Tb Flashcards by J Pint

Tb is what type of bacteria

Aerobe Acid fast bacili

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hiv/aids riks for tb is

10% every year

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Left untreated each person with active TB disease will infect between

10 to 15 people every year

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Negative for ppd skin test

can react to other microbacteria

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HIV+ (or IVDU and unknown HIV)
Close contact of active case
Fibrotic CXR lesions
Persons on steroids/immunosuppressive drugs
Transplant patients

> 5mm

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High prevalence country
IVDU and HIV negative
Medically underserved
Long-term care facilities
Healthcare workers

> 10mm

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Normal reactive size

> 15mm

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Complexities impacting tb

immigration
*immunosuppression drugs
non-compliance
MDR/XDR (resistance)

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Describe new blood test for TB

Interferon release gamma assays
1- take blood 
2- expose blood mononuclear cells to antigen
3- look for sign of immune response
ELISA OR ELISPOT

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benefits to igra

results in 24 hour with out return visit
not subject to biases or error
increase acceptacne to treatemtn for LTBI

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Latent vs active TB

 Cough (3 weeks or longer)
 Hemoptysis
 Unexplained weight loss
 Fever/chills/night sweats (drenching)
 Chest pain
 Fatigue
 Loss of appetite

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Treatment for LTBI

RIFAPENTINE 900mg once weekly x12weeks and Isoniazid

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Directly Observed Therapy (DOT)

Watch patient take medications

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Active TB workup

cxr

acid fast sputum with abdnormal cxr

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Active TB workup

cxr
acid fast Bacili sputum stain with abdnormal cxr
higher the number more positive

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tympically takes 8-10weeks for sputum culture what else can be done quicker

use PCR to start treatment earlier

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Active TB treatment

RIPE
rIFAMPIN
Isoniazid
Pyrazinamide
Ethambutol

When can Pyrazinamide and Ethambutol be discontinue

all 4 drugs can be used for 2 months if no resistance discontinue P & E

How long is Active TB treated

6 months

How long is active tb treated in cavitary dz or patients with HIV

9 months if cavitation is continued to be seen on CXR every 2 months

Precautions that should be used even after treatemen

airborn

How long after starting treatment can ppl come out of quarentine

2weeks

must be symptomatic to spread

what screening is important for Ethambutol use

baseline and periodic color vision

What vitamin deficiency can be risk factor for TB

VIT D

Is there evidence that treating vit d Deficiency prevents TB

What benefit does giving vit d supplement to TB patients with normal vit D provide

none

Tb infection control plan designed to ensure

Prompt detection of infectious patients -Airborne precautions (; neg air, PPE, UV) -Treatment of people suspected/ confirmed TB

some who has had BCG, asympotomatic with positive PPD and positive blood test may see

LTBI | many ppl from other countries will have BCG

WHO does not recommend use of BCG in countries with

- annuanl positive TB rate under 5/100,000 - average children with TB menigitis under 5 below 1/10m - avereage annual risk of TB below 0.1%

10 years after someone receives BCG for TB prophylaxis will the PPD look like? should different test be used?

may still be right under 10mm, Interferon gamma release assay should be used

Insoniazid side effects and consideration

SE: rash, lupus like syndrome, liver enzyme elevation, hepatitis, peripheral neuropathy, Considerations: Hepatitis risk increases with age and ETOH; Pyridoxine prevent neuropathy;adjust for kidney injuries

Rifampin side effects and considerations

SE: rash, hepatits, GI upset Considerations: care with protease inhibitorss and NNRTIs; -change urine orange

Rifapentine side effects and considerations

SE: rash, hepatitis, GI upset Considerations: Contraindicated in HIV positive patients (failure and relapse)

Rifabutin side effects and considerations

SE: Rash, Hepatitis, thrombocytopenia, severe arthralgia, uveitis, leukopenia Considerations: adjust with protease inhibitors and NNRTIs; -HAART drugs should be monitored for toxicity and effectiveness;

Pyrazinamide side effects and considerations

SE: Rash, Hepatitis, GI upset, hyperuricemia Considerations: Glucose control difficult adjust for kidney injury

Ethambutol side effects and considerations

SE: optic neuritis, rash considerations: baseline and periodic vision acuity and color screen Adjust for kidney injury

Second line TB agent: | Streptomycin and Capreomycin

SE: auditory vestibular and kidney toxic Consideration: Avoid (strepto) or reduce in age >59; monitor kidney and hearing (both meds)

Second line TB agent: | Cycloserine

SE: psychosis, convulsions depression, HA, rash drug interactions Considerations: pyridoxine by help with CNS side effects; monitor serurm drug levels

Second line Tb agent: | Ethionamide

SE: hypersensitiviy, hepatotoxicity, GI upset Consideration: hypothyroidism

Second line TB agents; | levofloxacin, moxifloxacin, gatifloxacin

SE: Hypersensitivity, GI upset, drug interactions Consideratoin: NOT FDA APPROVED

Second line TB agents: | Para-aminosalicylic acid

SE; hypersensitiviy, Hepatotoxiciy, GI upset Consideration: hypothyroidism monitor LFT