TB

Question 1

Latent TB

Answer 1

Do not feel sick and don not have any symptoms

Have TB in blood that are alive but NOT active

Will show positive on skin test or blood test BUT negative chest X-ray and sputum test

Are not infectious/ can’t spread

Should be treated bc it can become active (stress or other sickness)

Question 2

Active TB

Answer 2

Highly contagious and feel sick

Skin test or blood test positive

Abnormal chest X-ray or positive sputum test

Feels sick with symptom

Can speak TB

Needs treatment

Question 3

Active TB symptoms

Answer 3

Unexplained weight loss

Loss of appetite

Night sweats! !!!!

Fever!!!!!

Fatigue

Chills!!!!

Cough for 3 weeks or longer

Hemoptysis - cough up blood

Chest pain

Question 4

Initial Diagnosis for TB

Answer 4

1) PPD: test for immune response
2) quantiFERON : test for antibodies in the blood

• Positive test are indicative of exposure to TB
• Theses can’t distinguish between active or latent
• if someone out of US has had TB vaccine they will have a positive result, don’t need to test them

Question 5

PPD reaction > 5mm

Answer 5

• HIV positive
• Recent contact with a active TB patient
• Nodular or fibrotic changed of chest X-ray
• organ transplant
• immunosuppressed

Question 6

PPD skin reaction > 10 mm

Answer 6

• Recent arrivals from other country
• IV drug users
• Resident/ Employees of high risk settings (prisons and nursing home)
• Children under 4
• infants, children and adolescents exposed to high risk categories
• comirbid condition

Question 7

PPD skin reaction > 15mm

Answer 7

Person with no known risk factors for TB

Question 8

PPD read at

Answer 8

72 hours after

Question 9

Chest X-ray for TB

Answer 9

Can help identify active TB it is not 100% reliable for diagnosis

Question 10

Sputum culture for TB

Answer 10

• definitive test for active TB

This test occurs in 2 parts

1) sputum test for presence of AFB
- if active fast bacillus organisms are present then go to test two
2) identify the organisms

If mycobacterium tuberculosis is identified then a positive active TB diagnosis is made

Question 11

Treatment of Active TB

Answer 11

Treated with initial therapy that involves a 4 drug therapy (RIPE)

• Rifampin
• INH
• Pyrazinamide
• Ethambutol

6-12 month treatment

Question 12

Treatment for exposure to active TB

Answer 12

Can be give Isoniazid to prevent development of TB

Monotherpy to prevent development

9-12 month treatment

Question 13

RIPE therapy

Answer 13

Given in combination

Body has strong a loving to become resistant to drugs— if one is given alone it may be be effective and may actually get worse

If given the together less likely for it to happen

Long therapy

Question 14

Ethambutol side effects

Answer 14

Usually given for ONLY fist few months because it causes eye damage

• changes in color
• blurred vision

Question 15

Side effects for Isoniazide, Pyrazinamide and Rifampin

Answer 15

Toxic hepatitis
- not infections, directly related to the meds

Report:

• abdomen pain
• dark urine
• increase fatigue or fever
• nausea vomiting loss of appetite
• yellowish skin or eyes
• need to come in a get liver enzymes checked once a month

Question 16

Side effects for Isoniazide

Answer 16

Nervous system damage

Peripheral neuropathy:

• dizziness
• tingling
• numbness around mouth
• give niacin (B6) to prevent
  This is a vasodilator so it causes hot flashes and patient may not tolerate well

Question 17

Side effects of Pyrazinamide

Answer 17

Stomach upset:

• vomiting
• lack of appetite

Increased uric acid:

• joint aches
• gout (rare) body not breaking down protein correctly, uric acid build up of body and builds up in joints of body

Question 18

Side effects of Rifampin

Answer 18

Bleeding:

• easy bruising
• slow blood clotting

Discoloration of body fluids:

• orange urine (harmless)
• swear or tears
• permanent stained contacts

Drug interactions:

• birth control pills
• birth control implants

Sensitive to sun:
- sun burn, need to protect !