TB

Question 1

Name 5 contraindications for IPT (isoniazid preventative therapy)

Answer 1

• active Tb
• LIVER dysfunction
• excessive alcohol use
• severe peripheral neuropathy
• suicidal

Question 2

Name 5 key populations for Tb

Answer 2

• HIV patients
• household contacts of Tb patients
• Health care workers
• inmates
. Pregnant women
• children <5
• mine workers and people in peri-mining communities

Question 3

What is used as a tool to monitor tb Treatment?

Answer 3

sputum conversion rate

Question 4

What is used as a Tb evaluation tool?

Answer 4

Tb cure rates

Low = poor evaluation, high = good

Question 5

How can pulmonary Tb be diagnosed and which is Preferred?

Answer 5

• Xpert mtB/ rif preferred
• 2 sputum specimens for spear microscopy if Xpert not available
• culture of sputum of smears negative and if had Tb before for culture and sensitivity

Question 6

Next course of action if Xpert MTB / rif is positive?

Answer 6

Treat for Tb and send sputum specimen for smear microscopy for reporting

Question 7

Next course of action if Xpert MTB / rif is positive And susceptible To rif?

Answer 7

Treat for Tb

Question 8

Next course of action if Xpert MTB / rif is positive And resistant To rif

Answer 8

Commence MDR treatment and send sputum for drug susceptibility testing to confirm MDR Tb

Question 9

Next course of action if Xpert MTB / rif is negative and HIV positive?

Answer 9

Send sputum for culture and CXR if available

Question 10

Next course of action if Xpert MTB / rif is negative and HIV negative?

Answer 10

Treat with antibiotics and consider further investigation only if symptoms persist

Question 11

How diagnose Tb if patient was recently the treated for it?

Answer 11

Xpert could be false positive so send sputum for smear microscopy and culture instead

Question 12

Name 2 important drug interactions with rifampicin

Answer 12

• Reduce efficacy oral contraceptives

* interact with several ARVs eg reduce concentration of DTG

Question 13

Name 5 important adverse effects of Tb medicines

Answer 13

• Nausea- take with meals to minimise . Rifampicin
• hepatitis (drug induced liver injury) by rifampicin,isoniazid, pyrazinamide. ( also cotrimoxizole and efavírenz, nevirapine, lopinavir, ritonavir ARVs) - urgently refer and stop treatment
• new onset skin rash -rifampicin, isoniazid (anaphylaxis so stop)
• neuropathy-can be prevented by taking pyridoxine (b6) (isoniazid)
• arthralgia -pyrazinamide (give aspirin)

Also: orange/red urine (rifampicin), visual impair (ethambutol-stop)

Question 14

Tb control regimen? (4)

Answer 14

RHZE
Rifampicin
H- isoniazid
Z- PZA pyrazinamide
Emb- ethambutol

RHZE for 2 month initial phase, Rh four month continuation phase

Question 15

When is mono-resistant Tb diagnosed?

Answer 15

Isoniazid resistance

Question 16

When is MDR TB diagnosed?

Answer 16

Resistant to rifampicin and isoniazid

Question 17

When is XDR Tb diagnosed?

Answer 17

Resistant to rifampicin and isoniazid and resistance to fluoroquinolones and injectable medicine eg kanamycin

Question 18

How is mono-resistant Tb treated?

Answer 18

RZE and levofloxacin instead of isoniazid