TB control Flashcards
What are the 5 elements of TB control program?
- TB screening + testing
- EVAL + MGT. of LTBI patients
- TB contact investigation
- TB patient MGT.
- Reports
What are the 2 tests to identify individuals exposed to Mycobacterium TB?
Tuberculin Skin Test
Blood Assay for M. TB (BAMT)
What is the bacteria that causes TB?
mycobacterium tuberculosis
What are the 2 materials that are approved for performing TST?
Tuberculin PPD
Disposable 1ml tuberculin syringe
What is the preferred PPD product and PPD strength?
Tween-80-stabilized intermediate strength 5TU
Tubersol is preferred product
What is the alternate PPD product?
Aplisol
What syringe and needle size are used for tuberculin skin test?
1ml disposable syringe, 1/4 to 1/2in., 27 gauge needle with short bevel
What is used as a diagnostic aid for M. tuberculosis infection?
BAMT, QuantiFERON-TB Gold (QFT-G)
When should you use QFT-G?
diagnostic aid for M. TB
all circumstances in which TST is used
In place of, not in addition to a TST
Term: Bacteria present in latent TB infections and active TB patients
mycobacterium tuberculosis (spore forming)
Term: an illness in which TB bacteria are multiplying and attacking a part of the body, usually the lungs
active TB disease
Term: condition in which TB bacteria are alive but inactive in the body, have no symptoms, don’t feel sick, can’t spread TB to others, and positive STS
latent TB infection
Term: test often used to find out if you are infected with TB bacteria
TB skin test (TST)
Term: a new test that uses a blood sample to find out if you are infected with TB bacteria
TB blood test
Term: a vaccine for TB named after a French scientists who developed it, rarely used in US but given to infants/small children in TB common countries
BCG, Bacillus Calmette Guerin
Term: when you meet with a health care worker daily or several times per week to help patients take their medicine for TB
DOT, directly observed therapy
Term: test result that probably means you do not have TB infection?
neg TST
Term: test result that means you have a TB reaction and probably have TB infection
pos TST
What is the effective therapy and dosage to prevent the development of TB disease to LTBI patients?
INH 5mg/kg (300mg max) X9 months to accomplish 270 doses within 12 months
When should you use an alternate INH regimen?
in combination with DOT
What is the alternate INH regimen dosage?
15mg/kg (900mg max) twice weekly X9 months in combination with DOT only
How frequently should PPD testing be performed?
Initially entering AD or CIVMAR
Annually during PHAs
contact/outbreak/clinically indicated
Suitability screening
When does a person provide adequate documentation of hospitalizations, diagnosis, treatments, and clinical evaluations?
a person begins employment as CIVMAR for MSC
has a history of active or LTBI
has a reaction to TST
has a history of INH therapy
What is adequate medical documentation for persons with past, active, or reactive TST/INH therapy?
Include copies of pertinent medical records and
Physician statement on letterhead stationery
*if not then perform TST
When should a chest X-ray be performed during tuberculosis screening?
when clinically indicated or when ruling out active TB
Who do you contact if the rate of newly identified LTBI converters is more than one to two percent of personnel tested per year?
cognizant NAVENPVNTMEDU
What can be administered to people who have received BCG? And if positive what is the significance?
TST can be administered
individuals should be regarded as indicative of TB infection
INH risk: induration of =/>5mm
recent close contact of active TB patients
fibrotic or other changes on chest X-ray with prior TB
Suspected of having active TB
pos TST, High risk
INH risk: induration of =/>10mm
immigrants within 5yrs from high TB countries
Mycobacteriology lab personnel
clinical conditions that place them at increased risk
pos TST, medium risk
INH risk: induration of =/>15mm and no risk factors for TB
pos TST, low risk
INH risk: 15mm induration or greater
low risk
INH risk: 10mm induration or greater
medium risk
INH risk: 5mm induration or greater
high risk
What is included in the initial evaluation with pos BAMT or TST?
appropriate clinical history, PE, chest X-ray, baseline liver function tests + bilirubin
When should you perform a baseline liver function test (SGOT/SGPT) + bilirubin
patients with elevated risk for liver disease or INH-induced hepatoxicity
Prior to therapy, who must evaluate a person with pos BAMT or TST to rule out what?
MO, NP, PA, or IDC
r/o active TB
What are the requirements for INH therapy during monthly evaluations?
PE to check for signs of hepatitis or adverse effects
counseling on adverse drug reaction
discuss when to d/c meds
discuss when to report for prompt medical evaluation
How often do you follow up for INH preventive therapy?
Monthly and annually
What are the requirements for non-compliance extended doses of INH therapy?
Examine to r/o active TB if interrupted >2 months
administer at least 270 doses of INH within 12 months
15mg/kg (900mg max) twice weekly with DOT
When should you consider withholding INH in regards to blood levels? and why?
patient’s transaminase levels exceed 3-5X the upper limit of normal
INH may increase the liver enzyme (SGOT/SGPT) levels
What is the purpose for TB contact investigation?
initiated upon discovery of an active TB to prevent further propagation
What are the procedures for suspected or confirmed case of active TB?
CO notifies cognizant NEPMU + local hlth dept. ASAP
NEPMU conducts investigation w/ medical + IAW CDC
If separating from service be ID to local public hlth
Who is responsible for ensuring contact investigation is initiated rapidly?
CO/OIC of individual
Who are reports provided to when conducting TB contact investigations?
cognizant NEPMU provides copies to CMD, cognizant FLEET/TYCOM surgeon, and NMCPHC
Within how long should you submit an MER for suspicious or confirmed TB diagnosis?
within 24hrs
When should you submit a second MER?
when active TB is either ruled in or out
What are the method is preferred for administering PPD tests?
Mantoux method
What is the standard method to screen for exposure to tubercle bacilli?
Mantoux method
How much tuberculin is administered for PPD test and strength?
0.1 ml intermediate strength PPD
How do you administer tuberculin for PPD test?
intradermal 0.1 ml intermediate strength PPD (5tu) on volar aspect of forearm, bevel up, clean/dry site, inject outer layer of epidermis, so that a tense pale wheal 6-10 mml appears on skin
why should you repeat a PPD test if the wheal is <6 mm when initially administering? where should you administer it?
needle may have been inserted too deeply
adequate dose wasn’t administered
at least 2in from original site or opposite arm
When should you interpret PPD results after administering it?
examined by trained MDR, 48-72hrs after administration
How do you measure/record PPD induration results?
- @nearest whole mm + widest transverse diameter
- ignore redness
- move fingertips across reaction
- use mm ruler to measure at its widest point
- record lower reading between marks
What forms are used to record PPD results?
NAVMED 6230/4 or
NAVMED 6230/5
What is recorded when there is an absence of induration for PPD results?
what about failure to read results?
and what should not be recorded?
0 mm or zero mm
not read, no show >72hrs apply on opposite arm
don’t record as neg/pos
What happens if individual returns or does not return >72hrs from original administration of PPD?
recall the individual record as “not read” and apply TST on opposite arm
If live attenuated virus vaccines are given how long do you wait until administering PPD?
same day as parenteral live attenuated virus vaccine
or 4wks after live attenuated vaccines
What are some symptoms that are related with active tuberculosis disease?
weakness, weight loss, fatigue, fever, loss of appetite, chills, and night sweats, other symptoms bad cough, chest pain, dyspnea, hoarseness, and hemoptysis
What is the treatment for active TB patients?
Chemotherapy, INH daily 300mg for adults, 10-20mg/kg for children X6-9 months
what are the 2 classifications of anti-tuberculous drugs?
bactericidal (isoniazid, rifampin, pyrazinamide)
bacteriostatic (ethambutol, streptomycin)
what are the 3 bactericides for anti-tuberculous drugs?
isoniazid
rifampin
pyrazinamide
what are the 2 bacteriostatic anti-tuberculous drugs?
ethambutol
streptomycin
what are some complications for patients with active TB disease?
extrapulmonary TB infection
adverse effects,
INH associated HEP
superinfections/resistance to tx
What is BUMEDINST 6224.8 Series 8B, 21FEB13?
TB control program
What is the instruction for Tuberculosis Control Program?
BUMEDINST 6224.8
