PPS Tb Guidelines Flashcards by CM A

MDR-Tb

Resistant to at least isoniazid and rifampin

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XDR-Tb

Resistant to HR + Fluoroquinolone + at least 1 second-line injectable agent (amikacin, kanamycin, and/or capreomycin)

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Primary mode of transmission of Tb bacilli

Airborne droplet nuclei

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Tb transmission from children aged less than ___ is rare, since most children cannot expectorate sputum

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Associated with virulence of Tb bacilli

1) Trehalose dimycolate (cord factor) 2) Sulfatides

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Responsible for morphologic appearance of cell serpentine cords of Tb bacilli in close, parallel arrangements

Cord factor

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Peripherally located glycolipids that inhibit fusion secondary lysosomes with Tb bacilli-containing phagosomes within a macrophage, possibly promoting INTRACELLULAR SURVIVAL of the organisms

Sulfatides

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Gold standard for diagnosis of Tb

Demonstration/isolation of the organism by culture

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Doubling time of Tb bacilli

18-24 hours

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Cells responsible for containment of Tb bacilli as local pulmonary infiltrates and hilarity adenopathy

Th1 cells

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Progression from Tb infection to Tb disease occurs in ___% of affected individuals

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Key risk factors for Tb (4)

1) Household contact with a newly diagnosed smear (+) case 2) Age less than 5 years 3) HIV infection 4) Immunocompromised state

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Size of the infective droplet nucleus of Tb

5 micra

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5 stages of pulmonary pathology of Tb

1) Scavenging non activated alveolar macrophages digest tb bacillus 2) (Symbiosis) Macrophage fails to destroy the bacillus undergoing replication destroying the macrophage; other macrophages are attracted leading to development of GRANULOMA 3) Increase in number of tubercle bacilli inhibited by development of CELL-MEDIATED IMMUNITY and DELAYED-TYPE HYPERSENSITIVITY 4a) Enlargement of tubercle and its caseous center with hematogenous spread in weak immunity 4b) Stabilization or regression of tubercle in hosts with strong immunity 5) CASEOUS CENTER LIQUEFACTION, extracellular bacillary growth, cavity formation, and bronchial dissemination

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Lung lesion of primary Tb

Ghon focus

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Most frequent site of scrofula

Nodes in the ANTERIOR TRIANGLE of the neck

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MCC of mortality from Tb in children below 3 years of age

Tb meningitis

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T/F Tb men is ALWAYS secondary to a tuberculous process elsewhere in the body

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Tb of the long bones usually start as

Area of endarteritis in the metaphysis of the long bone

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Pott’s disease has a predilection for

Lower thoracic, upper lumbar and lumbosacral vertebrae

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Tb of the joints is rare in children; it has a predilection for

Joints of the upper extremities with monoarticular involvement

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Initial radiographic picture of primary tb

Parenchymal infiltration accompanied by ipsilateral LN enlargement

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LN in this area appear to be the ones most often affected in Tb lymphadenopathy

Right upper paratracheal area

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Why the right upper paratracheal LN are most often affected in Tb lymphadenopathy

Lymphatic drainage of the lungs occurs predominantly from left to right

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Radiologic finding that clearly differentiates primary from post primary/reactivation tb

Hilar or paratracheal LN enlargement

MC radiographic manifestation of reactivation pTB

Focal or patchy heterogeneous calcification in the apical and posterior segments of the upper lobes and superior segments of the lower lobes

Radiologic hallmark of reactivation TB

Cavities

Phemister triad

1) Juxtaarticular osteoporosis 2) Peripherally located osseous erosions 3) Gradual narrowing of interosseous space

What is the Phemister triad

Characteristic radiologic finding in tuberculous arthritis

Most specific finding in diagnosis of CNS Tb

Basal cistern hyperdensity

MC complication of TB meningitis

Communicating hcp

Vaccine category that may suppress tuberculin reaction

Live virus vaccine

DOH HTP recommends that TST be delayed for ___ after a bout of measles, mumps, chicken pox, or whooping cough

2 months

An induration of ___ is considered a (+) TST

≥10 mm

An induration ≥5mm is considered a positive TST in the presence of

1) History of close contact with a known or suspected infectious case of TB 2) Clinical findings suggestive of Tb 3) CXR suggestive of TB 4) Immunocompromised condition

Clinical manifestations which, when taken together, are most suggestive of childhood Tb disease

History of recent weight loss or failure to gain weight

Spectrum of TB

1) Exposure 2) Infection 3) Disease

Spectrum of TB: Exposed but no signs/symptoms, negative TST CXR sputum AFB and other diagnostics

Exposure or Class I

Spectrum of TB: Only one with signs and symptoms

Disease or Class III

Spectrum of TB: TST may be positive but negative in most children

Infection or Class II

Anti Tb drugs: Bactericidal

H, R, Z (weakly), S

Anti Tb drugs: Bacteriostatic

Ethambutol

Anti Tb drugs: Inhibits nucleic acid synthesis

H, R

Anti Tb drugs: Potent sterilizing activity within macrophages

Anti Tb drugs: Dose

HRZES in order: 10-15mg/kg, 10-20, 20-40, 15-25, 20-40

Anti Tb drugs: Max dose

HRZES in order: 300mg, 600, 2g, 1.2g, 1g

D/C INH if transaminase levels is ___ from normal or with hepatitis

>3.5x

Adverse reactions to Streptomycin

1) Sterile abscess 2) Auditory function impairment

Algorithm for Preventive Therapy of Childhood TB: TB exposure, less than 5 years old

INH x 3 months

Algorithm for Preventive Therapy of Childhood TB: TB exposure ≥ 5 years old

Mantoux test, if (+) with radiologic findings plus signs and symptoms, treat as TB disease; if (+) with no radiologic findings, signs or symptoms, treat as latent TB infection; if (-) with no BCG scar, give BCG after 2 weeks

After 3 months INH for TB exposure less than 5 years old

Repeat Mantoux test, if (-) with no BCG scar, give BCG after 2 weeks; if (+) with radiologic findings plus signs and symptoms, treat as TB disease; if (+) with no radiologic findings, signs or symptoms, treat as latent TB infection

Treatment for latent TB infection

9-12 months INH including 3 months initially given for exposure

Standard treatment for TB in pregnant women

HRZE

Can a woman breastfeed while treating for TB

Breastfeeding is encouraged because only minimal amounts of the drug are excreted in breastmilk

Treatment for mothers with latent TB infection

INH IMMEDIATELY WITHOUT DELAY

T/F The mother who has current TB disease but has undergone treatment for 2 weeks or more is presumed to be no longer contagious at the time of delivery

Management of newborn of mother with TB disease

Give INH for 3 months then TST; if TST (-) D/C INH and give BCG; if TST (+) with no radiographic findings, signs, and symptoms, complete 9 months of INH

Recommended for infants whose mothers have TB disease and has not yet undergone treatment

1) Separation from mother 2) Give INH or rifampicin if INH-resistant for 3 months 3) Do TST, if (+) but CXR (-) complete 9 months of INH or RIF; if (-), repeat after 3 months

Recommended for infants if CXR and TST of mother are negative and has completed treatment

Give BCG and D/C INH

Treatment for congenital TB

2 HRZS, 4-7 HR