Infection TB

Question 1

What causes TB?

Answer 1

Bacteria called Mycobacterium tuberculosis

Question 2

What is extrapulmonary TB?

Answer 2

Presents with symptoms specific to the site involved, such as CNS, peripheral lymph nodes, bones and joints, pericardium and genitourinary system

Question 3

What’s latent TB?

Answer 3

Occurs when the Mycobacterium remains dormant and is asymptomatic and not infectious. However, in about 10% of people, latent TB becomes active

Question 4

Symptoms of TB?

Answer 4

Slow and progressive
Loss of appetite = Weight loss
Persistent cough more than 3wks
Night sweats
Blood in spitum
Sometimes swelling around the neck
Tiredness

If symptomatic more than 3wks go to GP

Question 5

How is TB diagnosed?

Answer 5

Whole genome sequencing

Previously tool 4-6wks but now takes 10 days

Question 6

What does TB with CNS involvement mean?

Answer 6

Meningitis

Spinal cord invovement

Question 7

Treatment of TB without CNS involvement?

Answer 7

Isoniazid (with Pyridoxine)
\+ rifampicin
\+pyrazinamide
\+ethambutol
For 2 months

Then
Isoniazid with Pyridoxine and rifampicin for a further 4 months

Question 8

Treatment of TB with CNS involvement?

Answer 8

Isoniazid with Pyridoxine
Rifampicin
Pyrazinamide
Ethambutol
For 2 months

Then
Isoniazid with Pyridoxine
Rifampicin
For a further 10months

Plus steroid for 6-8wks

Question 9

What is Pyridoxine and why do you take it with isoniazid?

Answer 9

Pyridoxine is a B6 vitamin

It reduces isoniazid side effects like neuropathy

Question 10

How to take TB meds?

Answer 10

Preferably before breakfast and preferably OD
Can do 3 times weekly dosing if observed therapy needed

DOT=direct observed therapy for non adherent pts

Question 11

Which TB drugs cause lover toxicity?

Answer 11

Isoniazid
Rifampicin
Pyrazinamide
10-29% pts are affected

Question 12

Signs of liver toxicity?

Answer 12

Dark urine
Pale stools
Tired
Unwell
Jaundice
N and V

Question 13

Side effect of etambutol?

Answer 13

Affects vision so report any visual changes immediately

Visual needs to be checked prior to initiation of drug

Question 14

Pt advice on rifampicin?

Answer 14

Can colour urine, saliva and other bodily fluids orange red

Do not use COC, insert IUD

Question 15

Which one of the TB drugs are enzyme inducer?

Answer 15

Rifampicin

Question 16

Which one of the TB drugs are enzyme inhibitor?

Answer 16

Isoniazid

Question 17

Interaction that you néed to be aware of with isoniazid?

Answer 17

Avoid tyramine food or histamine rish food like alcohol, fermented and yoghurt

Question 18

Drug treatment If pt resistant to isoniazid?

Answer 18

First 2 month take rifampicin, pyrazinamide and ethambutol
Then
Rifampicin and ethambutol for 7 months

Question 19

Drug treatment If resistant to pyrazinamide?

Answer 19

First 2 months rifampicin, isoniazid and ethambutol
Then
Rifampicin and isoniazid for 7 months

Question 20

Drug treatment If pt resistant to ethambutol?

Answer 20

First 2 months rifampicin, isoniazid and pyrazinamide
Then
Rifampicin and isoniazid for 4 months

Question 21

What’s considered as a treatment interruption in TB treatment?

Answer 21

A break of at least 2wks during the initial phase or missing more than 20% of prescribed doses
Need to reestablish if this happens