TB Haase Flashcards
Transmission
Person-to-Person via droplet nuclei (cough/sneeze)
RF
Exposure Location HIV Race Adults Males
Patho
T cells activate macrophages and they destroy 90%
10% remain in the marcophages and replicated
Macrophage dies and they are released and go to others
Immune system does what to prevent spread?
Granulomas - wall off the infection
Antibodies form after?
3 weeks
Progression to active disease?
Proligerative granulomas –> caseating granulomas (unstable)
What happens with caseating granulomas?
Weak, break apart –> lung tissue is destroyed via adaptive
RF for Active Disease
Children
Elderly
Renal failure, cancer, immunosuppresed
HIV
Presentation
Dry cough
Bloody cough
Chest pain
1 Test?
Sputum staining (acid fast) 3 within 24 hrs
PPD?
TB Skin Test
IGRA?
Useful in those who have had a BCG vaccine
Latent Infection Diagnosis
No symptoms
TST/IGRA =
Normal chest
Smear/culture = negative
Active Disease Diagnosis
1+ symptoms
TST or IGRA positive
Abnormal chest
Positive smear or culture
Latent Treatment
Isoniazid Mono daily for 9 months or DOT twice a wk for 9 months
Isoniazid + Rifapentine DOT for 12 wks
Isoniazid requires?
B6
No alcohol
Hepatotoxcity
Active NonPharm Treatment
Respiratory isolation
Contact investigation
Nutritional Support
Active Initial Phase Treatment
2 months
Isoniazid + Rifampin + Pyrazinamide + Ethanbutol QD
Active Continuation Treatment
4 months if sensitive and positive response
Isoniazid + Rifampin
MDR or XDR Treatment
Group 1 agents
1+ Injectable
Progress to FQ or other if needed
18 months
Monitoring and Follow up
Culture and sensitivity at 2 months
Watch adherence
Ethambutal ADR
EYES
Hepato
