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Health.2 > TB > Flashcards

TB Flashcards

1
Q

What is tuberculosis?

A

Bacterial infection of the lung

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2
Q

What bacterium causes tuberculosis?

A

Mycobacterium tuberculosis

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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)

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4
Q

How is tuberculosis spread?

A
  • airborne droplets

contain viable bacilli

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5
Q

What actions can TB be transmitted by?

A

sneezing and singing, spitting, cough

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6
Q

What actions can TB NOT be transmitted by?

A
  • Shaking hands, sharing food/drink/toothbrushes
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7
Q

What are the main INNATE defence against TB?

A
  • Alveolar macrophages

- dendritic cells

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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
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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

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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
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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
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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
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13
Q

What are symptoms of TB?

A
  1. Persistent cough lasting longer than three weeks
  2. Purulent sputum, possibly blood streaked
  3. Fatigue and lethargy
  4. Weight loss and anorexia
  5. Night sweats
  6. Low-grade fever in the afternoon
  7. swelling in neck
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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)
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15
Q

pulmonary TB symptoms?

A
  1. Persistent cough lasting longer than three weeks
  2. Purulent sputum, possibly blood streaked
    breathlessness, gradually gets worse
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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
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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.
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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
Q

What should be offered in CNS-involved TB?

A
  • Isoniazid (with pyridoxine), rifampicin, pyrazinamide, and ethambutol for 2 months
  • THEN
  • isoniazid (with pyridoxine) and rifampicin for a further 10 months.
26
Q

What should be offered in Non-CNS-involved TB?

A
  • Isoniazid (with pyridoxine), rifampicin, pyrazinamide, and ethambutol for 2 months
  • THEN
  • Isoniazid (with pyridoxine) and rifampicin for a further 4 months.
27
Q

dosing of regimens: what to remember?

A

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
Q

whats the only TB suituation in which to consider 3x weekly dosing? always more though

A

risk assessment= need direct observed therapy + enhanced case management AND

  • daily directed observed therapy not possible
29
Q

What is multidrug resistant TB?

A

Resistant to both isoniazid and rifampin :(

30
Q

How can multidrug resistant TB be treated? MDR-TB

A

second line drug treatments

  • limited and use 2 years of chemotherapy using expensive and toxic drugs
31
Q

What is extensively drug resistant TB?

A

TB strains resistant to isoniazid, rifampicin, fluoroquinolone and at least one injectable second line drug.

medical therapy will liekly fail

32
Q

What are the risk factors for Multidrug resistant TB?

A

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
Q

What tests should be done for possible rifampicin resistance?

A

rapid nucleic acid amplification tests

34
Q

What is the plan if rifampicin resistnace is confirmed?

A

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
Q

What is the management plan for patients with CNS TB?

A

Initially offer dexamethasone/ prednisolone at high dose with gradual withdrawal over 4–8 weeks

36
Q

How can patient adherence be encouraged in TB?

A

· 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
Q

When can directly observed therapy be offered in TB?

A

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
Q

when to consider surgical management of CNS TB?

A

consider as therapeutic intervention only if there is evidence of raised intracranial pressure.

39
Q

consider referring px with spinal TB for surgery when?

A

consider if there is spinal instability or evidence of spinal cord compression.

40
Q

When shouldn’t surgery be used in spinal TB?

A
  • To eradicate the disease
41
Q

multidisciplinary TB teams?

A 
social worker
voluntary sect
local housing representatives
TB lead ohysician and nurse
case manager
pharmacist
infectious disease doc, consultt
42
Q

role of multidisciplinary TB teams?

A

assess TB px living circumstances
sort out housing if needed
accomadtation fully funded

43
Q

follow up clinic TB

A

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
Q

BCG immunisation

A 
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 ""
..
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green book

Health.2 (19 decks)

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