TB Haase

Question 1

Transmission

Answer 1

Person-to-Person via droplet nuclei (cough/sneeze)

Question 2

RF

Answer 2

Exposure
Location
HIV
Race
Adults
Males

Question 3

Patho

Answer 3

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

Question 4

Immune system does what to prevent spread?

Answer 4

Granulomas - wall off the infection

Question 5

Antibodies form after?

Answer 5

3 weeks

Question 6

Progression to active disease?

Answer 6

Proligerative granulomas –> caseating granulomas (unstable)

Question 7

What happens with caseating granulomas?

Answer 7

Weak, break apart –> lung tissue is destroyed via adaptive

Question 8

RF for Active Disease

Answer 8

Children
Elderly
Renal failure, cancer, immunosuppresed
HIV

Question 9

Presentation

Answer 9

Dry cough
Bloody cough
Chest pain

Question 10

1 Test?

Answer 10

Sputum staining (acid fast)
3 within 24 hrs

Question 11

PPD?

Answer 11

TB Skin Test

Question 12

IGRA?

Answer 12

Useful in those who have had a BCG vaccine

Question 13

Latent Infection Diagnosis

Answer 13

No symptoms
TST/IGRA =
Normal chest
Smear/culture = negative

Question 14

Active Disease Diagnosis

Answer 14

1+ symptoms
TST or IGRA positive
Abnormal chest
Positive smear or culture

Question 15

Latent Treatment

Answer 15

Isoniazid Mono daily for 9 months or DOT twice a wk for 9 months
Isoniazid + Rifapentine DOT for 12 wks

Question 16

Isoniazid requires?

Answer 16

B6
No alcohol
Hepatotoxcity

Question 17

Active NonPharm Treatment

Answer 17

Respiratory isolation
Contact investigation
Nutritional Support

Question 18

Active Initial Phase Treatment

Answer 18

2 months

Isoniazid + Rifampin + Pyrazinamide + Ethanbutol QD

Question 19

Active Continuation Treatment

Answer 19

4 months if sensitive and positive response

Isoniazid + Rifampin

Question 20

MDR or XDR Treatment

Answer 20

Group 1 agents
1+ Injectable
Progress to FQ or other if needed
18 months

Question 21

Monitoring and Follow up

Answer 21

Culture and sensitivity at 2 months

Watch adherence

Question 22

Ethambutal ADR

Answer 22

EYES

Hepato