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Infectious Diseases > TB > Flashcards

TB Flashcards

1
Q

Symptoms of TB

A

General
- Weight loss
- Fever
- Night sweats
- Anorexia
- Malaise

Pulmonary
- SOB
- Productive cough

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2
Q

Symptoms of extra-pulmonary TB

A
  • Swollen lymph nodes = lymphatic TB
  • Bone or joint pain/swelling = joint/spinal TB
  • Constipation/bowel obstruction = genitourinary or gastrointestinal TB
  • Headache, vomiting, irritability, confusion = meningitis TB
  • skin lesions = cutaneous TB
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3
Q

Which organism causes TB?

A

Mycobacterium tuberculosis

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4
Q

Risk factors of TB

A
  • Born in high prevalence areas
  • Children less than 5 years of age
  • Close contacts
  • Hx of untreated or inadequately treated active TB infection
  • Immunocompromised patients
  • Hx of excessive alcohol, injecting drug users, and smokers
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5
Q

When to start treatment in a patient with suspected active TB?

A

Immediately without waiting for culture results

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6
Q

What is considered treatment success?

A

Completion of therapy with negative follow-up on sputum smears

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7
Q

People have been in contact should have screening for latent TB.

Who would be considered a high risk contact?

A

All household members.

Close contacts (partner, house visitors, and close workplace contacts) if the person with TB has a positive sputum smear result.

Casual contacts (such as most work colleagues) if the index person with TB is particularly infectious

Immunocompromised people

People who are new entrants to the UK from a high TB prevalence country

People who are new NHS emplyees

People who have evidence of TB scarring or untreated fibrotic changes on chest X-ray

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8
Q

What is the usual total duration of treatment?

A

6 months

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9
Q

How is TB spread?

A

Through inhaling infected respiratory droplets from a person with infectious TB

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10
Q

What medications are used in the initial phase treatment?

A

RIPE

Rifampicin
Isoniazid (with pyridoxine)
Pyrazinamide
Ethambutol

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11
Q

What is the duration of the initial phase treatment?

A

2 months

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12
Q

What medications are used for the continuous phase treatment?

A

Rifampicin
Isoniazid (with pyridoxine)

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13
Q

What is the duration of the continuous phase treatment?

A

4 months

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14
Q

TB self management

A
  • Provide sources of information e.g., www.patient.info and tbalert.org
  • Encourage adherence to the treatment regimen
  • Lifestyle measures e.g., smoking cessation and alcohol reduction
  • Contact tracing is necessary for high-risk contacts of people with pulmonary and laryngeal TB
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15
Q

What is active disease?

A

Evidence of symptomatic or progressive disease of the lung and/or other organs

Symptoms are specific to the site involved

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16
Q

What is latent disease?

A

Persistent immune response stimulation by Mycobacterium tuberculosis antigens
No evidence of clinically active TB

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17
Q

What is the treatment of latent TB for patients with HIV?

A

3 months of isoniazid with pyridoxine and rifampicin

OR

6 months of isoniazid with pyridoxine

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18
Q

What is the treatment of latent TB for patients <35 years old?

A

3 months of isoniazid with pyridoxine and rifampicin if hepatotoxicity is a concern

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19
Q

What should patients with latent TB aged 35-65 years old be tested for?

A

Hepatotoxicity

20
Q

What is the treatment of latent TB for patients aged 35-65?

A

Where no concern of hepatotoxicity = no treatment

21
Q

Treatment of single-drug resistant TB without CNS involvement
- Resistance to isoniazid

A

Initial phase: 2 months
- Rifampicin
- Pyrazinamide
- Ethambutol

Continuation phase: 7 months (10 for extensive disease)
- Rifampicin
- Ethambutol

22
Q

Treatment of single-drug resistant TB without CNS involvement
- Resistance to pyrazinamide

A

Initial phase: 2 months
- Rifampicin
- Isoniazid (with pyridoxine)
- Ethambutol

Continuation phase: 7 months
- Rifampicin
- Isoniazid (with pyridoxine)

23
Q

Treatment of single-drug resistant TB without CNS involvement
- Resistance to ethambutol

A

Initial phase: 2 months
- Rifampicin
- Isoniazid (with pyridoxine)
- Pyrazinamide

Continuation phase: 4 months
- Rifampicin
- Isoniazid (with pyridoxine)

24
Q

Treatment of single-drug resistant TB without CNS involvement
- Resistance to rifampicin

A

Offer at least 6 anti-TB drugs which the mycobacterium is likely to be sensitive

25
Q

What is the general CNS TB treatment?

A

Initial high dose dexamethasone or prednisolone then slowly withdrawn over 4-8 weeks
Standard treatment with initial phase (RIPE) for 2 months
Continuation phase drug should be continued for a further 10 months treatment

26
Q

How does pericardial TB treatment differ to conventional TB treatment?

A

Initial high dose of prednisolone should be offered in those with active pericardial TB then slowly withdrawn over 2-3 weeks

27
Q

Why is pyridoxine (vitamin B6) used alongside treatment?

A

Peripheral neuropathy prophylaxis

28
Q

Specific side effects of rifampicin

A

Discolours contact lenses and bodily fluids orangey-red colour

Hepatotoxicity
Report signs of liver disorder

29
Q

Specific side effects of isoniazid

A

Peripheral neuropathy

Be aware that it is also a CYP enzyme inhibitor = CYP450 interactions

30
Q

Specific side effects of pyrazinamide

A

Hepatotoxicity - report signs

31
Q

Specific side effect of ethambutol

A

Visual impairment and ocular toxicity

32
Q

Which aminoglycoside is active against TB?

A

Streptomycin (used when resistant to other treatment)

33
Q

Why can’t aminoglycosides be given orally?

A

Metabolised too quickly by GI tract so must be injected

34
Q

How does rifampicin interact with hormonal contraceptives?

A

Effectiveness of hormonal contraceptives are reduced - alternative method required

35
Q

How many antibacterials are used in the initial phase of TB treatment and how long for?

A

4
2 months

36
Q

How many used in continuous phase of tb? How long?

A

2
4 months

37
Q

If someone is taking isoniazid, what else must be prescribed and why?

A

Pyridoxine (Vitamin B6) as peripheral neuropathy prophylaxis

38
Q

After 2 months of RIPE treatment for TB, what antibiotics are continued for a further 4 months?

A

Rifampicin
Isoniazid

39
Q

Directly Observed Treatment (DOT) TB therapy should be offered to which groups of people?

A

People who are at high risk of not completing their TB treatment e.g.,

  • Hx of non-adherence
  • Substance misuse
  • Homelessness
  • Previously been treated for TB
  • Have cognitive impairment
  • Too ill to self-administer

Daily dosing is preferred
3 times weekly dosing schedule can be considered

40
Q

Patient with HIV and TB how long should the TB treatment be for? What is the exception to this?

A

Should not routinely exceed 6 months
Unless TB has CNS involvement then should not exceed 12 months

41
Q

6 toxicity syndromes associated with intermittent TB treatment?

A

GI
Cutaneous toxicity
Neurological toxicity
Ocular toxicity
Haematological toxicity
Hepatotoxicity

42
Q

A break in TB treatment of how many weeks is classed as a treatment interruption?

A

2 weeks during the initial phase

OR

Missing >20% of prescribed doses

43
Q

Treatment interruptions due to drug-induced hepatotoxicity

A

Stop treatment and only reintroduce once LFTs in range and patient has no symptoms of hepatotoxicity

Start with:
- Ethambutol and either isoniazid (with vit B6) or rifampicin

Patients with severe or highly infectious TB -
Consider continuing treatment with 2 drugs with low risk of hepatotoxicity e.g.,
- Ethambutol and streptomycin

44
Q

Treatment interruptions due to cutaneous reactions

A

Patient with severe or highly infectious TB -
Consider continuing treatment with 2 drugs with low risk of cutaneous reactions e.g.,
- Ethambutol and streptomycin

45
Q

Why is ethambutol cautioned in young children?

A

Can cause optic neuritis which can lead to vision loss
Children are more susceptible to this side effect because their optic nerves are still developing

Infectious Diseases (8 decks)

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