TB

Question 1

TB Characteristic
a) The leading killer of people with?
b) Transmission rate

Answer 1

a) HIV
b) Rate slowing
>50% cause found CA, TX, NY, FL and IL

Question 2

Infection caused by?

Answer 2

Mycobacterium tuberculosis (MTB)
-thick, waxy cell wall
-very slow growing
-generation time >15hr

Question 3

Risk factors

Answer 3

-Foreign travel/residence
incidence 15X higher than US-born

-Close contact
homeless
prison

Immune weakness
-DM
-HIV
-Excess alcohol use

IV drug use(sharing needles)

Question 4

Transmission

Answer 4

Airborne via droplet　coughing, sneezing
Can stay airborne for several hours

Question 5

Types of TB 3

Answer 5

Latent TB
Active pulmonary TB
Extra-pulmonary TB

Question 6

Latent TB
a) characteristic

Answer 6

a) Infected but not contagious
Become active TB anytime
b) Risk of reactivation
Non-HIV coinfection 重複感染
5%
HIV coinfection 5-10%

Will test positive for TB( skin test IGRA)

Question 7

Reactivation of latent TB
Greatest risk of reactivation

Answer 7

HIV coinfection
Contact with an infected person
Because suppress the immune system

Use of corticosteroids
Chronic kidney disease
DM
irritates lungs
Smokers

Question 8

Active pulmonary TB

Answer 8

Tubercle bacilli reach the alveoli of the lungs
Ingested by alveolar macrophages
-Most destroyed
-Deposit in the terminal airspaces
-Spread thru blood

Question 9

Symptoms of active disease

Answer 9

Fever
Weight loss
Night sweats
Productive cough
Hemoptysis Fatigue

Pt presenting with these symptoms should be put in ISOLATION

Question 10

Extra-pulmonary TB

Answer 10

Lymph node
Pleural
Bone and joint
Central Nervous System

Question 11

TB skin test

Answer 11

0.0001mg of purified protein derivative (PPD)
Induration read 48-72hr
Positive in pt receiving BCG vaccine

Question 12

TB skin test result
≥5 mm

Answer 12

HIV
Recent TB contacts
Classic X-ray changes
Organ transplant

Question 13

TB skin test result
≥10 mm

Answer 13

Immigration from endemic
area within 5 years
IVDU
Residents of high risk
congregate settings
Microbiology lab workers
CKD/DM/cancer

Question 14

TB skin test result
≤15 mm

Answer 14

All others

Question 15

Diagnostic Tests
Blood

Answer 15

Interferon-Gamma Release Assays (IGRA)
Blood test used to measure immune response to TB
Only one visit needed for the test
Not affected by BCG vaccine

Question 16

Diagnostic Tests
Bacterial Culture

Answer 16

Often done from sputum
collection (not 唾を吐く)
Poor samples common
–Takes up to 12 weeks for final
reading
–Only finds pulmonary TB

Question 17

Anti-Tuberculosis Agents
First Line Agents 3

Answer 17

Rifampin
Rifabutin
Rifapentine

Question 18

Rifampin

Answer 18

Most commonly used in the US
Cheap

Question 19

Rifabutin

Answer 19

Fewer drug interactions
- Commonly used in HIV+ patients

Question 20

Rifapentine

Answer 20

Longer duration of action
- Used in weekly regimens
-Less dose

Question 21

a) Drug Interactions
b) Administration

Answer 21

a) Potent inducer of CYP-450
Oral contraceptives
-inc the chance of pregnancy
Anti-retroviral
-dec effective HIV
Anticonvulsants
-Inc seizure

b) Take 1 hour before or 2 hours after meals
Food decreases absorption

Question 22

Adverse Drug Reactions

Answer 22

Rash(very common)
Mild GI discomfort

Hepatotoxicity
*Monitor for anorexia, fatigue, jaundice
*Avoid alcohol consumption

Discoloration of Body Fluids
*Reddish-orange
*Urine, saliva, sweat, tears

Pseudomembranous colitis
*Monitor for fever, diarrhea, and blood in stools

Question 23

Isoniazid
Used with?

Answer 23

Used with rifampin in most regimens

Question 24

Isoniazid
ADRs

Answer 24

Peripheral neuropathy
-Tingling, burning, pins-and-needles pain　チクチク感
-Results from pyridoxine (B6) deficiency

Hepatotoxicity
-Monitor for anorexia, fatigue, and jaundice

Hyperglycemia
-See in diabetic patients
-Need to monitor blood glucose closely and adjust regimens

Question 25

Pyrazinamide
Used in?

Answer 25

Generally used in the initial phase of
treatment

ピラミッド　Pyra—- mide

Question 26

Pyrazinamide
ADRs

Answer 26

Hepatotoxicity
GI upset
Hyperuricemia/Gout(crystallized in joint)
Non-Gout Polyarthralgia

Question 27

Ethambutol
Used in?

Answer 27

Generally used in the initial phase of
treatment

Question 28

Ethambutol
ADR

Answer 28

Retrobulbar neuritis
(a disease of the optic nerve)
-Visual acuity or red-green color blindness
-Not typically used in children

Least hepatotoxic of the first-line agents

Question 29

Directly Observed Therapy (DOT)
Characteristic

Answer 29

Use for maintain excellent adherence
At the county health department or in home

Question 30

Directly Observed Therapy (DOT)
Recommended for

Answer 30

Resistant TB
HIV infected patients
Intermittent regimens (non-daily)

Question 31

Latent TB Infection
Treatment Options

Answer 31

Isoniazid daily or twice weekly for 6-9 months
Rifampin daily for 4 months
Isoniazid and rifapentine weekly for 3 months (common)

Question 32

Active Tuberculosis
Treatment
1st step
2nd step

Answer 32

intensive Phase
RIF + INH + PZA + EMB for 2 months

Continuation Phase
–If not resistant:
RIF + INH for 4 months
–If resistant:
More drugs and longer duration

Question 33

Resistance
Multidrug-Resistant (MDR TB)

Answer 33

Resistant to INH and rifampin
(two big main drugs so this complicates things)

Question 34

Resistance
Extensively Drug-Resistant TM (XDR TB)

Answer 34

Resistant to INH + rifampin + at least 2 other drugs

Question 35

Which one causes hyperglycemia in DM patient?

Answer 35

Isoniazid