TB

Question 1

Who would have a positive TST if > than 5mm?

Answer 1

Persons who are HIV positive
Recent Contact of persons with active TB
Persons with Fibrotic changes on chest xray consistent with old TB
Patients with Organ transplants and other immunosuppressive conditions ( receiving > 15mg of prednisone > 4 weeks)

Question 2

Who would have a positive TST if > 10mm?

Answer 2

Recent ( <5yr) arrivals from high prevalence countries)
Injection Drug Users
Residents or Employees of High Risk Congregate settings: Prisons/ jails/ NH and other long term care facilities, residential facilities for AIDS patients, Homeless Shelters
Mycobacteriology lab personnel; persons with clinical conditions that put them at high risk for active disease
Children aged < 4 years or those exposed to adults in high risk categories

Question 3

How many mm is considered positive for a TST in a patient who does not have risk factors

Answer 3

15mm

Question 4

What is the treatment for latent TB

Answer 4

Latent TB in HIV negative patient is INH for 6 months or rifampin for 4 months
In a HIV positive patient the treatment is INH for 9 months

Question 5

How does Mycobacterium Avium Complex present

Answer 5

Pulmonary Disease is classic, may present with dyspnea, cough, hemoptysis, chest discomfort and constitutional symptoms.
Common in middle age/ older male adult smokers who have underlying lung disease, XRAY may show nodular bronchiectatic disease
Also seen in Healthy older white female with RML or Left Lingular lobe lung infection, These women usually have evidence of underlying connective tissue defect ( scoliosis, pectus excavatum or MVP)

Question 6

How does disseminated MAC present in an HIV patient

Answer 6

Usually CD4 count is less than 50 and they are not on prophylaxis
Will present as fevers/ night sweats/ weight loss ( constitutional) and GI symptoms

Question 7

What is the treatment for MAC

Answer 7

Clarithromycin ( should get susceptibility) or Azithromycin with Ethambutol and either rifampin or rifabutin