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OS 213 Respiratory Exam 2 > TB in children > Flashcards

TB in children Flashcards

1
Q

Exposure of TB in Children

A

(+) History

(-)PPD, CXR, Ssx, Microbiology

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2
Q

Different Ssx of TB in children

A 
Chronic cough
Hemoptysis
Weight Loss
Non-specific
Cervical Lymphadenopathy
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3
Q

Chest Xray findings in TB

A

Adult: Cavitary Lesions
Pedia: Hilar lymphadenopathy

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4
Q

Typical SSx in adult TB

A

Chronic cough with hemoptysis
CXR: Upper Lobe Lesions (Apical Gohn’s focus)
Sputum: (+)

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5
Q

Typical Ssx in Pedia TB

A

Non-specific

Difficulty to obtain sputum

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6
Q

Typical History of pediatric TB patients

A

Exposure within householf; howwever informations might be hard to illicit due to stigma

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7
Q

PPD

A

SQ - > 48-72 hours -> induration or erythema

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8
Q

Cut Off Measurement for positive effect

Based on Population

A

Low Endemicity : >5mm

High Endemicity: >10 mm

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9
Q

Cut off measurement for positive effect based on risk

A

High Risk: >5mm

Low risk: >8mm

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10
Q

Exposure

A

(+)Exposure
(-) PPD, CXR, SSx, SPutum

Significant contract with adult

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11
Q

Reasons why children is not included as source of infections

A

Do not have significantly bacillary load
Their cough is not forceful enough
Cavitary disease is rare are not severe

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12
Q

_____TB is more common in children

A

Pacuibacillary TB

-low bacillary load

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13
Q

Minimum Distance to be infective

A

3 ft or 1 meter

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14
Q

Management for exposure of TB

A

<5 years (specially <2 years): Primary prophylaxis

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15
Q

INFECTION

A

(+) Exposure, PPD
(-) CXR, SSX, Sputum

NoteL CXR may be normal or reveal presence of granulomatous or calcifications

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16
Q

Group of radiologic/ pathologic findings, not clinical

A

Primary Complex

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17
Q

Most common way of Transmission of TB

A

Droplet nuclei

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18
Q

Immunocompetent adult cut off

A

15 years old

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19
Q

In what years is the greatest risk for progression from infection to disease

A

2-3 years

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20
Q

Treatment of infection

A

Secondary Prophylaxis

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21
Q

T or F, PPD testing is routine for adults?

A

False

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22
Q

Role of PPD in pediatric patients

A

Know when treatment is most beneficial

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23
Q

DISEASE

A

(+) Exposure, PPD and any of the following

CXR, SSX, or SPutum AFB

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24
Q

Criteria for Pedia TB

A

3 out of 5 (Exposure, PPD, CXR, Ssx, Sputum)

25
Q

Extrapulmonary sites for adults (TB)

A

15%

Lymphatic (25%)
Pleura (23%)
Meningeal (4%)

26
Q

Extrapulmonary sites for Pedia

A

25-30%

Lymphatic 67%
Meningeal 23%

27
Q

2 ways of Transmission for TB

A

Droplet nuclei

Direct nuclei

28
Q

Children are usually infected by?

A

Untreated adolescent or adult in the household

29
Q

Interval necessary for source to convert to a smear neagtive state if organisms are fully sensitive

A

2 weeks

30
Q

Children or adolescent that should be considered as potentially contagious

A

“symptomatic adult type pTB”

31
Q

Role of child in transmission

A

harbor latent infection

-partially healed but dormant infection can be reactivated as infectious PTB

32
Q

Other portals of entry of entry may be important for the pediatric TB patient

A

Ingestion - unpasteurized milk

Contamination of a supeficial skin infection

Congenital infection is rare

33
Q

Perinatal (Congenital) TB can be acquire via:

A

Transplacental - umbilical vein
In utero aspiration of amniotic fluid
Ingestion of infected amniotic fluid or secretions

34
Q

Perinatal (Postnatal) TB can be acquired via

A

Inhalation of tubercle bacilli

Ingestion of infected breast milk or cow’s milk

35
Q

Perinatal TB ssx appear during

A

2 weeks of life:

Loss of appetite
Failure to gain weight
fever
ear/nasal discharge
cough
pneumonia
jaundice
hepatosplenomegaly
36
Q

Lesion on the skin overlying a lymphnode usually in the cervical area

A

Scrofuloderma

37
Q

Complications usually occur during___

A

5 years after acquisition of TB infection in childhood

especially the 1st year

38
Q

Complications:

A 
Miliary or acute meningeal TB (2-6 months)
Endobronchial TB 
Bone/joint involvement (1 year)
Renal Lesions (5-25 years)
39
Q

Timetable of tb

A

Wallgren’s timetable

40
Q

Primary Complex

A

parenchymal pulmonary focus
Regional lymph nodes
Since about 70% of lung foci are subpleural, localized pleurisy is common

41
Q

Hallmark of primary TB in the lung

A

Relatively large size of the regional lymphadenitis vs relatively small size of initial lung focus

42
Q

usual sequence in primary TB

A

hilar lymphadenopathy -> focal hyperinflation -> atelactasis of supplied portion: COLLAPSE-CONSOLIDATION or SEGMENTAL TB

43
Q

Tuberculin skin test

A

PPD, test for cell mediated immunity againts M.TB

44
Q

Negative results in PPD…

A

Incubation period (3 weeks to 3 months)
Temporary desensitization with measles (regained after 1 month)
Influenza and immuniztaion with influenza
Sensitization to tuberculin tends to remain undiminished for life (Immune system is working, even if treated -> will detect antigen from now or forever)

45
Q

Considerations: LTBI treatment

A
  1. infants and children < 5 years of age with LTBI have been
  2. Risk for progression to disease is high
  3. Infants and young children are more likely to have life
46
Q

Optimal dosing of new patients

A

Daily, but if not possible, weekly

47
Q

Treatment: LTBI

A

9 month course of INH as self administered daily therapy

48
Q

Treatment of TB in children

A

WHO:

Isoniazid (H) -> 10 mg/kg Max: 300mg/day
Rifampicin (R) -> 15mg/kg Max: 600mg/day
Pyranazinamide(Z) 35 mg/kg
Ethambutol(E) 20mg/kg
Streptomycin (S) - IM replaced by ethambutol
49
Q

Side effect of ethambutol

A

optic neuritis

50
Q

Use treatment regimen 2 HRZ 4 HR in the ff:

A

Children with suspected or confirmed PTB or TB peripheral lymphadenitis

Low HIV prevalence or Low resistance to isoniazid

Children who are HIV negative

51
Q

Continuation phase of treatment

A

3x weekly regimens HIV uninfected with well established DOT

52
Q

Treatment for infants (0-3 months) with suspected or confirmed PTB or TB peripheral lymphadenitis

A

Standard treatment

53
Q

Treatment for children with suspected or confirmed TB menigitis

A

HRZE 2 HR 10, for a total of 12 months

If not penetrative to CNS, 6 month duration

54
Q

Treatment for children with suspected or confirmed osteoarticular TB

A

HRZE 2 HR 10 for a total of 12 months

55
Q

Treatment for Children with proven or suspected PTB or TB meningitis caused by MDR-TB

A

fluoroquinolone in the context of a well functioning control program and within an appropriate regimen.

Other options:
(6-9 mos): bedaquiline, delamanid

56
Q

Treatment modality on Exposure

A

H x 3 mos + repeat PPD (if positive, extend tx for 9 mo)

57
Q

Treatment modality on Infection

A

H x 9 months

58
Q

treatment Modality (extent of disease) Pulmonary

A

HRZ x 2 mo + HR 4 x months

use 3x weekly regimens during continuation phase is as effective as daily regimen

59
Q

treatment modality (extra pulmonary)

A

6 months - non life threatening forms
9 months - bone and joint
12 months - TB meningitis

OS 213 Respiratory Exam 2 (15 decks)

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