ____ specimens are required in ____ visits for ____ days ; Spot – _____ –Spot)
3
2
two days
Morning
Gold standard for laboratory confirmation of TB is ??
By Culture
A person with LTBI
Has small amount of TB in their body
TB is dead in their body
Can spread TB bacteria to others
Positive for TB skin test
Radiography is typically abnormal
T
F( alive , but inactive)
F( cannot)
T
F( normal)
A person with LTBI
Sputum smears are positive
Culture is negative
Should not consider LTBI treatment
Does not require respiratory isolation
Is a TB case
F
T
F( should, to prevent TB disease)
T
F( not)
Person with TB disease
Large amount of TB bacteria in their body
Active Tb in their body
Can spread TB to others
Does not feel sick or have symptoms
Negative for skin test
T
T
T
F
F(positive)
Person with TB disease
Radiography may be abnormal
Sputum smears are negative for TB
Cultures are positive for TB
Needs treatment for TB disease
Does not require respiratory isolation
Is a TB case
T
F
T
T
F
T
multidrug resistant TB is a TB that is Resistant to ___________________
at least isoniazid and rifampicin
For MDR TB, use ______
2nd line antibiotics
2nd line TB Drugs, compared to 1st line
More or less toxic
More or less effective
More
Less
1st line TB Drugs, compared to 2nd line
More or less toxic
More or less effective
Less
More
ATYPICAL MYCOBACTERIA
Has ___________ animal host
No animal
ATYPICAL MYCOBACTERIA
No evidence for human-to-human transmission (T/F)
Human infection probably results from ________________
Cause _______ infections
Infections associated with Immunosuppression, Trauma, surgical wounds
Can be detected by microscopy
T
inhalation or ingestion of bacilli from the environment.
opportunistic
