module 2: points to ponder TB

Question 1

what are some risk factors or TB?

Answer 1

• overcrowding
• homelessness
• alcohol abuse
• impaired immune function
• HIV
• heavy air pollution
• smoking
• unemployment
• poor nutrition

Question 2

how are homelessness, unemployment, and poor nutrition related in TB?

Answer 2

interrelated
- unemployment leads to homelessness
- malnutrition is common in homeless people
- active TB can contribute to people being unable to maintain proper nutrition

Question 3

how does malnutrition increase susceptibility to TB?

Answer 3

impairing the immune system function

Question 4

what have the relationship between alcohol abuse and TB been linked to?

Answer 4

• impaired ability of macrophages to phagocytize and kill the organism

Question 5

what environments of alcohol abuse make TB easier to spread to susceptible people?

Answer 5

bars
prisons
homeless shelters

Question 6

what is a secondary affect of alcohol abuse in relation to TB?

Answer 6

increases the likelihood of liver damage secondary to use of antituberculosis drugs

Question 7

what are two drugs/agents lower the body’s immune system

Answer 7

• administration of chemotherapeutic agents used to treat cancer
• drugs given to organ transplant recipients to reduce their immune systems’ response to the organ

Question 8

what are two common diseases that reduce the body’s immune response?

Answer 8

diabetes mellitus
HIV

Question 9

why are people with HIV at higher risk in developing TB?

Answer 9

impaired immune systems make it easier for M. tuberculosis to avoid being killed

Question 10

if a person with HIV is found to have latent TB, how long should isoniazid be prescribed?

Answer 10

6-36 months

Question 11

describe the relationship of co-inefction between TB and HIV

Answer 11

M. tuberculosis results in the increased replication of HIV virus, increased incidence of opportunistic infection by other pathogens, and acceleration of the progression from HIV infection to AIDS

Question 12

which drug was found to be effective and much cheaper than para-aminosalicylic acid, but determined to be toxic to people co-infected with HIV?

Answer 12

thioacetazone

Question 13

what new antibiotic was developed in place of thiacetazone in people with HIV?

Answer 13

ethambutol

Question 14

what was the first successful treatment of TB that some strains of M. tuberculosis developed resistance to?

Answer 14

antibiotic streptomycin

Question 15

what two drugs were added to streptomycin?

Answer 15

para-aminosalicylic acid and isoniazid

Question 16

what two additional antibiotics became available and were added to treatment protocols that included either isoniazid or thiacetazone?

Answer 16

rifampicin
pyrazinamide

Question 17

what is the current first line of treatment protocol for TB?

Answer 17

2 months of isoniazid, rifampicin, ethambutol, and pyrazinamide followed by 4 months of isoniazid and rifampicin

Question 18

how does M. tuberculosis become resistant to antibiotics?

Answer 18

they identify a component within themselves that is targeted by a specific antibiotic and then mutating that component so the antibiotic fails to work

Question 19

what is an example of how M. tuberculosis became resistant to antibiotics?

Answer 19

one of the abx that was effective against M. tb bound to a specific protein involved in RNA synthesis by the organism so M. tb mutated the gene encoding that specific protein and the abx no longer worked

Question 20

why do the antibiotics need to be taken in longer periods?

Answer 20

its easier for many drugs to kill bacteria when its dividing

Question 21

what is a con to taking so many drugs for longer periods of time?

Answer 21

the organism can take advantage and become resistant

Question 22

what are other ways M. tuberculosis have become resistant on the patient’s end?

Answer 22

• patients fail to take the appropriate amount on the prescribed schedule needed to kill the organism
• patient quits taking the drug based on side effects like nausea, vomiting, and fatigue

Question 23

what happens when a person with TB has multiple drug resistant organisms?

Answer 23

require treatment with more expensive “second-line” drugs that can have even more side effects

Question 24

what are the organisms called when they are resistant to both first and second line anti-tuberculosis drugs?

Answer 24

extensively drug resistant organisms

Question 25

what kind of acetylators are more likely to develop side effects during isoniazid treatment?

Answer 25

slow

Question 26

what are some side effects of slow acetylators taking isoniazid?

Answer 26

minor: fever and skin rashes
severe: liver toxicity and numbness/tingling in fingers

Question 27

what is the chronic toxic effect of isoniazid due to?

Answer 27

cumulative effect the drug may have in slow acetylators

Question 28

why were people in the 1800s northeastern US rumored to be vampires?

Answer 28

these people with TB were progressively pale, gaunt, and sensitive to light

Question 29

what happened to the undead TB people in the 1800s that were thought to be vampires?

Answer 29

exhumations and burning of their hearts

Question 30

who identified M. tuberculosis to be the causative agent in 1882?

Answer 30

Robert Koch

Question 31

what was a positive response to the tuberculosis epidemic?

Answer 31

founding of the American Lung Association