TB Flashcards
1
Q
What is tuberculosis?
A
Bacterial infection of the lung
2
Q
What bacterium causes tuberculosis?
A
Mycobacterium tuberculosis
3
Q
What other parts of the body can be affected in tuberculosis?
A
o CNS (meningitis, brain, spine etc.)
o Lymph nodes
o Miliary: Whole body (rare but fatal)
4
Q
How is tuberculosis spread?
A
- airborne droplets
contain viable bacilli
5
Q
What actions can TB be transmitted by?
A
sneezing and singing, spitting, cough
6
Q
What actions can TB NOT be transmitted by?
A
- Shaking hands, sharing food/drink/toothbrushes
7
Q
What are the main INNATE defence against TB?
A
- Alveolar macrophages
- dendritic cells
8
Q
What is the innate defence mechanism against TB?
A
- Macrophages + Dentritic cells recognise bacterial PAMPS using their pattern recognition receptors (PRRs)
- PRR-mediated phagocytosis of the pathogen by macrophages
9
Q
What is latent TB vs TB disease?
A
Latent TB:
- Lives in body but doesn’t grow
- Doesn’t cause sickness in individuals
- Can’t be spread between people
- Can advance to TB disease
TB Disease: does all these things and can be fatal
10
Q
How can you screen for TB disease? Person w TB disease….
A
- Has symptoms
- Feels sick
- CAN spread TB to others
- May have a skin/blood test indicating TB infection
- May have a ABNORMAL chest X-ray and +ve sputum smear
- Needs treatment for TB disease
11
Q
Person with latent TB infection symptoms:
A
no symptoms doesnt feel sick cant spread TB bac to others usually has skin tests/ blood test-> TB infection normla chest xray, -ve sputum smear needs treatment. to prevent TB disease
12
Q
What are the Risk factors for TB disease?
A
- recently infected with TB bacteria
- close contact to someone with TB disease
- immigrants from high rate TB countries
- People with weakened Immune systems (HIV, Diabetes etc..)
- people who work in hospitals
13
Q
What are symptoms of TB?
A
- Persistent cough lasting longer than three weeks
- Purulent sputum, possibly blood streaked
- Fatigue and lethargy
- Weight loss and anorexia
- Night sweats
- Low-grade fever in the afternoon
- swelling in neck
14
Q
What are the symptoms of Extra (outside lungs) pulmonary TB?
A
- Persistently swollen glands
- Abdominal pain
- Pain and loss of movement in an affected bone or joint
- Confusion
- Persistent headache
- Fits (seizures)
15
Q
pulmonary TB symptoms?
A
- Persistent cough lasting longer than three weeks
- Purulent sputum, possibly blood streaked
breathlessness, gradually gets worse
16
Q
How can TB be diagnosed?
A
· Mantoux test (Tuberculin Skin Test- TS)
· Interferon Gamma Release Essay (blood test)
· Sputum test
More extreme: · Nucleic acid amplification tests · Bronchoscopy, CT scan, MRI, USG, Endoscopy · Laparoscopy · Urine and blood test · Biopsy · Lumbar puncture
17
Q
What is a Mantoux test?
A
- An intradermal skin test to screen for TB-called PPD
- injects PPD into skin of forearm
- people with latent TB are sensitive to PPD and develop a red spot within 48-72h
- reaction to antigen.
18
Q
How can you detect whether a patient has Latent TB or TB disease using the Mantoux test?
A
- depending on the strength of the reaction
- stronger reaction may suggest TB disease
19
Q
What should be considered with the Mantoux test relative to BCG vaccinations?
A
- Those with BCG vaccination will show mild reaction- so IGRA test needs doing
- mark 5mm or larger indicates positive test regardless of BCG history
20
Q
What drugs should be given in patients who:
- are 35-65
- have HIV
- have evidence of Latent TB
A
- 3 months = ISONIAZID (with pyridoxine) and rifampicin
- 6 months = ISONIAZID (with pyridoxine)
21
Q
What drugs should be given in patients who:
- are under 35
- have no hepatotoxic concerns
A
- 3 months = ISONIAZID (with pyridoxine) and rifampicin
22
Q
What drugs should be given in patients who:
- may have rifampicin interactions
- have HIV or Transplant
A
6 months = ISONIAZID (with pyridoxine)
23
Q
What testing can be offered before TB treatment?
A
- HIV, Hep B and Hep C
24
Q
What does management of active TB depend on
A
Whether TB is CNS based or not
25
What should be offered in CNS-involved TB?
- Isoniazid (with pyridoxine), rifampicin, pyrazinamide, and ethambutol for 2 months
- THEN
- isoniazid (with pyridoxine) and rifampicin for a further 10 months.
26
What should be offered in Non-CNS-involved TB?
- Isoniazid (with pyridoxine), rifampicin, pyrazinamide, and ethambutol for 2 months
- THEN
- Isoniazid (with pyridoxine) and rifampicin for a further 4 months.
27
dosing of regimens: what to remember?
use fixed dose combo tabs during any TB treatment
- DO NOT OFFER anti-tb of fewer than 3x a week
- offer daily dosing schedule to px w active pulmonary TB
- consider daily dosing as 1st choice in px w active extrapulmonary TB
28
whats the only TB suituation in which to consider 3x weekly dosing? always more though
risk assessment= need direct observed therapy + enhanced case management AND
- daily directed observed therapy not possible
29
What is multidrug resistant TB?
Resistant to both isoniazid and rifampin :(
30
How can multidrug resistant TB be treated? MDR-TB
second line drug treatments
- limited and use 2 years of chemotherapy using expensive and toxic drugs
31
What is extensively drug resistant TB?
TB strains resistant to isoniazid, rifampicin, fluoroquinolone and at least one injectable second line drug.
medical therapy will liekly fail
32
What are the risk factors for Multidrug resistant TB?
o history of previous TB drug treatment, particularly if there was known to be poor
o adherence to that treatment
o contact with a known case of multidrug-resistant TB
o birth or residence in a country in which the WHO reports that a high proportion (5% or more) of new TB cases are multidrug-resistant.
33
What tests should be done for possible rifampicin resistance?
rapid nucleic acid amplification tests
34
What is the plan if rifampicin resistnace is confirmed?
o Offer a treatment regimen involving at least 6 drugs to which the mycobacterium is likely to be sensitive
o Test for resistance to second-line drugs
o More intensive follow up
o Consider surgery if extensively MDR or if DOT fails
35
What is the management plan for patients with CNS TB?
Initially offer dexamethasone/ prednisolone at high dose with gradual withdrawal over 4–8 weeks
36
How can patient adherence be encouraged in TB?
· Reminder letters, printed information, telephone calls, texts and apps home visits
· Random urine tests and other monitoring (for example, pill counts)
· Advice and support for parents and carers
· Incentives and enablers to help people follow their treatment regimen.
37
When can directly observed therapy be offered in TB?
in patients who:
- do not adhere to treatment (or have not in the past)
· have been treated previously for TB
· have a history of homelessness, drug or alcohol misuse
· are currently in prison, or have been in the past 5 years
· have a major psychiatric, memory or cognitive disorder
· are in denial of the TB diagnosis
· have multidrug-resistant TB
38
when to consider surgical management of CNS TB?
consider as therapeutic intervention only if there is evidence of raised intracranial pressure.
39
consider referring px with spinal TB for surgery when?
consider if there is spinal instability or evidence of spinal cord compression.
40
When shouldn't surgery be used in spinal TB?
- To eradicate the disease
41
multidisciplinary TB teams?
```
social worker
voluntary sect
local housing representatives
TB lead ohysician and nurse
case manager
pharmacist
infectious disease doc, consultt
```
42
role of multidisciplinary TB teams?
assess TB px living circumstances
sort out housing if needed
accomadtation fully funded
43
follow up clinic TB
DONT CONDUCT routinely after treatment completion
- tell px look for symptoms of relapse + contact TB serrvice asap through primm care/clinic
- w drug resistant TB: consider for follow up every 12 months after treatment done
- MDRTB prolonged follow up
44
BCG immunisation
```
offer to ALL INFANTS(0-12m) in UK/ born in other country where annual incidence TB is 40/100,000 or higher
prev unvaccinated kids ""
..
..
green book
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