TB

Question 1

mycobacterium tuberculosis stains

Answer 1

gram stain- gram positive bacillus

Ziehl-Neelsen stain - “Acid-fast stain” due to lipid-rich cell wall; mycobacteria stain red

Obligate aerobe - takes up to 60 days to grow

Question 2

latent TB spread infection?

labs show

Answer 2

no

positive blood test, negative chest xr

Question 3

tb cough longer than___weeks

Answer 3

2-3 weeks

Question 4

most healthy adults have which type of presentation of TB

children?

Answer 4

pulmonary

other tissues in the body- GI, lymph node, genitourinary, skeletal (potts disease)

Question 5

IGRA

Answer 5

quantiferon

gold spot

Question 6

this symptom indicative of TB

Answer 6

cervical lymph nodes that open and drain fluid

Question 7

dx tb in children

Answer 7

CXR- 1/2 negative

Sputum culture- only in children >10

PPD- negative if coinfected with HIV

Gastric aspirate on 3 separate days

Question 8

how many who have latent tb will turn active?

those with HIV?

Answer 8

10% over lifetime

5-10% per year

Question 9

Treatment TB

Answer 9

4 drugsx 2 months
2 drugsx 4 months

rifampin + inh +pyrazinimide (PZA) + ethambutol (EMB)

then

rif+ inh

Question 10

MDR-TB=

tx options

Answer 10

drug resistant tb (rif/inh)

Options include:
Quinolones: moxifloxacin, levofloxacin, gatifloxacin

AGs: streptomycin, capreomycin, kanamycin

Other drugs: PZA, cycloserine, ethionamide, PAS
Minimum of 4 drugs used usually for 12 months

Question 11

xdr-tb means?

tx options?

Answer 11

extremely drug resistant (inh+rif+fluoroquinolone)

need injection- capreomycin, kanamycin, amikacin

Question 12

TB drugs efficacy with ART

how to initiate both

if started at the same time what can happen?

Answer 12

more efficaceous when given together

start tb first, then initiate art after 2 weeks (and BY 8 weeks irrespective of cd4)

IRIS- huge inflammatory response

Question 13

rifampin increases or decreases level of HIV drugs

Answer 13

decreases

Question 14

preferred art tx for adults who are also being treated for TB

Answer 14

efavirennz (EFZ)

Question 15

most widely used vaccine worldwide

efficacy for adults and children

Answer 15

bcg for tb

adults- 50%
pedi- BEST FOR PREVENTION OF SERIOUS FORMS OF TB

Question 16

chest xray and sputum cultures in immunocompromised patients- what is result?

Answer 16

may be negative despite having TB

Question 17

Testing for latent TB

First line? or?

Answer 17

PPD, IGRA for those who may not come back

Question 18

IGRA preferred method of screening for?

Answer 18

if had bcg vaccine, poor rate of return

Question 19

preferred method of screening children?

Answer 19

PPD <5 y/o

Question 20

PPD positive results

Answer 20

> 5mm: HIV + (or IDU and unknown HIV), close contact of active case, fibrotic CXR lesions, persons on steroids, transplant patients

> 10mm: high prevalence country, IDU and HIV neg, medically underserved, long-term care facilities, certain medical conditions

> 15mm: no increased risk

Question 21

PPD interpretation for those who received vaccine for those that didnt?

Answer 21

same per cdc

Question 22

treatment latent TB

pregnant?

Answer 22

rifampin x 9 months
inh x 4 months

inhx 9 months for pregnancy, may delay

Question 23

immune reconstitution syndrome (IRIS)

definition

can occur up to ____ months

consider adding what drug?

Answer 23

paradoxical clinical deterioration after starting combination ART, resulting from inflammation directed at underlying infections that are unmasked as the immune system improves

can occur up to 6 months

prednisone