IDS-TB

Question 1

Question 1:

What is the recommended screening method for asymptomatic adults with risk factors for pulmonary tuberculosis?

Answer 1

Answer:

Chest X-ray is recommended for screening asymptomatic adults with risk factors for pulmonary tuberculosis.

Rationale:

The table states that among asymptomatic adults with risk factors, chest X-ray has a sensitivity of 93.8%, meaning it effectively identifies individuals who actually have the disease. This high sensitivity makes it a valuable tool for further investigation with bacteriologic work-up.

Question 2

Question 2:

What is the recommended diagnostic test of choice for pulmonary tuberculosis?

Answer 2

Answer:

GeneXpert® is recommended as the initial diagnostic test of choice for pulmonary tuberculosis.

Rationale:

The table indicates that Xpert® (GeneXpert®) is more accurate than other tests like DSSM, with higher sensitivity and specificity. It also has the advantage of detecting rifampicin resistance, which is crucial for treatment decisions.

Question 3

Question 3:

In areas where Xpert® is unavailable and the risk of rifampicin resistance is low, what diagnostic test can be considered?

Answer 3

Answer:

TB LAMP can be considered as a diagnostic test in areas where Xpert® is unavailable and the risk of rifampicin resistance is low.

Rationale:

The table states that TB LAMP has comparable accuracy to GeneXpert® in diagnosing pulmonary tuberculosis. In situations where Xpert® is not accessible and the risk of resistance is low, TB LAMP can be a suitable alternative.

Question 4

What diagnostic workup is recommended for adults clinically diagnosed with extrapulmonary TB (EPTB)?

Answer 4

Answer:

In addition to radiologic/imaging findings, bacteriologic workup (i.e., GeneXpert® and TB culture) and histopathology are recommended for the diagnosis of EPTB.

Rationale:

This comprehensive approach combines imaging, microbiological tests, and tissue examination to confirm the diagnosis and guide treatment decisions for extrapulmonary TB cases.

Question 5

Is empiric treatment recommended for patients with negative bacteriologic tests but with clinical signs and symptoms of TB?

Can Xpert Ultra be used as the initial test in adults with presumptive PTB?

Answer 5

nswer:

There is no strong evidence to support or oppose empiric treatment in such cases. However, empiric treatment may be considered for HIV-positive patients.

Rationale:

The decision to initiate empiric treatment in this scenario should be made on a case-by-case basis, considering the clinical context and the patient’s overall risk profile.

Question 6

What is the recommended treatment regimen for adults newly diagnosed with rifampicin-susceptible pulmonary tuberculosis?

Answer 6

The recommended treatment regimen is 2HRZE/4HR.

Question 7

Is the inclusion of fluoroquinolones recommended in the treatment of pulmonary tuberculosis?

Answer 7

Answer:

No, the inclusion of fluoroquinolones is not recommended in the treatment of pulmonary tuberculosis.

Rationale:

This emphasizes the importance of adhering to established treatment guidelines and avoiding unnecessary use of fluoroquinolones.

Question 8

In patients requiring TB retreatment with confirmed rifampicin susceptibility by rapid drug susceptibility testing, which regimen should no longer be prescribed?

Answer 8

Answer:

The Category II regimen should no longer be prescribed in such cases.

Question 9

What is the recommended standard first-line treatment regimen for rifampicin-susceptible TB based on the availability of rapid drug susceptibility testing?

Answer 9

nswer:

The standard first-line treatment regimen of 2HRZE/4HR is recommended.

Question 10

What should be done if rifampicin resistance is present during retreatment for TB?

Answer 10

Answer:

If rifampicin resistance is detected, referral to a facility for the evaluation of drug-resistant TB is recommended.

Question 11

What is a recommended regimen for MDR/RR-TB?

Answer 11

Answer:

A shortened regimen of moxifloxacin, clofazimine, ethambutol, and pyrazinamide in 40 weeks, supplemented by kanamycin, isoniazid, and protionamide in the first 16 weeks, may be recommended for MDR/RR pulmonary tuberculosis.

Rationale:

This regimen offers a shorter treatment duration compared to traditional regimens for MDR/RR-TB.

Question 12

What is an alternative all-oral regimen for MDR/RR-TB?

1

Answer 12

Answer:

An all-oral bedaquiline-containing regimen of 9-12 months duration is recommended for eligible patients with confirmed MDR/RR-TB who have not been exposed to second-line TB medicines used in this regimen for more than 1 month, and in whom resistance to fluoroquinolones has been excluded.

Question 13

What screening methods are recommended for non-HIV adult household/close contacts of patients with active TB?

Answer 13

Answer:

Either a tuberculin skin test or an interferon-gamma release assay (IGRA) may be used to screen for latent tuberculosis infection (LTBI) in these individuals.

Rationale:

This proactive screening helps identify individuals with LTBI who may benefit from preventive treatment to prevent the development of active TB.

Question 14

What is the recommended treatment for LTBI in non-HIV adult patients?

Answer 14

Answer:

Isoniazid given once daily for 6 months is the recommended treatment.

Question 15

Are there any alternative treatment options for LTBI?

Answer 15

Answer:

Yes, alternative treatments include:
* Rifampicin given once daily for 4 months
* Rifampicin + isoniazid given once daily for 3 to 4 months
* Directly observed therapy with Rifapentine + Isoniazid for 12 doses weekly

Question 16

What measures are recommended to reduce the transmission of M. tuberculosis in healthcare settings?

Answer 16

Triage: People with TB signs and symptoms or with TB disease should be triaged to minimize transmission risk to healthcare workers and other individuals in the healthcare facility.

Separation/Isolation: People with presumed or documented infectious TB should be separated or isolated to further reduce the risk of transmission.

Question 17

What is the importance of prompt initiation of effective TB treatment in reducing transmission?

Answer 17

Prompt initiation of effective TB treatment is crucial to reduce the transmission of M. tuberculosis to healthcare workers, persons attending healthcare facilities, and others in settings with a high risk of transmission.

Rationale:

By quickly starting appropriate treatment, the patient’s infectiousness is reduced, minimizing the risk of spreading the infection to others.

Question 18

What are some measures recommended to promote respiratory hygiene in patients with presumed or confirmed TB?

Answer 18

Answer:

Respiratory hygiene practices, such as cough etiquette, are recommended to reduce the transmission of M. tuberculosis.

Rationale:

Cough etiquette, such as covering the mouth and nose with a tissue or elbow when coughing or sneezing, helps prevent the spread of respiratory

droplets containing M. tuberculosis.

Question 19

What role does upper-room germicidal ultraviolet (GUV) systems play in reducing TB transmission?

Answer 19

Answer:

Upper-room GUV systems are recommended to reduce M. tuberculosis transmission in healthcare settings.

Rationale:

GUV systems can inactivate airborne M. tuberculosis bacteria, thereby reducing the risk of transmission.

Question 20

How can ventilation systems contribute to reducing TB transmission?

Answer 20

Answer:

Proper ventilation systems, including natural, mixed-mode, mechanical ventilation, and recirculated air through high-efficiency particulate air (HEPA) filters, are recommended to reduce M. tuberculosis transmission.

Rationale:

These ventilation strategies can help to dilute and remove airborne M. tuberculosis bacteria, reducing the risk of exposure.

Question 21

What role do particulate respirators play in protecting healthcare workers and others from TB transmission?

A

Answer 21

Particulate respirators, within the framework of a respiratory protection program, are recommended to reduce M. tuberculosis transmission to healthcare workers, persons attending healthcare facilities, and others in settings with a high risk of transmission.

Rationale:

Particulate respirators, such as N95 respirators, can effectively filter out airborne M. tuberculosis bacteria, providing protection for healthcare workers and others at risk.

Question 22

How do rifampicin-containing regimens compare to non-rifampicin-based regimens in patients with TB-HIV co-infection?

Answer 22

Answer:

Rifampicin-containing regimens are comparable to non-rifampicin-based regimens in terms of effectiveness and safety in patients with TB-HIV co-infection.

Rationale:

This statement indicates that both types of regimens can be effective in treating TB in patients with HIV co-infection, and there is no significant difference in terms of their safety profile.

Question 23

What caution should be exercised when treating HIV patients with TB co-infection who are on rifampicin-based regimens?

Answer 23

Answer:

Caution should be exercised when increasing the dose of lopinavir/ritonavir in HIV patients with TB co-infection who are on rifampicin-based regimens.

Rationale:

Increasing the dose of lopinavir/ritonavir in this context may increase the risk of adverse events without significantly improving virologic outcomes.