ID-Tuberculosis Flashcards
TB PPD test >5mm, positive in whom?
HIV positive
Recent contacts of those with active TB
Persons with fibrotic changes on chest radiograph consistent with old TB
Patients with organ transplants, immunosuppressive conditions or receiving >15mg of prednisone for >4 weeks
TB PPD test >10mm, positive in whom?
Recent arrivals <5 years from high prevalence countries
IJ drug users
Residents or employees of high risk congregate settings: prisons, jails, nursing homes and other health care facilities, residential facilities for p patients with AIDS
Mycobacterial lab personell
TB PPD test >15mm positive in whom?
Anyone else with no other risk factors
For someone who has received the BCG vaccine, which TB test is preferred?
The interferon gamma release assay is preferred because on ppd you can get a false positive
also interferon gamma good for those who may have trouble returning
How is TB confirmed?
culture and nucleic acid amplification testing
AFB stain-> culture in a liquid medium, followed by a solid medium
A positive AFB is helpful but not diagnostic
CSF pattern of TB meningitis
Lymphocytic pleocytosis
Elevated protein
Decreased glucose level
Why does pyridoxine need to be added to isoniazid?
to reduce the risk of isoniazid associated peripheral neuropathy
Regimens for Latent TB
1- Isoniazid 9 months
2-Isoniazid 6 months
3-Isoniazid and rifapentine
4-Rifampin
LTBI: Who cannot take the isoniazid rifapentine combo that is once weekly for three months?
Those suspected of having rifampin or isoniazid resistant TB, pregnant women or women planning to become pregnant
LTBI: What is a good alternative if isoniazid resistant infection is suspected?
Rifampin for 4 months
LTBI: What if someone is pregnant what do you use?
You defer therapy until after delivery
Can you take isoniazid while breastfeeding?
Yes! Isoniazid is not a contraindication to breast feeding.
For active, non-resistant TB, what is the treatment regimen?
Initiation Phase: RIPE for two months
Continuation Phase: INH and RIF daily for 4.5 months
OR INH and RIF twice weekly for 7 months
Who should get the 7 month duration of the continuation phase for active TB?
- Cavitary pulmonary disease
- Positive sputum culture after completing initiation phase
- Did not receive pyrazinamide as part of initial therapy
How is completion of treatment determined?
It is determined when the appropriate number of doses over a certain period of time are taken
What happens if someone misses two weeks or more in the initiation phase?
They have to start over:(
What is the duration of treatment for extra pulmonary TB?
6.5 month minimum
What is the duration of treatment for TB meningitis? What is the treatment regimen?
9-12 months
RIPE with initiation and continuation phase AND adjunctive glucocorticoids
what is the treatment regimen for TB pericarditis?
Also 9-12 months PLUS adjunctive corticosteroids
Side effects of Isoniazid?
Elevated LFTs
Peripheral neuropathy
Adjust for AKI
*add pyrazinamide to offset peripheral neuropathy
Side effects of pyrazinamide?
Hyperuricemia
Elevated LFTs
Side effects of Rifampin?
Elevated LFTs
GI upset
Turns body fluid colors orange
Cannot administer in patients on protease inhibitors and NNRTIs
Side effects of Ethambutol?
Optic neuritis, rash
MDR TB: How can it occur?
suboptimal treatment regimen, medication non adherence, drug malabsorption, or drug interactions resulting in subtherapeutic drug levels
What is extensively drug resistant TB?
Resistant to rifampin and isoniazid, any fluoroquinolone, and at least one second line drug (amikacin, kanamycin, capreomycin)
Criteria required to establish that a patient is no longer infectious with TB
1-improvement of synmptoms
2-three consecutive negative sputum smears
3-adequate treatment for >2 weeks
