TB/NTM

Question 1

What is the usual regime for TB?

Answer 1

all 4 for 2 months and then just iso and rifamp for 4 months for pulmonary disease

latent: 3RH or 6H (if hep risk)
ocular disease- 10-12 months
CNS 10+months
LN disease- 6 months

Question 2

When are steroids indicated for TB?

Answer 2

active CNS disease
Pericardial

Question 3

In isoniazid (H) resistance how would you change your treatment?

Answer 3

Depends on risk/burden of disease/country of high resistance.

but you would complete initiation with REZ and then do continuation with RE for 7-10 months

Question 4

in which order is there resistance likely in the UK?

Answer 4

isoniazid (H)
pyrazinamide (Z)
rifamp (R)
etham (E)

Question 5

In pyrazinamide (Z) resistance how would you change your treatment?

Answer 5

2 months RHE and then 7months RH

Question 6

In ethambutol (E) resistance how would you change your treatment?

Answer 6

2 months RHZ and then 4months RH

Question 7

What is the regime in MDRTB?

Answer 7

bedaquiline, pretomanid, linezolid and moxifloxacin 6months- but can be 9

as long it is not complicated

other regimes include
6 bdq-cfx-lfx-Z-E-hH-Eto/5 cfx-lfx-Z-E

Question 8

when do you treat latent TB?

Answer 8

16-65 yr old
close contacts
healthcare workers with no Hx of TB from high risk areas
prior to biologics (pos quant)

Question 9

What proportion of latent patients develop TB?

Answer 9

5-10% lifetime risk

Question 10

How do you treat NTM?

Answer 10

RE plus azithro/clari

+/-amikacin in cavitatory disease

Question 11

What is the treatment for NTM?

Answer 11

Rifamp+Etham +…

MAC, malmoense- clari or azithro
xenopi- clari or azithro plus quinolone/iso
kansasii- clari or iso

abscessus is special-
1. initially 4 weeks of IV amikacin, IV tigecycline, IV imipenem and oral clari (if no resistance) then
2. Neb amikacin and clari/azi in combo with 1-3 of: doxy, moxiflox, cipro, co-trimox, linezolid, clofazimine

Question 12

Which NTM are slow growing?

Answer 12

MAC, M kansasii, M malmoense, M xenopi

Question 13

WHich NTM are fast growing?

Answer 13

M abscessus, M chelonae, M fortuitum

Question 14

What is Lady Windermere syndrome?

Answer 14

Described as nodular bronchiectatic NTM disease.

normally affects women- tall, thin, white women with PECTUS EXCAVATUM, scoliosis and MVP who develop RML and lingular bronchiectasis

Question 15

What is specific mac treatment?

Answer 15

Non severe- smear neg etc:
Rifamp 600mg x3/week, etham 25mg/kg x3/week and azi/clari X3/week

Severe:
Smear pos etc:
Rifamp 600 OD, etham 15mg/kg OD and azi/clari OD + consider neb amikacin for 3mo

Question 16

What is Eales disease?

Answer 16

retinal vasculitis characterised by occlusive disease and neovascularisation, leading
to recurrent vitreous haemorrhage and tractional retinal
detachment

SHOULDN’T be used in TB but often is

Question 17

In ocular TB, how long do you treat and what with?

Answer 17

6 months as per NICE, but under MDT can be 12 months depending on severity and response to treatment. You replace ethambutol with Moxiflox or Levoflox in view of eye SE of ethambutol

Question 18

How does anti-TB treatment work in ocular TB?

Answer 18

Treats systemic inflammation (ie the cause of inflammation) doesn’t act directly on the Uvea