TB, Histoplasmosis, Cocci Flashcards
How is TB transmitted?
Airborne droplet nuclei expelled with coughing, sneezing, etc
When can latent TB become activated to disease state?
If patient becomes immunocompromised and granulomas break down
When do symptoms of TB typically present?
Within weeks of exposure or years later when immune system is compromised
What population is at the highest risk of TB?
Untreated HIV
When are patients infected with TB become contagious?
During active disease
When is a chest x-ray indicated when evaluating for TB?
Recommended with positive infection testing or symptoms present
Cannot confirm diagnosis but may be able to rule out
What are four TB risk factors?
- Immunocompromised
- Immigrants from areas with high TB prevalence
- Injection drug users
- Close living quarters
What symptoms are associated with active TB?
- Fever
- Cough for 3+ weeks (+/- productive)
- Hemoptysis (+/-)
- Chest pain (pleuritic or retrosternal)
- Weight loss, anorexia
- Chills, night sweats
What symptoms are associated with active TB?
- May be normal
- Posttussive crackles (classic finding)
- Dullness or decreased fremitus
- Lymphadenopathy
- Clubbing (severe)
What is measured in TB skin testing?
The size of induration
When would you obtain a QuantiFeron-TB Gold blood draw?
May be used in place of skin test if concerns of patient not returning for reading or patient received BCG vaccination
What may be seen on chest x-ray in an individual with primary active TB?
- Hilar lymphadenopathy or normal
- May progress with pleural effusions and/or infiltrates
- Cavitation seen with progressive pulmonary TB
- Miliary pattern
Where are abnormalities typically seen in the lungs with TB?
Apical/posterior upper lobes because the bacteria is an obligate aerobe and requires oxygen
What is the gold standard to confirm diagnosis of TB?
Sputum culture
What should you do if the patient has both a positive AFB and NAA?
TB disease is presumed and treatment begins
What is the general treatment for active TB disease?
- Isolation in negative pressure inpatient hospital room
- RIPE drugs
- Direct observed treatment
What are some side effects of RIF?
- Excreted as red-orange compound in tears, sweat, urine
- Skin sensitivity
What are some side effects of INH?
- Hepatoxicity (monitor LFTs)
- Peripheral neuropathy
- Fatal hepatitis (pregnant women at increased risk)
What are some side effects of PZA?
- Hepatotoxicity
- Hyperuricemia
What are some side effects of EMB?
- Optic neuritis (test visual acuity and color vision)
What is the specific medication regimen for TB treatment?
Initial phase:
- RIFE drugs daily x 2 months (8 weeks)
- Repeat CXR, AFB smear, and culture
Continuation phase:
- RIF and INH daily or twice weekly x 4 months (18 weeks)
Which RIFE drug is not given to pregnant women?
PZA
What RIFE drug is not given to infants/children?
EMB
What criteria needs to be met in order to be considered not infectious with TB?
- 2 weeks of treatment regimen
- 3 negative sputum smears
- Symptoms improve
