TB

Question 1

State the clinical features of TB

Answer 1

•	Increased lack of energy and breathing problems
•	Productive cough
•	Unintentional weight loss
•	Looks anorexic
•	Intermittent pyrexia
.   purulent blood stained sputum.

Question 2

What does unsupervised treatment regimen for TB mean?

Answer 2

An unsupervised treatment regimen should be used for patients who are likely to take antituberculosis drugs reliably without supervision.

Question 3

Patients who are unable or unlikely to comply with daily administration of therapy should be treated with the regimen described as Supervised Treatment. True or false?

Answer 3

True

Question 4

Directly observed therapy should be offered to patients who…

Answer 4

• have a history of non-adherence;
• have previously been treated for tuberculosis;
• are in denial of the tuberculosis diagnosis;
• have multidrug-resistant tuberculosis;
• have a major psychiatric or cognitive disorder;
• have a history of homelessness, drug or alcohol
misuse;
• are in prison, or have been in the past 5 years;
• are too ill to self-administer treatment;
• request directly observed therapy.

Question 5

The standard unsupervised and supervised treatment regimens will last for….

Answer 5

6 months

Question 6

There are two phases to the treatment of TB true or false?

Answer 6

True

Question 7

Facts about initial phase treatment of TB

Answer 7

Treatment within the initial phase lasts two months and consists of rifampicin, ethambutol hydrochloride, pyrazinamide and isoniazid (also available as a combination known as Rifater). Patients will need to take this combination medication or the individual drugs if the combined formulation is not appropriate daily

Question 8

Facts about the continuation phase in Tuberculosis

Answer 8

Treatment within the continuation phase lasts four months and consists of rifampicin and isoniazid (also available as a combination known as Rifinah. Patients will also need to take this combination medication or the individual drugs daily.
For those patients that require a supervised regimen, the same phases apply however a three times a week dosing schedule may be considered if a daily direct observed option is not available.

Question 9

It is thought that the risk of developing TB is 16-27 time greater if you are living with HIV compared to individuals that are not. True or false?

Answer 9

True

Question 10

Treatments consideration in TB

Answer 10

When treating this patient you may also decide to investigate other pathologies. It is thought that the risk of developing TB is 16-27 time greater if you are living with HIV compared to individuals that are not. With this in mind, further pathology investigations may be beneficial.
This patient will also require regular monitoring, as drugs including rifampicin, ethambutol and isoniazid can be associated with acute kidney damage, particularly in patients over the age of 60. As the patient is going to receive treatment for six months, monitoring kidney function will be important in the management of this patient.
On top of monitoring kidney function, TB treatment is also know to affect the liver and is associated with liver damage. Monitoring liver enzyme levels is important to identify liver problems, as it is estimated that 4-11% of patients may need to stop their treatment to allow the liver to recover.

Question 11

Chemoprophylaxis for TB

Answer 11

If a patient has come into close regular contact with a TB infected individual, they may need to receive chemoprophylaxis.
The choice of agents used in the chemoprophylaxis is very patient/susceptibility of the organism dependent.
Isoniazid and rifampicin are commonly used for chemoprophylaxis purposes.

Question 12

List the drugs used in chemoprophylaxis of TB

Answer 12

Isoniazid and rifampicin

Question 13

TB vaccinations has now changed for the following patient groups

Answer 13

• Neonates with a family history of tuberculosis in the last 5 years.
• All neonates and infants (0–12 months) born in areas where the incidence of tuberculosis is greater than 40 per 100 000.
• Neonates, infants, and children under 16 years with a parent or grandparent born in a country with an incidence of tuberculosis greater than 40 per 100 000.
• New immigrants aged under 16 years who were born in, or lived for more than 3 months in a country with an incidence of tuberculosis greater than 40 per 100 000.

Question 14

TB vaccination groups contd

Answer 14

• Contacts aged under 36 years of those with active respiratory tuberculosis (for healthcare or laboratory workers who have had contact with clinical materials or patients with tuberculosis, age limit does not apply).
• Healthcare workers and laboratory staff (irrespective of age) who are likely to have contact with patients, clinical materials, or derived isolates; other individuals under 35 years (there is inadequate evidence of protection by BCG vaccine in adults aged over 35 years; however, vaccination is recommended for healthcare workers irrespective of age because of the increased risk to them or their patients) at occupational risk including veterinary and other staff who handle animal species susceptible to tuberculosis, and staff working directly with prisoners, in care homes for the elderly, or in hostels or facilities for the homeless or refugees.
• Individuals under 16 years intending to live with local people for more than 3 months in a country with an incidence of tuberculosis greater than 40 per 100 000.