PBL LOs 2 Flashcards
What is the best approach to screening a patient for suspicion of active TB?
Clinical evaluation. Refugees are able to buy and provide x-rays that may show them to be clear of an active TB infection.
When should a chest radiograph be taken?
For all refugees with a positive TST or IGRA test, a previous history of TB disease, including those with Class A or B TB designation form an overseas examination or other symptoms consistent with TB disease.
Is Latent TB a reportable condition in MN?
NO
Is Active TB (confirmed or suspected cases) a reportable condition in MN?
YES
How quickly must confirmed or suspected cases of TB be reported?
Within 24 hours
What types of TB cases are reportable?
Both pulmonary and extra pulmonary cases
Physicians, infection preventionists, laboratory or other reporting agents should report to the MDH all TB cases that meet what?
Laboratory or clinical case definition.
What is the TB lab case definition?
- Isolate of M. tuberculosis complex from a clinical specimen
OR - Demonstration of M. tuberculosis complex from a clinical specimen by a nucleic acid amplification test
OR - Demonstration of acid-fast bacilli in a clinical specimen when a culture has not bene or cannot be obtained or is false negative or contaminated
What is the TB case definition?
Must meet all criteria:
- A positive TST or positive inferferon gamma release assay for M. tuberculosis
- Other signs and symptoms compatible with tuberculosis (TB) (e.g. abnormal CXR, abnormal CT, or clinical evidence of current disease)
- Treatment with two or more anti-TB medications
- A completed diagnostic evaluation
What suspected cases should you report to MDH prior to confirmation?
- Positive microscopic smear of acid-fast bacilli from a respiratory or extra-pulmonary specimen AND clinical, radiographic, laboratory or epidemiological evidence consistent with active TB disease
- Clinical, radiographic, laboratory, or epidemiological evidence consistent with active TB disease AND clinical specimens for bacteriologic testing are not available or bacteriologic test results are negative for M. tuberculosis
- Multi-drug therapy for treatment of TB disease has been prescribed.
When should HIV drug resistance testing be implemented?
Genotypic testing recommended to guide therapy at first contact.
What does genotypic testing look for?
Mutations in reverse transcriptase (RT) and protease (PR) genes. Can also do genotypic testing of integrase and envelope proteins if this is a concern.
What testing should be done if treatment is failing?
Drug-resistance testing. Would want to follow-up with phenotypic testing if person is known or suspected to have complex drug resistance mutation patterns, especially to protease inhibitors.
What are CCR5 mutation homozygotes resistant to?
ONLY R5 Tropism of HIV
What are CCR5 Mutation heterozygotes resistant to?
They have slower progression of ONLY R5 tropism.
