TB in Infancy and Childhood Flashcards
1
Q
_____ causes tuberculosis in humans.
A
Mycobacterium tuberculosis
2
Q
_____ are obligately aerobic, non-motile, slightly curved or straight bacilli.
A
Mycobacteria
3
Q
MTB retains _____ dye when decolorized with acid-ethanol by the _____ method (acid fastness).
A
carbofuchsin, Ziehl-Neelsen
4
Q
MTB Survival Strategies
A
- prevention of acidification of phagosomes 2. neutralization of the effects of reactive oxygen intermediates by the mycobacterial cell wall 3. inhibition of plasma membrane repair 4. inhibition of phagosome-lysosomal fusion through secretion of SapM (acid phosphatase)
5
Q
Key Risk Factors for TB
A
smear (+) household contact < 5 y.o. immunodeficiency
6
Q
TB Transmission
A
inhalation of droplet nuclei (5-200 bacilli)
7
Q
TB Incubation Period
A
3-12 weeks
8
Q
_____ is the condition in which a child is in close contact with a contagious host but without any signs and symptoms, with (-) TST and (-) CXR and laboratory findings.
A
TB Exposure
9
Q
_____ is the condition in which a child has no signs or symptoms, (-) CXR and laboratory findings but has (+) TST.
A
TB Infection Latent TB Infection (LTBI)
10
Q
_____ is presumptive TB with (+) CXR and/or TST.
A
TB Disease
11
Q
_____ TB has biological specimen which is positive by sear microscopy, culture or rapid diagnostic tests.
A
Bacteriologically Confirmed
12
Q
_____ TB does not fulfill the criteria for bacteriological confirmation but has been diagnosed with active TB.
A
Clinically Diagnosed
13
Q
_____ is a case of tuberculosis involving lung parenchyma and tracheobronchial tree ± other sites of the body.
A
Pulmonary TB (PTB)
14
Q
_____ is a case of TB involving orgens outside the pulmonary system.
A
Extrapulmonary TB (EPTB)
15
Q
Laryngeal TB is considered as _____.
A
EPTB
16
Q
_____ is the initial stage in children who inhale MTB.
A
Primary Disease
17
Q
Primary PTB Disease Components
A
Ghon focus lymphadenitis lymphangitis
18
Q
95% of primary PTB disease heals by _____.
A
fibrosis and/or calcification
19
Q
Primary TB in children is asymptomatic up to _____ of patients.
A
65%
20
Q
Fever in primary Tb is usually _____ and lasts for _____.
A
low-grade 14-21 days
21
Q
_____ is the condition which develops when initial TB infection fails to heal and continues to progress for months or years.
A
Progressive Primary TB
22
Q
_____ is the condition which represents reactivation of an old, possibly subclinical TB infection.
A
Secondary (Reactivation) TB
23
Q
Secondary TB occurs in _____ of the cases of primary infection.
A
< 10%
24
Q
Secondary TB is more common on _____.
A
adolescents
25
Clinical Manifestations of Secondary TB
chronic or persistent cough prolonged fever chest pain hemoptysis supraclavicular adenitis
26
\_\_\_\_\_ is the clinical disease resulting from the hematogenous dissemination of MTB.
Miliary Tuberculosis
27
\_\_\_\_\_ is the most common clinically significant form of disseminated TB.
Miliary Tuberculosis
28
\_\_\_\_\_ is now used to denote all forms of progressive widely disseminated hematogenous TB.
Miliary Tuberculosis
29
The most common extrapulmonary sites of Miliary TB include the \_\_\_\_\_.
lymphatic system bones joints liver
30
\_\_\_\_\_ are more common in childhood TB than in adults.
peripheral lymphadenopathy hepatomegaly
31
Peritonitis is found in _____ of patients with advanced Miliary TB.
20-40%
32
\_\_\_\_\_ can be a complication of primary TB which results in enlargement of peribronchial lymph nodes with subsequent compression or nodal extension into the bronchus.
Endobronchial Tuberculosis
33
Compression from Endobronchial TB cam cause \_\_\_\_\_.
asphyxia obstructive emphysema atelectasis
34
The _____ is more vulnerable to Endobronchial TB due to its anatomy and drainage.
R middle lobe
35
Endobronchial TB can cause _____ which could be mistaken for pertussis or bronchial asthma.
crepitant rales wheezes
36
\_\_\_\_\_ is the most common form of extrapulmonary TB and probably the most common cause of chronic lymphadenitis in children.
Tuberculous Lymphadenitis (Scrofula)
37
TB Lymphadenitis occurs most frequently in the _____ age group.
10-18 y.o.
38
The most common location for TB Lymphadenitis is the \_\_\_\_\_, followed by the _____ areas.
anterior cervical space (49.4%) axillary and supraclaavicular areas
39
The most common presentation of TB Lymphadenitis is \_\_\_\_\_.
unilateral or multiple slow-growing nontender lymphadenopathies
40
The involved lymph node in TB Lymphadenitis is usually described as \_\_\_\_\_.
firm painless ruberry discrete matted fixed overlying skin induration
41
Fistula formation is seen in _____ of TB Lymphadenitis cases.
10%
42
The use of _____ can improve the diagnosis of TB Lymphadenitis.
FNAB with rapid molecular diagnostic tests
43
\_\_\_\_\_ is the most severe form of extrapulmonary TB.
Tuberculous Meningitis
44
TB Meningitis occurs most commonly in children _____ but uncommon in infants \_\_\_\_\_.
\< 6 y.o., \< 4 mos.
45
TB Meningitis usually appears within _____ after initial infection.
2-6 mos.
46
TB Meningitis usually accompanies Miliary TN in _____ of cases.
50%
47
TB Meningitis Stages: personality changes, irritability, anorexia, listlessness, fever
Stage 1
48
TB Meningitis Stages: increased ICP, cerebral damage, drowsiness, stiff neck, CN palsies, anisocoria, vomiting, tâche cérébrale, absence of abdominal reflexes, seizures
Stage 2
49
TB Meningitis Stages: coma, irregular HR and RR, rising fever
Stage 3
50
TB Meningitis CSF Findings
↑ WBC 50-500 WBC/mm3 PMNS - early Lymphocytes - late ↓ glucose ↑ protein
51
TB Meningitis Neuroimaging Triad
Hydrocephalus (80%) Basal Meningeal Enhancement (75%) Arteritis (cerebral infarcts)
52
\_\_\_\_\_ are enlarged granulomatous foci within the brain parenchyma.
Tuberculomas
53
Tuberculous brain abscesses lack _____ associated with tuberculomas.
giant cells granulomatous reaction
54
Tuberculomas occur most often in children \_\_\_\_\_.
\< 10 y.o.
55
Tuberculomas are often located at the\_\_\_\_\_.
infratentorial area cerebellar area
56
The most common areas affected by TB spinal meningitis are \_\_\_\_\_.
dorsal cord (most common) lumbar region cervical region
57
TB osteomyelitis and arthritis account for _____ of EPTB and only _____ of all cases of TB.
10-15%, 2%
58
TB osteomyelitis and arthritis can be cause by _____ spread from an initial infection.
lymphohematogenous spread
59
Younger children are more vulnerable to TB osteomyelitis and arthritis due to the \_\_\_\_\_
increased blood flow to growing bones
60
TB osteomyelitis usually starts as an area of endarteritis in the _____ of long bone where blood supply is more abundant.
metaphysis
61
The most common skeletal sites affected by TB are \_\_\_\_\_.
spine (most common) hip knee
62
The most common sites affected by Pott's Disease are \_\_\_\_\_.
upper lumbar lower thoracic lumbosacral
63
In Pott's Disease, there is destruction of the intervertebral disk space and adjacent vertebral bodies, collapse of spinal elements and anterior wedging leading to \_\_\_\_\_.
angulation gibbus kyphosis
64
\_\_\_\_\_ is the most frequent symptom of Pott's Disease.
back pain
65
Duration of Pott's Disease ranges from \_\_\_\_\_.
4-11 mos.
66
TB arthritis is _____ in children and is usually \_\_\_\_\_.
rare, monoarticular
67
\_\_\_\_\_ is an aseptic reactive polyarthritis caused by TB..
Poncet's Disease
68
\_\_\_\_\_ is second to PTB in frequency.
GITB
69
The most common forms of abdominal TB are \_\_\_\_\_.
nodal involvement peritonitis intestinal involvement liver (6.1%) ileum (1.5%) perineum (1..5%) spleen (1.5%)
70
Ingested of sputum infected with MTB is the most important suggested cause of \_\_\_\_\_.
TB Enteritis
71
TB Enteritis usually affects the \_\_\_\_\_.
ileocecal area mesenteric LN peritoneum
72
Enlarged caseous and calcified meseneric LNs also known as _____ are often seen as densities on abdominal x-ray.
tabes mesenterica
73
\_\_\_\_\_ is commonly due to rupture of a caseous abdominal LN and less frequently from a focus in the intestine or fallopian tube.
TB Peritonitis
74
\_\_\_\_\_ TB Peritonitis is less common and is characterized by tender abdominal masses and a doughy abdomen.
Plastic
75
\_\_\_\_\_ TB Peritonitis presents with ascitis and classic signs of peritonitis.
Serous
76
TB Peritonitis Peritoneal Fluid Analysis
exudative lymphocytic predominance serum ascitic fluid albumin gradient \< 1.1 g/dl ↑ protein content (\> 25 g/L)
77
\_\_\_\_\_ is referred to as primary miliary TB of the liver.
Hepatobiliary TB
78
Hepatobiliary TB Types
diffuse hepatic involvement with PTB or miliary TB diffuse hepatic involvement without PTB focal tuberculoma or abscess
79
The overall incidence of isolated liver TB is \_\_\_\_\_.
0.3%
80
Hepatic TB lesions that are larger than 2 mm are called \_\_\_\_\_.
macronodular TB pseudotumoral TB
81
Cutaneous TB Classification: tuberculous chancre
Primary
82
Cutaneous TB Classification: miliary tuberculosis
Primary
83
Cutaneous TB Classification: lupus vulgaris
Secondary
84
Cutaneous TB Classification: scrofuloderma
Secondary
85
Cutaneous TB Classification: tuberculous verrucosa cutis
Secondary
86
Cutaneous TB Classification: tuberculous gumma (metastatic abscess)
Secondary
87
Cutaneous TB Classification: orificial tuberculosis
Secondary
88
Cutaneous TB Classification: micropapular lichen
Tuberculid
89
Cutaneous TB Classification: scrofuloderma
Tuberculid
90
Cutaneous TB Classification: papular-papulonectrotic
Tuberculid
91
Cutaneous TB Classification: nodular (erythema induratum)
Tuberculid
92
Cutaneous TB Classification: Primary
tuberculous chancre miliary TB
93
Cutaneous TB Classification: Secondary
lupus vulgaris scrofuloderma tuberculous verrucosa cutis tuberculous gumma (metastatic abscess) orofocial TB
94
Cutaneous TB Classification: Tuberculids
micropapular lichen scrofuloderma papular-papulonecrotic nodular (erythema induratum)
95
\_\_\_\_\_ are hypersensitivity reactions to MTB.
Tuberculids
96
\_\_\_\_\_ is the most common form of childhood cutaneous TB.
Scrofuloderma
97
Cutaneous TB Manifestations
inoculation from an exogenous source or BCG hematogenous dissemination erythema nodosum
98
Ocular TB frequently involves the conjunctivae and the cornea in the form of \_\_\_\_\_.
phlyctenular keratoconjunctivitis
99
Phlyctenular Keratoconjunctivitis is considered a hypersensitivity reaction to \_\_\_\_\_.
tuberculin
100
Phlyctenular Keratoconjunctivitis presents as \_\_\_\_\_.
1-3 mm grey to yellow colored jelly-like nodules
101
Renal TB is an uncommon complication of primary TB which occurs _____ after primary infection.
15-20 years
102
Genitourinary TB is usually seen in children \_\_\_\_\_.
\> 7 y.o.
103
\_\_\_\_\_ spread could cause tubercles in the glomeruli with caseating sloughing lesions.
Hematogenous
104
Children whose urine reveal presence of MTB are considered highly infectious and should be isolated until \_\_\_\_\_.
their urine is sterile
105
The most common sites for genital TB in females are \_\_\_\_\_.
fallopian tubes (90-100%) endometrium (50%) ovaries (20-30%) cervix (2-4%)
106
\_\_\_\_\_ should be highly suspected in the presence of painless otorrhea unresponsive to conventional treatment ina patient with TB.
TB Mastoiditis
107
Pathophysiology of Perinatal TB
hematogenous spread from umbilical vein → ingestion of infected amniotic fluid or postpartum inhalation
108
Criteria for Congenital TB
1. 1st week of life 2. primary hepatic complex or caseating hepatic granuloma 3. TB infected placenta or endometrium
109
Effects of Maternal TB
infertility poor reproductive performance recurrent abortions stillbirth PROM preterm labor
110
Spectrum of TB: (+) exposure (-) signs and symptoms (-) TST (-) CXR (-) sputum smear (-) other diagnostics
TB Exposure
111
Spectrum of TB: (+) exposure (-) signs and symptoms (+) TST (-) CXR (-) sputum smear (±) other diagnostics
TB Infection
112
Spectrum of TB: (+) exposure (+) signs and symptoms (+) TST (±) CXR (±) sputum smear (±) other diagnostics
TB Disease
113
Classification of TB Disease is based on \_\_\_\_\_.
bacteriological status anatomical site history of previous treatment HIV status drug susceptibility
114
Those who can expectorate sputum may be classified into PTB, \_\_\_\_\_.
sputum smear positive or negative
115
TB Classification: a patient who has never had treatment for TB or who has taken anti-TB drugs for \< 1 mo. Isoniazid Preventive Therapy (IPT) or other preventive regimens are not considered.
New Case
116
TB Classification: a patient who has been previously treated with anti-TB drugs for ≥ 1 mo.
Retreatment Case
117
TB Classification: a case of TB who has a (-) HIV result at the time of diagnosis
HIV (-) Patient
118
TB Classification: a case of TB who has a (+) HIV result at the time of diagnosis
HIV (+) Patient
119
TB Classification: resistant to 1 first-line anti-TB drug
Monoresistant TB
120
TB Classification: resistant to \> 1 first-line anti-TB drug (other than Isoniazid or Rifampicin)
Polydrug-Resistant TB
121
TB Classification: resistance to at least both Isoniazid and Rifampicin
Multidrug-Resistant TB (MDR-TB)
122
TB Classification: resistance to any fluoroquinolone and to at least 1 of 3 second-line injectable drugs (capreomycin, kanamycin, amikacin)
Extensively Drug-Resistant TB (XDR-TB)
123
TB Classification: resistance to Rifampicin, detected using phenotypic or genotypic methods, ± resistance to other anti-TB drugs.
Rifampicin-Resistant TB (RR-TB)
124
A child is presumed to have active TB if ≥ 3 of the following criteria are met:
exposure to host with active TB (Epidemiologic) signs and symptoms (Clinical) (+) TST (Immunologic) (+) CXR findings (Radiologic) (+) laboratory findings (Laboratory)
125
\_\_\_\_\_ refers to any person with signs and/or symptoms suggestive of TB or those with CXR findings suggestive of TB.
Presumptive TB
126
Children who are ≥ 15 y.o. with cough of ≥ 2 weeks are presumed to have TB if they have any of the ff.:
weight loss fever hemoptysis chest or back pains easy fatigueability malaise night sweats shortness of breath difficulty of breathing
127
Children who are ≥ 15 y.o. with unexplained cough of any duration are presumed to have TB if they have \_\_\_\_\_.
close contact to host with active TB immunocompromised state
128
A child \< 15 y.o. is presumed to have active TB if ≥ 3 of the following criteria are met:
coughing/wheezing x 2 weeks unexplained fever x 2 weeks weight loss failure to thrive loss of appetite failure to respond to 2 weeks of antibiotics failure to regain previous state of health 2 weeks after viral infection fatigue reduced playfulness lethargy
129
A child \< 15 y.o. and has had _____ is presumed to have TB if at least 1 of the clinical criteria are met.
close contact to a known case of active TB
130
A child is presumed to have EPTB if the any of the ff. are present:
gibbus non-painful enlarged cervical lymphadenopathy with or without fistula nuchal rigidity pleural effusion pericardial effusion distended abdomen with ascites non-painful enlarged joint tuberculin hypersensitivity
131
Treatment for active TB should be done if the child has ≥ 3 of the ff.:
exposure (+) TST signs &amp; symptoms (+) CXR (+) laboratory tests
132
\_\_\_\_\_ is the most important diagnostic tool in TB.
TST
133
Reaction to TST starts after _____ and reaches its peak at \_\_\_\_\_.
5-6 hours, 48-72 hours
134
The current standard for TST is the \_\_\_\_\_.
Mantoux Test
135
The Mantoux Test is done with _____ of solution containing _____ of purified protein derivative (PPD).
0.1 ml, 0.1 μg
136
PPD for Mantoux Test
5 tuberculin units of PPD-S 2 tuberculin units of PPD-RT 23 with Tween 80
137
Immunologic-based testing for TB is done with \_\_\_\_\_.
Interferon-Gamma Release Assay (IGRA)
138
The delayed hypersensitivity reaction is manifested as a _____ immune response mediated by _____ and is characterized by an indurated response to the intradermal injection from the cell wall of the MTB.
Type IV, sensiitized T-Lymphocytes
139
Administration of Mantoux Test
2 in. below elbow in the volar aspect of the forearm g.25-27 short bevel needle (1/4-1/2 in.) 0.1 ml of PPD intradermal - wheal of 6-10 mm
140
TST should be read within \_\_\_\_\_.
48-72 hours
141
(+) TST reactions can be read accurately for up to \_\_\_\_\_.
7 days
142
(-) TST reactions can be read accurately for up to \_\_\_\_\_.
72 hours
143
False (+) TST
infection with non-tuberculous mycobacteria previous BCG vaccination (≤ 5 years) incorrect TST administration incorrect measurement or interpretation incorrect strength of antigen
144
False (-) TST: Host Factors
infections live attenuated virus vaccinations (measles, mumps, polio, varicella) metabolic derangements nutritional factors lymphoid organ diseases coricosteroids immunosuppressive agents age (newborns, elderly) advanced TB infection stress complete anergy
145
False (-) TST: Tuberculin Factors
improper storage (light, heat) improper dilution chemical denaturation contamination adsorption into syringe (controlled with Tween 80)
146
False (-) TST: Administration Factors
too little antigen delayed administration after drawing into syringe too deep
147
False (-) TST: Reading and Recording Factors
inexperienced reader conscious or unconscious bias error in recording
148
The tuberculin solution must be stored at \_\_\_\_\_.
2-8°C
149
(+) TST: populations with no risk factors
≥ 15 mm
150
(+) TST: high risk populations
≥ 10 mm
151
(+) TST: ≥ 5 mm
HIV (+) close contact CXR with untreated TB organ transplant immunosuppression
152
\_\_\_\_\_ is the inability to react to a TST because of a weakened immune system.
Anergy
153
\_\_\_\_\_ is the change from a (-) to a (+) TST result.
Skin Test Conversion
154
\_\_\_\_\_ can distinguish latent TB from previous BCG vaccination.
IGRA
155
\_\_\_\_\_ is preferred for childern \< 5 y.o.
TST
156
IGRA is preferred for children who \_\_\_\_\_.
have receivedd BCG are unlikely to return for reading
157
IGRA results are available within \_\_\_\_\_.
24 hours
158
IGRA blood samples should be processed within \_\_\_\_\_.
8-30 hours
159
\_\_\_\_\_ of blood is needed to perform IGRA.
1-2 ml
160
The only finding that may be highly suggestive of TB infants and children is the _____ found in miliary TB.
uniform stippling of both lungs
161
Gastric AFB is only (+) in _____ of cases.
30-40%
162
Primary Complex CXR Findings
parenchymal involvement (primary focus) lymphangitis localized pleural effusion regional lymphadenitis
163
\_\_\_\_\_ is the most common CXR finding in children with TB.
Lymphadenopathy
164
Proper Exposure for CXR
300-500 mA
165
PTB CT Scan Findings
\< 1 cm LN calcified nodes ring enhancement granuloma peribronchial, axillary, hilar, paricardiac nodes
166
PTB CXR Findings
Ghon Complex (64%) parenchymal infiltrates (78%) air-space opacities (63%) atelectasis (22%) cavitary lesions (21%) bronchial and tracheal compression (12%) miliary pattern (10%)
167
The parenchymal reaction to TB is typically \_\_\_\_\_.
acinar consolidation (homogenous with ill-defined borders)
168
PTB predominantly affects the _____ with preferential location between \_\_\_\_\_.
upper lobes anterior-posterior segments right-left segments
169
Atelectasis in TB usually affects the \_\_\_\_\_
R upper and middle lobes \*bronchial compression by enlarged LN
170
Progression from Ghon focus and lymohadenopathy occur in children \_\_\_\_\_.
\< 5 y.o. \> 10 y.o.
171
Radiographic clearing of TB usually occurs within _____ after therapy.
6 mos. - 2 years
172
Chronic PTB tends to localize in the \_\_\_\_\_.
apical and posterior segments of the upper lobes R \> L
173
Chronic PTB CXR Findings
Local Exudative TB Local Fibroproductive TB Cavitation Tuberculoma
174
\_\_\_\_\_ is the radiolodic hallmark of reactivation TB.
Cavitation
175
Tuberculomas are usually found in the \_\_\_\_\_.
upper lobe R \> L
176
In advanced Miliary TB, stippling in the lungs coalesce and produce a richly stippled patter called the \_\_\_\_\_.
snowstorm effect
177
Radiographic Improvement of Miliary TB starts at _____ and complete clearing is seen in \_\_\_\_\_.
5 weeks 7-22 mos. (mean 16 weeks)
178
Bronchiectasis from TB is 2x more frequent in patients with \_\_\_\_\_.
hemoptysis
179
Pott's Disease begins with deposition of MTD through end arterioles into the \_\_\_\_\_.
anterior part of the vertebral body adjacent to the end plate.
180
\_\_\_\_\_ bone loss from TB is needed before changes are manifested on x-ray.
\> 50%
181
X-ray Triad of TB Arthritis
Phemister Triad juxtaarticular osteoporosis peripherally located osseous erosions narrowing of the interosseous space
182
the Phemister Triad is characteristic of \_\_\_\_\_.
TB Arthritis
183
The most specific CT Scan finding in TB Meningitis is \_\_\_\_\_.
basal cistern enhancement
184
The majority of infarcts caused by TB Meningitis are located at the \_\_\_\_\_.
basal ganglia internal capsule
185
The _____ are the most commonly affected regions of Tuberculoma.
frontal and parietal lobes
186
If the caseous core of a tuberculoma liquefies, it results in a \_\_\_\_\_.
TB Abscess
187
Tuberculomas are usually _____ while TB Abscesses are usually \_\_\_\_\_.
multiple (tuberculoma) solitary (abscess)
188
Spinal TB MRI Findings
CSF loculation obliteration of he spinal subarachnoid space loss of outline of the spinal cord (cervicothoracic) matting of nerve roots (lumbar)
189
Routes of Abdominal TB
ingestion of infected sputum hematogenous spread local spread
190
\_\_\_\_\_ is the most common radiographic manifestation of abdominal TB.
Lymphadenopathy (55-66%) \*mesenteric, omental, peripancreatic
191
\_\_\_\_\_ is the most common clinical manifestation of abdominal TB.
Peritonitis (1/3)
192
\_\_\_\_\_ involvement is seen in 80-90% of abdominal TB cases.
Ileocecal
193
The wide gaping of the ileocecal valve with narrowing of he terminal ileum is called the \_\_\_\_\_.
Fleischner Sign
194
The earliest radiographic abnormality seen in Renal TB is _____ due to erosion.
moth-eaten calyx
195
Genital TB in males is usually confined to \_\_\_\_\_.
seminal vesicles prostate gland
196
The primary sign of TB Pericarditis is pericardial thickening _____ on CT scan.
\> 3 mm
197
Most patients with TB Pericarditis have distention of the inferior vena cava to a diameter \_\_\_\_\_.
\> 3 cm
198
\_\_\_\_\_ microscopy is the easiest, least expensive and most rapid (1 hour) procedure in diagnosing TB.
AFB Smear
199
Fluorescence Microscopy uses _____ which causes the acid-fast bacilli to fluoresce against a dark background.
auramine-based
200
Traditional TB culture methods used solid culture media like \_\_\_\_\_.
egg-potato-based agar-based
201
Solid TB culture requires _____ to isolate organisms and another _____ for sensitivity testing.
4-6 weeks, 2-4 weeks
202
Mycobacterial culture with the use of _____ are more rapid and sensitive.
broth-based culture media
203
Liquid TB culture provides results in \_\_\_\_.
7-14 days
204
Specimen Collection: _____ is recommended for infants and children who are unable to produce sputum even with aerosol inhalation.
Gastric AFB
205
Specimen Collection: _____ of gastric content should be aspirated for gastric AFB.
5-10 ml (max 15 ml)
206
Specimen Collection: For gastric lavage, _____ of sterile distilled water is injected through a stomach tube.
25-50 ml
207
Specimen Collection: Gastric AFB should be done once daily for \_\_\_\_\_.
3 consecutive days
208
Specimen Collection: If transfer of gastric AFB is delayed for more than 1 hour, it must be neutralized with _____ and stored at \_\_\_\_\_\>
sodium carbonate, room temperature
209
Specimen Collection: For older children who can expectorate, a series of _____ should be collected in _____ before start of therapy.
2 sputum specimens 2 different days
210
Specimen Collection: Sputum AFB
1. clean and thorough rinse of mouth with water 2. breathe deeply 3 times 3. after 3rd breath, cough hard and bring sputum from deep in the lungs. 4. expectorate the sputum into a sterile container.
211
Specimen Collection: _____ of sputum should be collected for AFB.
3 ml (1 tsp.)
212
Specimen Collection: If a sputum AFB sample is delayed for more than 1 hour, it should be \_\_\_\_\_.
refrigerated
213
Specimen Collection: The minimum amount for a respiratory aspirate AFB sample is \_\_\_\_\_.
3 ml
214
Specimen Collection: If respiratory aspirate AFB sample is delayed for more than 1 hour, it should be \_\_\_\_\_.
refrigerated
215
Specimen Collection: The minimum amount for a CSF AFB sample is \_\_\_\_\_.
1-2 ml
216
Specimen Collection: If a CSF AFB sample is delayed for more than 1 hour, it should be \_\_\_\_\_.
kept at room temperature
217
Specimen Collection: CSF AFB samples should be _____ if for PCR testing.
refrigerated or frozen
218
Specimen Collection: Tissue AFB samples should have _____ added for transport.
2-3 ml sterile saline
219
Specimen Collection: If a tissue AFB sample is delayed for more than 1 hour, it should be \_\_\_\_\_.
refrigerated
220
Specimen Collection: If an exudate or abscess AFB sample is delayed for more than 1 hour, it should be \_\_\_\_\_.
refrigerated
221
Specimen Collection: Exudate AFB swabs should have _____ added for transport.
2-3 ml sterile saline \*ideally 7H9 broth
222
Specimen Collection: _____ of blood should be taken for TB culture.
1-10 ml
223
Specimen Collection: Blood for TB culture must be placed in a \_\_\_\_\_.
yellow top vial (sodium polyanetholsulfonate, SPS) green top vial (heparin)
224
Specimen Collection: Blood for TB culture must be transported at \_\_\_\_\_.
room temperature
225
Specimen Collection: BMA AFB specimen should be placed in a \_\_\_\_\_.
yellow top vial (sodium polyanetholsulfonate, SPS)
226
Specimen Collection: _____ of first morning urine should be collected for _____ for urine AFB testing.
40 ml (min. 10-15 ml) 3 consecutive days q8-24 hours
227
Specimen Collection: Stool AFB is not recommended except in patients with \_\_\_\_\_.
HIV
228
When MTB antigen load is small and the degree of tissue sensitivity is high, granuloma formation results from \_\_\_\_\_.
organization of lymphocytes, macrophages, Langerhans giant cells and fibroblasts
229
\_\_\_\_\_ utilize techniques to amplify nucleic acid regions specific to the MTB complex.
Nucleic Acid Amplification Tests (NAATs)
230
The most common target of NAATs is the _____ followed by the \_\_\_\_\_.
IS6110, 65-kDa
231
Line probe assays are recommended for _____ specimen only.
smear(+)
232
The _____ is the first fully automated, cartridge-based NAAT for TB which simplifies molecular testing by integrating and automating sample preparation, amplification and detection.
Gene Xpert MTB/RIF Assay
233
The _____ is a time-PCR-based molecular test that can simultaneously detect TB and Rifampicin resistance.
Gene Xpert MTB/RIF Assay
234
The Gene Xpert MTB/RIF Assay will show results within \_\_\_\_\_.
2 hours
235
The _____ is recommended by the WHO as a replacement for conventional microscopy, culture and drug susceptibility testing as the initial diagnostic test for TB.
Gene Xpert MTB/RIF Assay
236
T-Lymphocytes from an infected host release _____ as a marker of infection or active TB.
Interferon Gamma (IFN-g)
237
Drug Efficacy TB Groups
1. actively growing MTB in open cavities (bactericidal drugs) 2. slowly multiplying MTB in caseous lesions (sterilizing drugs) 3. intracellular MTB in acidic compartments of macrophagesor acidic lung lesions (sterilizing drugs 4. TB persisters in hypoxic environments which are unresponsive to most anti-TB medication
238
Children have fewer mycobacterial organisms and are thus less likely to develop \_\_\_\_\_.
secondary drug resistance
239
EPTB is more common in \_\_\_\_\_.
children
240
\_\_\_\_\_ involves direct observation of anti-TB medication intake.
Direct Observed Treatment Short Course (DOTS)
241
3 Properties of Anti-TB Drugs
bactericidal activity sterilizing activity ability to prevent resistance
242
Properties of Anti-TB Drugs: killing of bacteria in a log-phase growth
bactericidal activity
243
Properties of Anti-TB Drugs: kill slowly growing or intermittently replicating bacilli
sterilizing activity
244
\_\_\_\_\_ is the most potent sterilizing anti-TB drug.
Rifampicin
245
\_\_\_\_\_ is only active in the acidic intracellular environment of macrophages and in areas of acute inflammation.
Pyrazinamide
246
\_\_\_\_\_ is bactericidal against rapidly multiplying MTB in an environment with high oxygen tension and neutral pH.
Streptomycin
247
\_\_\_\_\_ is used together with other drugs to prevent emergence of resistant bacilli.
Ethambutol
248
First-Line Anti-TB Drugs
Isoniazid Rifampicin Pyrazinamide Ethambutol
249
Second-Line Anti-TB Drugs: Injectables
Aminoglycosides (Streptomycin, Kanamycin, Amikacin) Polypeptides (Capreomycin)
250
Second-Line Anti-TB Drugs: Fluoroquinlones
Levofloxacin Moxifloxacin Ofloxacin
251
Second-Line Anti-TB Drugs: Rifampicin Analogs
Rifabutin Rifapentine
252
Second-Line Anti-TB Drugs: Oral Bacteriostatic Agents
Para-Aminosalicylic Acid Cycloserine Terizidone Ethionamide Prothionamide
253
\_\_\_\_\_, formerly a first-line anti-TB drug, is now classified as a second-line drug due to the increasing resistance and its IM route.
Streptomycin
254
In cases of \_\_\_\_\_, Streptomycin may still be used as part of the initial treatment
meningitis liver disease
255
\_\_\_\_\_ and _____ have recently been approved as anti-TB drugs as they have been proven to be effective in culture conversion.
Bedaquiline (hastens conversion) Delamanid (increasing conversion rates after 8 weeks of treatment)
256
Children should be given the adult dose of anti-TB drugs once they reach \_\_\_\_\_.
25 kg
257
Isoniazid: Dose
children - 10 (10-15 mkday) adults - 5 (4-6 mkday) \*max. 300 mg/day
258
Isoniazid: Mechanism of Action
bactericidal against actively growing MTB inhibits mycolic acid synthesis inhibits catalase-peroxidase enzyme
259
Isoniazid: Adverse Reactions
hepatitis, peripheral neuropathy, allergic sken reactiong, possible hemolysis in G6PD, inhibits drug-metabolizing enzymes (DME) leading to increased risk of phenytoin, ethosuximide and carbamazepine toxicity
260
First-Line Anti-TB Drugs: bactericidal against actively growing MTB inhibits mycolic acid synthesis inhibits catalase-peroxidase enzyme
Isoniazid
261
First-Line Anti-TB Drugs: hepatitis, peripheral neuropathy, allergic sken reactiong, possible hemolysis in G6PD, inhibits drug-metabolizing enzymes (DME) leading to increased risk of phenytoin, ethosuximide and carbamazepine toxicity
Isoniazid
262
Plasma half-life of Isoniazid varies from _____ to \_\_\_\_\_.
\< 1 hour (fast acetylators) \> 3 hours (slow acetylators)
263
Discontinue Isoniazid, Rifampicin and Pyrazinamide if AST and/or ALT are \_\_\_\_\_.
\> 3-5x normal values
264
For Isoniazid and Rifampicin, there is _____ for renal dysfunction.
no dose adjustment
265
Isoniazid and Rifampicin are best absorbed on an \_\_\_\_\_.
empty stomach
266
When co-administering Isoniazid and Rifampicin, Isoniazid must not exceed \_\_\_\_\_.
10 mkday
267
Rifampicin: Dose
children - 15 (10-20 mkday) adults - 10 (8-12 mkday) \*max. 600 mg/day
268
Rifampicin: Mechanism of Action
inhibits DNA-dependent RNA polymerase
269
Rifampicin: Adverse Reactions
hepatitis, hypersensitivity reactions, flu-like symptoms, thrombocytopenia, orange discoloration of body fluids, induces drug-metabolizing enzymes (DME) resulting in decreased plasma levels of AEDs, antibiotics, hormonal therapy agents and corticosteroids
270
First-Line Anti-TB Drugs: inhibits DNA-dependent RNA polymerase
Rifampicin
271
First-Line Anti-TB Drugs: hepatitis, hypersensitivity reactions, flu-like symptoms, thrombocytopenia, orange discoloration of body fluids, induces drug-metabolizing enzymes (DME) resulting in decreased plasma levels of AEDs, antibiotics, hormonal therapy agents and corticosteroids
Rifampicin
272
Pyrazinamide: Dose
children - 30 (20-40 mkday) adults - (20-30 mkday) \*max. 2 g/day
273
Pyrazinamide: Mechanism of Action
disruption of membrane energy metabolism
274
Pyrazinamide: Adverse Reactions
nausea, vomiting, most common cause of hepatotoxicity, hypersensitivity reactions, polyarthralgia
275
First-Line Anti-TB Drugs: disruption of membrane energy metabolism
Pyrazinamide
276
First-Line Anti-TB Drugs: nausea, vomiting, most common cause of hepatotoxicity, hypersensitivity reactions, polyarthralgia
Pyrazinamide
277
Pyrazinamide requires dose modification in \_\_\_\_\_.
renal failure
278
Ethambutol: Dose
children - 20 (15-25 mkday) adults - 15 (15-20 mkday) \*max. 1.2 g/day
279
Ethambutol: Mechanism of Action
inhibits transferase enzymes involved in cell wall synthesis
280
Ethambutol: Adverse Reactions
peripheral neuropathy, retrobulbar optic neuritis (impairment of visual acuity and red-green color vision)
281
First-Line Anti-TB Drugs: inhibits transferase enzymes involved in cell wall synthesis
Ethambutol
282
First-Line Anti-TB Drugs: peripheral neuropathy, retrobulbar optic neuritis (impairment of visual acuity and red-green color vision)
Ethambutol
283
\_\_\_\_\_ was previously omitted from anti-TB regimens in children \< 6 y.o. due to difficulty monitoring optic neuritis.
Ethambutol
284
No anti-TB drug is effective against \_\_\_\_\_.
non-replicating or dormant MTB
285
\_\_\_\_\_ has the best bactericidal activity against rapidly multiplying MTB.
Isoniazid
286
Rifabutin's advantages are \_\_\_\_\_.
reduced induction of hepatic metabolism used in patients also receiving antiretroviral therapt for HIV
287
\_\_\_\_\_\_ was developed for once-weekly anti-TB therapy because it was more potent and longer-acting.
Rifapentine
288
Amikacin: Dose
children - 15-30 mkday IM/IV adults - 15 mkday IM/IV \*max. 1 g/day
289
Kanamycin: Dose
children - 15-30 mkday IM/IV adults - 15 mkday IM/IV \*max. 1 g/day
290
Streptomycin: Dose
children - 20-40 mkday IM adults - 15 mkday IM \*max. 1 g/day
291
Aminoglycosides: Mechanism of Action
bactericidal inhibits protein synthesis
292
Aminoglycosides: Adverse Reactions
nephrotoxicity, electrolyte disorders, CN VIII damage (ototoxicity), neuromuscular blockade
293
Second-Line Anti-TB Drugs: bactericidal inhibits protein synthesis
Aminoglycosides Polypeptides
294
Second-Line Anti-TB Drugs: nephrotoxicity, electrolyte disorders, CN VIII damage (ototoxicity), neuromuscular blockade
Aminoglycosides
295
Aminoglycosides are contraindicated in \_\_\_\_\_.
pregnancy
296
Aminoglycosides need dose adjustment in \_\_\_\_\_.
renal insufficiency
297
Capreomycin: Dose
children - 15-30 mkday IM adults - 15 mkday IM \*max. 1g
298
Capreomycin: Mechanism of Action
bactericidal inhibits protein synthesis
299
Capreomycin: Adverse Reactions
personality changes, psychosis, depression, seizures
300
Second-Line Anti-TB Drugs: personality changes, psychosis, depression, seizures
Capreomycin
301
Ofloxacin: Dose
≤ 5 y.o. - 15-20 mkday PO BID \> 5 y.o. - 10-15 mkday PO OD adults - 10-15 mkday PO OD
302
Levofloxacin: Dose
children - 7.5-10 mkday PO adults - 10-15 mkday PO \*max. 740 mg/day
303
Moxifloxacin: Dose
children - 7.5-10 mkday PO adults - 10-15 mkday PO \*max. 400 mg/day
304
Fluoroquinolones: Mechanism of Action
bactericidal inhibits DNA gyrase
305
Fluoroquinolones: Adverse Reactions
nausea, bloating, headache, dizziness, insomnia, tremulousness, tendon rupture, arthralgia, QTc prolongation, hypoglycemia
306
Second-Line Anti-TB Drugs: bactericidal inhibits DNA gyrase
Fluoroquinolones
307
Second-Line Anti-TB Drugs: nausea, bloating, headache, dizziness, insomnia, tremulousness, tendon rupture, arthralgia, QTc prolongation, hypoglycemia
Fluoroquinolones
308
Fluoroquinolones are avoided during _____ due to concerns for arthropathy.
pregnancy \< 18 y.o.
309
Fluoroquinolones need dose adjustment in \_\_\_\_\_.
renal insufficiency
310
Later-generation quinolones such as _____ are recommended instead of Ofloxacin since they are more potent.
Levofloxacin Moxifloxacin
311
Children _____ metabolize Levofloxacin faster.
\< 5 y.o.
312
Prothionamide: Dose
children - 15-20 mkday BID or TID adults 15-20 mkday OD or BID (500 or 750 mg/day) \*max. 1 g/day
313
Prothionamide: Mechanism of Action
weakly bactericidal blocks mycolic acid synthesis
314
Prothionamide: Adverse Reactions
GI upset, anorexia, metallic taste, hepatotoxicity, endocrine disorders, gynecomastia, hair loss, acne, impotence, menstrual irregularity, reversible hypothyroidism
315
Second-Line Anti-TB Drugs: weakly bactericidal blocks mycolic acid synthesis
Prothionamide
316
Second-Line Anti-TB Drugs: GI upset, anorexia, metallic taste, hepatotoxicity, endocrine disorders, gynecomastia, hair loss, acne, impotence, menstrual irregularity, reversible hypothyroidism
Prothionamide
317
GI symptoms caused by Prothionamide can be minimized by \_\_\_\_\_.
food bedtime intake
318
\_\_\_\_\_ is recommended while on Prothionamide.
Vit. B6
319
Ethionamide: Dose
15-20 mkday PO \*max. 750 mg/day
320
Ethionamide: Mechanism of Action
bactericidal inhibits cell wall (mycolic acid) synthesis
321
Ethionamide: Adverse Reactions
GI upset, hepatotoxicity, hypothyroidism
322
Second-Line Anti-TB Drugs: bactericidal inhibits cell wall (mycolic acid) synthesis
Ethionamide
323
Second-Line Anti-TB Drugs: GI upset, hepatotoxicity, hypothyroidism
Ethionamide
324
Ethionamide should be given at a _____ initially and if there is no adverse GI events then it can be given OD.
split dose
325
Ethionamide is contraindicated in pregnancy due to its \_\_\_\_\_.
teratogenicity
326
Cycloserine: Dose
children - 10-20 mkday q12 adults - 10-15 mkday OD or BID (500 or 750 mg/day) \*max. 1 g/day
327
Cycloserine: Mechanism of Action
bacteriostatic inhibits cell wall synthesis
328
Cycloserine: Adverse Reactions
CNS toxicity, inability to concentrate, lethargy, personality changes, peripheral neuropathy, skin problems, lichenoid eruptions, SJS
329
Second-Line Anti-TB Drugs: bacteriostatic inhibits cell wall synthesis
Cycloserine
330
Second-Line Anti-TB Drugs: CNS toxicity, inability to concentrate, lethargy, personality changes, peripheral neuropathy, skin problems, lichenoid eruptions, SJS
Cycloserine
331
Cycloserine should be used with caution in patients with pre-existing \_\_\_\_\_.
mental health issues
332
Cycloserine may be associated with severe _____ adverse reactions.
neuropsychiatric
333
Cycloserine should be avoided in patients with a history of \_\_\_\_\_.
seizure disorder.
334
\_\_\_\_\_ is recommended while on Cycloserine.
Vit. B6
335
Para-Aminosalicylic Acid (PAS): Dose
150 mkday PO OD \*max. 12 g/day
336
Para-Aminosalicylic Acid (PAS): Mechanism of Action
bacteriostatic inhibits folic acid synthesis inhibits iron metabolism
337
Para-Aminosalicylic Acid (PAS): Adverse Reactions
GI upset, hypothyroidism, hypersensitivity, crystallization in urine
338
Second-Line Anti-TB Drugs: bacteriostatic inhibits folic acid synthesis inhibits iron metabolism
Para-Aminosalicylic Acid (PAS)
339
Second-Line Anti-TB Drugs: GI upset, hypothyroidism, hypersensitivity, crystallization in urine
Para-Aminosalicylic Acid (PAS)
340
Advantages of Fixed-Dose Combination (FDC) Tablets
prescription errors are less likely less tablets to ingest the patient cannot be selective about which drugs to take
341
Fixed-Dose Combination (FDC) Tablets Preparations
H 50 mg + R 75 mg + Z 150 mg H 50 mg + R 75 mg
342
Fixed-Dose Combination (FDC) Tablets: 4-7 kg, Intensive Phase (HRZ)
1
343
Fixed-Dose Combination (FDC) Tablets: 8-11 kg, Intensive Phase (HRZ)
2
344
Fixed-Dose Combination (FDC) Tablets: 12-15 kg, Intensive Phase (HRZ)
3
345
Fixed-Dose Combination (FDC) Tablets: 16-24 kg, Intensive Phase (HRZ)
4
346
Fixed-Dose Combination (FDC) Tablets: 25+ kg, Intensive Phase (HRZ)
adult dose
347
Fixed-Dose Combination (FDC) Tablets: 4-7 kg, Continuation Phase (HR)
1
348
Fixed-Dose Combination (FDC) Tablets: 8-11 kg, Continuation Phase (HR)
2
349
Fixed-Dose Combination (FDC) Tablets: 12-15 kg, Continuation Phase (HR)
3
350
Fixed-Dose Combination (FDC) Tablets: 16-24 kg, Continuation Phase (HR)
4
351
Fixed-Dose Combination (FDC) Tablets: 25+ kg, Continuation Phase (HR)
adult dose
352
\_\_\_\_\_ should be added in the intensive phase for children with extensive disease or living in settings where the prevalence of HIV or of Isoniazaid resistance is high.
Ethambutol
353
TB Registration Groups: a patient who has never had treatment for TB or who has taken anti-TB drugs for \<1 mo.
New
354
TB Registration Groups: a patient previously treated for TB who has been declared cured or completed treatment in their most recent treatment episode, and is presently diagnosed with bacterioloically-confirmed or clinically diagnosed TB
Relapse (Retreatment)
355
TB Registration Groups: a patient who has been previously treated for TB and whose treatment failed at the end of their most recent course
Treatment After Failure (Retreatment)
356
TB Registration Groups: a patient whose sputum smear or culture is (+) at 5 mos. or later during treatment
Treatment After Failure (Retreatment)
357
TB Registration Groups: a clinically diagnosed patient for whom sputum examination cannot be done and who does not show clinical improvement anytime during treatment
Treatment After Failure (Retreatment)
358
TB Registration Groups: a patient who was previously treated for TB but was lost to follow-up for ≥ 2 mos. in their most recent course of treatment, and is currently diagnosed with either bacteriologically-confirmed or clinically-diagnosed TB
Treatment After Lost to Follow-up (TALF) (Retreatment)
359
TB Registration Groups: a patient who has been previously treated for TB but whose outcome after their most recent course of treatment is unknown or undocumented
Previous Treatment Outcome Unknown (PTOU)
360
TB Registration Groups: a patient who does not fit into any of the other groups
Others
361
TB Categories: new PTB or EPTB (except CNS/bones/joints)
Category I
362
TB Categories: new EPTB (CNS/bones/joints)
Category Ia
363
TB Categories: previously treated drug-susceptible PTB or EPTB (except CNS/bones/joints)
Category II
364
TB Categories: previously treated drug-susceptible EPTB (CNS/bones/joints)
Category IIa
365
TB Treatment: Category I
2 HRZE / 4 HR
366
TB Treatment: Category Ia
2 HRZE / 10 HR
367
TB Treatment: Category II
2 HRZES / 1 HRZE / 5 HRE
368
TB Treatment: Category IIa
2 HRZES / 1 HRZE / 9 HRE
369
TB prophylaxis is recommended for \_\_\_\_\_.
children \< 5 y.o. HIV (+) immunosuppressed individuals
370
Isoniazid Preventive Therapy (IPT) Dose
10 mkday
371
\_\_\_\_\_ is a case of TB, usually PTB, excreting bacilli which are resistant to one or more anti-TB drugs.
Drug-Resistant TB
372
\_\_\_\_\_ is the bacterial resistance present in patients who have not received prior treatment with anti-TB drugs.
Primary Resistance
373
\_\_\_\_\_ is the bacterial resistance in patients with some record of previous treatment.
Secondary Resistance
374
\_\_\_\_\_ is defined as clinical evidence of TB together with the detection of MTB from a specimen collected from the subject with genotypic or phenotypic resistance to at least Rifampicin.
Confirmed MDR-TB
375
\_\_\_\_\_ is defined as clinical evidence of TB and with positive clinical response to MDR-TB treatment or with immunological evidence of TB and documented exposure to a source case of MDR-TB.
Probable MDR-TB
376
TB is said to be cured when \_\_\_\_\_.
treatment is completed as recommended by the national policy without evidence of failure and ≥ 3 consecutive cultures taken at least 30 days apart are (-) after the intensive phase
377
The outcome when TB treatment is completed as recommended by the national policy without evidence of failure but no record that ≥ 3 consecutive cultures taken at least 30 days apart are (-) after the intensive phase is \_\_\_\_\_.
Treatment Completed
378
Risk Factors for Drug Resistance
failure to adhere to the appropriate regimen previous inappropriate treatment contact with DRTB host immigration from an area withhigh incidence of DRTB HIV (+)
379
Treatment Strategies for DRTB
Standardized Empirical Individualized
380
Treatment Strategies for DRTB: drug resistance and susceptibility (DRS) data from representative patient populations are used to base regimen design in the absence of individual drug susceptibility testing, and all patients in a defined group or category receive the same regimen
Standardized
381
Treatment Strategies for DRTB: each regimen is individually designed based in the patient's previous history of anti-TB treatment and with consideration of drug resistance and susceptibility (DRS) data from the representative patient population
Empirical
382
Treatment Strategies for DRTB: each regimen is individually designed based in the patient's previous history of anti-TB treatment and individual drug susceptibility testing results
Individualized
383
TB Treatment: focuses on sputum culture conversion
Intensive Phase
384
TB Treatment: focuses on ensuring sterilization
Continuation Phase
385
Anti-TB Drug Groups: Group 1
First-Line Oral Agents (HRZE)
386
Anti-TB Drug Groups: Group 2
Injectable Agents (Kanamycin, Amikacin, Capreomycin, Streptomycin)
387
Anti-TB Drug Groups: Group 3
Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)
388
Anti-TB Drug Groups: Group 4
Oral Bacteriostatic Second-Line Agents (Ethionamide, Prothionamide, Cycloserine, Terizidone, PAS)
389
Anti-TB Drug Groups: Group 5
Agents with Unclear Efficacy (Clofazimine, Linezolid, Amoxicillin-Clavulanic Acid, Thioacetazone, Imipenem, Cilastatin, Clarithromycin, High Dose Isoniazid - 16-20 mkday)
390
XDR-TB Treatment
use any Group 1 agents use an injectable agent to which the strain is susceptible and consider an extended duration of use if resistant to all injectable agents, use one which has not yet been given use later-generation fluoroquinolones use all Group 4 agents that have not been used extensively in a previous regimen use ≥ 2 agents from Group 5 consider low dose H treatment if with low-level resistance adjuvant surgery for local disease strong infection control measures treat HIV comprehensive monitoring and full adherence support
391
BCG Vaccine Storage
lyophilized powder (heat and light sensitive) refrigerated (2-8°C)
392
Once reconstituted, BCG must be refrigerated and used within \_\_\_\_\_.
2-3 hours
393
Contraindications for BCG
HIV (+) Immunosuppression
394
\_\_\_\_\_ are intended to be used on newborns and young infants to replace or amplify BCG early in life and on older children who have not yet been exposed or infected.
Pre-Exposure TB Vaccines
395
\_\_\_\_\_ are given post-infancy and to older age groups to reduce progression of latent TB.
Post-Exposure TB Vaccines
396
\_\_\_\_\_ are given to those with active TB in conjunction with anti-TB treatment to shorten the duration of drug therapy or reduce relapses after completion of treatment
Therapeutic Vaccines
397
Algorithm for Preventive Therapy of Childhood Tuberculosis
398
Diagnostic Algorithm for TB
399
Screening of Pediatric Drug-Susceptible Household Contacts of TB
