Global burden of respiratory disease

Question 1

Multi-drug resistant TB

Answer 1

Organism resistant to rifampicin and isoniazid

Question 2

Extensively drug resistant TB

Answer 2

Resistant to isoniazid and rifampin and any fluroroquinolone
Atlas one of second line drugs - amikacin, kanamycin or capreomycin

Question 3

Causes of MDR-TB

Answer 3

Poor quality and supply of drugs 
Poor leadership of TB programs
Non-compliance
Incorrect prescription
Poor diagnostics

Question 4

Active TB treatment

Answer 4

Standard treatment is minimum 6 months:
- 2 months (initial phase) isoniazid, rifampicin, pyrazinamide and ethambutol - quadruple therapy

• 4 months (continuation phase) isoniazid and rifampicin = standard dual therapy

CNS involvement in continuation = extension to 10 months

TB treatment is taken all together on an empty stomach 1 hour before breakfast; compliance is essential for cure.

Question 5

Pneumocystis pneumonia

Answer 5

Pneumocystis jivorecci (P. Carini)
Yeast like fungus

Classic symptoms of pneumonia
Poor exercise tolerance

Question 6

HIV related pneumonias - Bacterial pneumonias (CAP and HAP)

Answer 6

Bacterial pneumonias (CAP and HAP)
Pneumococcal pneumonia
H influenza
Staphylococcus aureus
Atypical agents (C pneumoniae
& M pneumoniae)

Question 7

HIV related pneumonias

Fungal
Viral

Answer 7

Fungal pneumonias
Aspergillosis
Cryptococcis
Histoplasmosis

Viral pneumonias
CMV pneumonitis
Influenza

TB

Question 8

Risk factors - pneumonia

Answer 8

Smoking 
HIV 
Age 
cART 
Recreational drug use 
Comorbidities

Question 9

Respiratory infections in cART era - high income CD4>250

Answer 9

Bacterial pneumonia
Hospital acquired pneumonia
Other respiratory conditions: COPD, asthma, Lung cancer
TB

Question 10

Respiratory infections in cART era - low income CD4<250

Answer 10

All of above plus (high income)
PCP
Fungal pneumonias
TB

Question 11

Interventions

Answer 11

Seasonal flu vaccine
Wash hands! 
Pneumovax vaccine
Smoking cessation
Substance abuse counselling
ART

Question 12

COPD disproportionate burden on

Answer 12

Women
Babies + children
Elderly
Colder climates

Question 13

Pneumoconiosis

Answer 13

Silicosis

Asbestos

Question 14

MDR TB treatment

Answer 14

At least 5 drugs from groups below plus high dose (isoniazid/Ethambutol)
Group A=levofloxacin, moxifloxacin, gatifloxacin;
Group B=amikacin, capreomycin, kanamycin, (streptomycin);
Group C= ethionamide (or prothionamide), cycloserine (or terizidone), linezolid, clofazimine;
Add on groups
Group D2bedaquiline, delamanid;
Group D3aminosalicylic acid, imipenem–cilastatin, meropenem, amoxicillin clavulanate, (thioacetazone

Shorter regimens – New WHO guideline
9-12 month regimen now in use

Question 15

5 WHO priorities - MDR TB

Answer 15

Prevent drug resistance developing through high quality treatment
Expand rapid testing and detection
Provide immediate access to effective treatment
Prevent transmission through infection control
Increase political commitment with financing

Question 16

UK latent TB screening program

Answer 16

Primary care based testing 
Secondary care based treatment 
National protocols and pathways 
Fully funded 
Monitoring and screening

Question 17

Eligibility criteria for TB screening programme

Answer 17

Born or spent >6mo in high TB incidence country 
Entered the UK within last 5 years 
Aged between 16 and 35 
No history of TB or LTBI 
Not previously screened for LTBI in UK

Question 18

WHO End TB strategy

Answer 18

Reaching the “missed” cases (3 million not in the system)

Address MDR-TB as crisis

Accelerate response to TB/HIV

Increase financing to close resource gaps

Intensify research and ensure rapid uptake of innovations