TB Flashcards
What is TB affected by? 3 things
Ventilation
Filtration
U.V. light
What are some risk factors for getting TB?
Immune status
Previous infection
Age less than 4
malnutrition
If you are exposed to TB, what are the chances that you will become infected?
30%
If you are infected with TB, what are the chances that it will become contain or be in early progression?
5% early progression
95% containted
If you were infected and the TB was contained, what are the chances that it will be continually contained or become a late progression?
10% late progression
90% continued containment
Tell me about TB in terms of spread, incubation in the body, and the damage it does to the body.
Mycobacterium are inhaled, migrate throughout the body and end up (most commonly) in the apices. AEROBIC PLACES OXYGEN RICH
Granuloma results and causes Caseation
What are the different forms of TB?
Primary/Latent, Active, Miliary, Extrapulmonary
Tell me about latent or primary TB infecions
Infection is walled off by fibrosis, difficult to see on CXR
Bacteria lay dormant
The patient will have a +PPD
Evidence of previous infection, the immune system has been activated.
Tell me about active TB infections
also called secondary or reactivation TB
happens when Age, malnutrition, alchoholism, diabetes, immunocompromised activates it
- infiltrate in upper lobes, granuloma turns into cavity, larger area with fibrosis / collapsed – evident on CXR
There is destruction of both the alveoli and blood vessels equally - Not a shunt disease
Tell me about Miliary TB
Diffuse, spread out through the organs – Seed like on CXR all over
More common in immunocompromised and infants
What is extrapulmonary TB
Can be seen in more than 50% of HIV pts infected with pulmonary TB
Commonly involves the lymph nodes (40%), pleura (4%) , eyes, and CNS – but can infect any organ
Tell me about HIV and TB together
Asymptomatic / subclinical presentation may occur
TB increases HIV replication and accelerates progression of HIV infection
What about the patient history is important in TB?
Foreign born HIV infection Homeless or unstably housed Residence in institution Health care worker Contact with infectious patient
What are the clinical symptoms of TB?
Fatique Low grade fever Night sweats Weight loss Chronic Cough, sputum production and hemoptysis Decreased appetite
What should you do to collect sputum samples for AFB C and S?
coughing is good
if no cough, hypertonic saline
Protect yourself
What should you do when bronching a TB patient?
Usa as little Lidocaine / xylocaine as possible, as this reduces viability or Mycobacterium
What should you look for in a CXR in TB?
Infiltrates in apical- posterior segments, cavitations, atelectasis, pleural effusion
Signs and symptoms of TB
Generally, Unless in severe active TB, Vitals are not helpful.
Labs like WBC are normal in primary but 15 to 20 in Miliary TB
ABG’s rarely helpful (respiratory acidosis and hypoxemia in end stage TB in respiratory failure)
How do you Diagnose TB
PPB mantoux Skin test
Quantiferon Gold - Interferon Gamma Release Assay or T-spot
AFB C and S x 3 and Nucleic Acid Amplification
Radiology
Biopsy - Rare
What can cause a false positive PPD?
those with the BCG vaccine
What constitutes an active and infective case?
positive AFB smear with a positive NAA
What happens with a Postive AFB smear and a Negative NAA
Treat patient as high risk but get a 2nd NAA to confirm
What happens if you have a positive NAA but a negative AFB smear
Assume TB but get a 2nd NAA to confirm.
What is the Prophylactic Treatment for TB?
Given to Healthcare workers with primary exposure
Its INH for 6-9 months
Rifampin and INH once weekly for three weeks (DOT) may be just as effective
What do you have to assess when given INH as a treatment for TB?
Liver enzymes as Hepatitis is a side effect and can dictate the length of treatment
Take B6 with it.
If the patient is being treated and the follow up AFB smear turns negative, what happens to the treatment?
Continue treatment but you can take the patient away from isolation
If the patient is being treated and the follow up AFB smear turns positive again, what happens to the treatment?
Continue Treatment
Continue Isolation
Assess Adherence to regimen
