TB- IM Plat

Question 1

Etiopathogenesis of TB

Answer 1

• caused by Mycobacterium Tuberculosis
• Transmission: droplet nuclei
• 85% lungs
• Most infectious patients: cavitary pulmonary disease
• Typical TB lesion
  
  • epitheloid granuloma with central caseation necrosis

Question 2

Presumptive TB

Answer 2

• Any person who presents with sx or signs (>15 years old)
  
  • Cough >2 weeks
  • Unexplained cough of any duration in those with close contact with a known active TB case, high risk group
  • Associated sx: weight loss, fever, hemoptysis, chest/back pain, fatigue, night swets, dyspnea
  • CXR findings suggetive of TB
• Presumptive EPTB; may have gibbus, neck stiffness, lymphadenopathy, pleural or pericardial effusion, ascites, painful joints, tuberculin hypersensitivity

Question 3

TB EXPOSURE

Answer 3

Individual is in close contact with an active adult TB case, but without signs and symptoms of TB;

• with negative TST reaction, and
• no radiologic or laboratory findings suggestive of TB

Question 4

TB infection or Latent TB infection

Answer 4

• Individuals have no signs, symptoms, Radiologic nor laboratory evidence of TB, but has a positive TST reaction
• Treatment is not recommended

Question 5

TB Disease

Answer 5

Individual with presumptive TB who is confirmed to have TB by any clinical and diagnostic evaluation

Question 6

Classification of TB-Disease based on Anatomical Site and bacteriologic Status

Answer 6

Question 7

Classification Based on History of Previous Treatment

Answer 7

• New case
  
  • Never had treatment or who has taken anti-TB meds <1 month
• Retreatment case
  
  • previously treated for at least 1 month
• Relapse
  
  • previously treated, was declared cured or completed the treatment, and is now bacteriologically or clinically diagnosed TB
• Treatment After Failure
  
  • Previously treated and failed treatment
    
    • Sputum smear or culture (+) at 5 months or later during treatment
    • Clinically diagnosed patient, no sputum, without clinical improvement anytime during the course
• Treatment after Lost to follow-up
  
  • Previously treated but Lost to follow up for >2 months and currently diagnosed TB
• Previous Treatment Outcome Unknown
  
  • Previously treated
  • Outcome not documented

Question 8

Classification based on Drug Susceptibility

Answer 8

• Monoresistant TB
  
  • only to 1 first line drug
• Polydrug resistant
  
  • >1 first line (other than both INH and Rifampicin)
• MDR-TB
  
  • both INH and Rifampicin
• XDR-TB
  
  • any fluoroquinolone and to at least 3 2nd lne injectable drug (capreomycin, Kanamycin, Amikacin) in addition to MDR
• RR-TB
  
  • Rifampicin detected using phenotypic or genotypic methods with or without Resistance to other
  • Rifampicin, whether monoresistance, MDR, PDR, or XDR

Question 9

algorithm for DX of TB

Answer 9

Question 10

Management of TB

Answer 10

Question 11

Category I

Answer 11

New PTB

New EPTB

• Initial Phase
  
  • 2 HRZE
• Continuation
  
  • 4HR

Question 12

Category Ia

Answer 12

New EPTB (CBS/bones or joints)

• Initial phase:
  
  • 2HRZE
• Continuation Phase:
  
  • 10 HR

Question 13

Category II

Answer 13

Previously Treated PTB or EPTB (escept CNS, bones or joint)

• Relapse
• Treatment after Failure
• TALF
• Previous Treatment Outcome Unknown PTOU
• Other
• Initial Phase
  
  • 2 HRZES and 1 HRZE
• Contunuation Phase
  
  • 5 HRE

Question 14

Category IIa

Answer 14

Previously treated drug-suceptible EPTB in CNS/bones orjoints

• Initial Phase
  
  • 2 HRZES and 1 HRZE
• Continuation
  
  • 9HRE

Question 15

Drug resistant TB

Answer 15

Standard regimen Drug Resitant: RR-TB or MDR-TB

XDR TB Regimen

Question 16

Isoniazid

Answer 16

• inhibits fatty acid synthase and mycolic acid synthesis
• Excellent bactericidal activity against both intracellualr and extracellualr actively dividing MTB
• Bacteriostatic against slowly dividing mciroorganisms

5mg/kg

Max: 400 mg

Question 17

Rifampicin

Answer 17

• Binds to and inhibits mycobacterial DNA-dependent RNA polymerase thereby blocking RNA synthesis
• Has both intracellular and extracellular bactericidal activity, both in dividing and non-dividing MTB
• Has sterilizing activity
• Most Active antimycobacterial agent available and therefroe the keystone of 1st line TB

10mg/kg

max 600 mg

Question 18

Pyrazinamide

Answer 18

• Exact mechanism is unclear (fatty acid synthetase-I may be the primary target)
• More active against slowly replicating organisms than against actively repliating organisms
• Active only in acidic environment (ph<6.0) as are fouund within phagocytes or granulomas

25 mg/kg

max: 2 g

Question 19

Ethambutol

Answer 19

• Inhibits arabinosyltrasnferases involved in cell wall synthesis, which probably inhibits the formation of arabinogalactan and lipoarabinomannan
• Bacteriostatic antimycobacterial agent which provides synergy with other drugs
• Least potent against MTB

15 mg/kg

Question 20

Streptomycin

Answer 20

• Inhibits protein synthesis by binding at a site on the 30s mycobacterial ribosome
• Bactericidal against dividing MTB but has only low level early bactericidal activity

15g/kg

max 1 g

Question 21

Minor SIde effects of Drugs

(may continue anti-TB drugs and check doses)

Answer 21

Question 22

Monitoring Response to Treatment using follow-up DSSM

Answer 22

Question 23

Bacteriologically-confirem TB patient (sputum-positve at the beginning of treatment) and smear is smear (-) or culture (-) at the last month of treatment and on at least 1 previous occasion in the continuation phase

Answer 23

CURE

Question 24

A patient completes treatment, but does not meet the criteria of “cured: or failure”

• Bacteriologically confirmed patient who has completed treatment but without DSSM follow-up in the last month of treatment and on at least 1 previous occasion
• Clinically diagnosed patient who has completed treatment

Answer 24

Treatment completed

Question 25

• For bacteriologically-confirmed TB: patient who is sputum smear positive at 5 months or later during the treatment, or
  
  • For clinically diagnosed TB: patient for whome sputum examination cannot be done and who does not show clinical improvement during treatment

Answer 25

Treatment Failed

Question 26

Sum of “cured: and “treatment completed”

Answer 26

Treatment success

Question 27

PAtient whose treatment was interrupted for >=2 consecutive months

Answer 27

Lost-to follow up

Question 28

• A patient for whom no treatment outcome s assigned
• Includes patients transferred to another treatment facility with outcome unknown

Answer 28

Not evaluated