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TB Flashcards

1
Q

What is a TB chancre?

A

Caused by Multibacillary inoculation
Primary cutaneous TB (exogenous source)

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2
Q

What is a scrofuloderma

A

Classically on the neck
Fistula forming draining from underlying stuctrue such as LN, bone or epidydimis
Secondary TB

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3
Q

What are Gummas

A

Cold abscesses which ulcerate
Caused by haemaogenous spread

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4
Q

What is TB periorificalis? Or perianal

A

Multibacillary TB
Lesions in mouth or round anus

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5
Q

What is lupus vulgaris?

A

Paucibacillary
Through haemaogenous spread to face
Can be on face/soles/hand
Hand is typically people who work with cattle

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6
Q

What is TB verrucosa cutis

A

Whole plaque is warty

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7
Q

What is papular necrotic Tuberculids?

A

Looks like molluscum

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8
Q

How do you treat cutaneous TB?

A

It is usually paucibacillary
Tx same pulmonary TB
Resistant strains uncommon

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9
Q

Who should get tested for latent TB?

A

Active TB contacts
Current or planned immunosuppression
Individuals from TB endemic countries
Prisoners/homeless

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10
Q

Who is a 5mm PPD test considered positive in?

A

HIV patients
Recent contacts
Immunosuppressed
Fibrotic changes on lung consistent with old TB

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11
Q

10mm PPD test considered positive in who?

A

IVDU
Recent arrival from endemic country
Lab tec
Health workers

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12
Q

What are Tuberculids?

A

A cutaneous allergic reaction to TB, no AFB are actually in the skin.
-erythema nodosum
-papulonecrotic TB
-lichen scrofuloderma

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13
Q

Most common site of spinal TB

A

Thoracolumbar

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14
Q

What typically accompanies Potts disease?

A

Gibbus deformity of spine
Cold paravertebral abscesses

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15
Q

What is the most common form of TB CNS disease? Who is it most dangerous in?

A

TB meningitis followed by tuberculoma
Most dangerous in children <2yrs

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16
Q

How do you diagnose TB meningitis?

A

Xpert CSF (after centrifuging)

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17
Q

Monoresistant TB
Polyresistant TB

A

Resistance to one drug
Resistance to multiple but not RR-TB or MDR

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18
Q

MDR definition

A

At least rifampicin and isoniazid resistance

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19
Q

R-R TB definition?

A

Rifampicin Resistant TB, considered same as MDR TB (90% rif is also resistant to INH)

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20
Q

Pre XDR?

A

Fulfills definition of MDR TB plus resistant to fluoroquinolone

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21
Q

XDR definition

A

Extensive Drug Reisistance: resistant to isoniazid and rifampicin plus any fluroquionolone plus at least one additional group A drug

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22
Q

Examples of Group A drugs?

A

Bedaquiline
Linezolid

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23
Q

What is early bactericidal activity and why is it necessary?

A

Fall in log 10 colony forming units of mycobacterium TB per ml sputum per day during first 2 days. PREVENTS RESISTANCE

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24
Q

Most bactericidal TB drug?

A

Isoniasid>rifampicin>ethambutol

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25
What is sterilising activity? What drugs are most sterilising?
Kills dormant bacteria. PREVENTS RELAPSE. most sterilising is pyrizinamide>rifampicin>isoniazid
26
Complications of TB meningitis?
Vasculitis mainly- give aspirin Hyponatrameia Tuberculomas
27
Treatment of drug susceptible Pulmonary TB?
RIPE 6 month treatment Rifapentin/moxifloxacin/isoniasid/pyrazinamide for 4 months
28
Tx of TB meningitis?
Isonasid and rifampicin for 7-9 months Ethambutol and pyrazinamide 2 months Needs steroids and consider aspirin for vasculitis cx
29
When do you give ARVs in HIV postive patients with TB meningitis?
Not start ARV until intensive phase (8 weeks) of TB tx complete WHO states within 2 weeks if CD4<50
30
Tx of cavity disease TB
CDC suggests extending therapy to 9 months If culture positive at 2 months, extend intensive phase to 3 months long
31
Tx duration of bone disease in TB?
9-12months duration RI for 7-9 months in continuation phase following 2 months of RIPE
32
Which smear microscopy is better?
Auramine>ZN staining More sensitive, quicker reading time
33
What type of culture is superior?
Liquid medium, faster turnaround for positive and negative result
34
Which DST culture are best?
Liquid medium MGIT; 5-7 days Detects multiple drug resistances Agar place and LJ also goof but take 4-6 weeks
35
What are disadvantages to using MODS liquid medium?
Contamination rate very high Only test for rifampicin and isoniazid resistance
36
Benefits of using TRUENAT
Battery operated, good in low income settings But Low sensitivity in smear negative
37
Benefits of using LaMP
Results in 1hr Can do large volume of tests Uses sputum only, no drug susceptibility testing!
38
Benefits of XPERT?
Looks for rif resistance only Results fast, expensive
39
When do you use urine LAM TB Test?
Only in HIV positive inpatients who have low CD4 counts/are very unwell
40
How do you dx pleural TB?
Pleural fluid superior to pleural tissue
41
How do you treat Hr TB?
6 months of rifampicin, ethambutol, pyrazinamide and levofloxacin
42
How do you treat MDR or RR TB?
BPaL (9 months) or BPaLM (6 months) Bedaquiline, pretomanid and linezolid Now all oral regimen of 7 drugs: 4-6 months bedaquiline 4-6months levo/moxi, clofazamine, ethionamide, pyraziamide and isoniaside Followed by 5 months of levo/moxi, pyrazinamide, ethambutol and clofazamine
43
MDR TB individualised tx regimen
Choose at least four drugs from Group A, B and C Need tx for 18 months
44
XDR tb Treatment
5 drugs from group a through to C Treatment is in hospital!
45
When can you not use BPaL/ BPaLM
CNS or Bone disease or milairy disease only Pulmonary and LN disease
46
Important SE of linezolid?
Myelosuppression, peripheral amd optic neuropathy
47
SE of ethionamide?
Hypothyroid
48
SE of pretonamide?
Hepatotoxic
49
SE ethambutol?
Colour blindness (optic neuritis)
50
SE pyrazinamide?
Hyperuricemia (gout) Arthralgia Hepatitis
51
Isoniasid SE?
Sideroblastic anaemia Peripheral neuritis (give B6) Hepatitis
52
What age most at risk in children of severe TB?
Infancy <2yrs At risk of disseminated disease
53
When do most cases occur in children?
<5yrs Majority cases occur within 1yr of exposure
54
What kind of TB do children get?
Mostly pulmonary Mostly smear negative, smear positive seen in older children
55
How do you prevent TB in HIV positive children?
6 or 9 months isoniazid 3 months of Weekly isoniasid and rifapentine or daily
56
How do you dx TB in children?
Plot on growth chart, kids get failure to thrive CXR Sputum in order children
57
What are atypical presentations of TB in children?
Acute severe pneumonia not getting better with abx, especially in HIV positive children. Suspect if asymmetrical, persistent wheeze
58
Most common CXR finding in PTB in children?
Asymmetrical lymphadenopathy Can look like widened mediastinum
59
What are common extrapulmonary TB findings in children?
TB adenitis: asymmetrical painless usually cervical LN. Visibly enlarged TST usually strongly positive TB pleural effusion: school- aged children, need pleural tap for dx Miliary and CNS TB more common <2 Bone TB often monoarticular painless effusion
60
When do you admit a child with TB ro hospital?
Severe TB Severe malnutrition Severe resp distress and other comprbidities
61
What is most accurate sample for Xpert in children?
Sputum sample Gastric aspirate slightly lower
62
How do you tx TB in children?
Same as adults Doses are weight based- not age From 24kg change to adult dosing
63
Tb drug toxicities in children?
Rare Watch out for hepatotoxicity
64
Tx of TB HIV confection in children
First line drugs Commence ART within 2-4 weeks Cotrimoxazole preventative therapy Pyridoxine supplement
65
What is a good indication of response to tx in children with TB?
Weight!!
66
Dx of congential TB
Proven TB in the infant PLUS; - lesions occurring in first week of life - a primary hepatic complex -maternal gentian tract or placental TB -exclusion of postnatal transmission by investigating contacts
67
When is BCG CI in children?
<34 weeks <2kg
68
Tx of congential TB?
RIPE for 6-9 months for mother and baby
69
Tx of latent TB in HIV patient?
If positive TST need to give isoniasid If TST not possible give IPT to; -PLHIV in areas >30% -health workers, prisoners, contacts, miners
70
How to screen for TB in PLHIV
1)Four symptoms screen- cough, fever, weightless, night sweats 2) CRP >5 3) CXR 4) RDTs 5) any inpt with HIV on wards where TB prevalence >10%
71
Xpert sensitivity in Pulmonary vs EP?
Much more sensitive for pulmonary specimens
72
When do you use TB LAM?
HIV patients with CD4 <50 RDT
73
When do you start ART in HIV patients with TB?
Within 2 weeks if CD4 <50 No later than 8 weeks irrespective of CD4 count Immediate ART does increase mortality
74
What ARVs good with rifampicin?
Efavirenz Dolutegravir Raltegravir Double dose of dolutegravir and raltegravir, efavirenz same dose
75
When do you start ARVs with TB meningitis?
Within 8 weeks
76
Tx of latent TB?
ISH for 6 months or rifampicin for 3-4 months or isoniasid and rifampicin for 3 months Can give weekly rifapentine and isoniasid for 3 months
77
What is the general epidimology of TB-who has symptoms/ who tests positive?
Most people don't have symptoms Lower concentrations of mycobacterium in sputum so test is false negative in about 1/3 of people
78
How can you reduce transmission of TB in clinics?
Open windows Wear masks
79
Who are superspreaders of TB?
People with MDR TB who are not yet identified and on incorrect treatment
80
How much more likely are people with HIV and malnourishment to get TB?
Malnourishment and air pollution more important risk factors than TB in LMIC as malnourishment and air pollution affect a much larger proportion of population

GORGAS (33 decks)

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