TB (Quiz 2) Flashcards
1
Q
What is TB?
A
- ○scientific name: mycobacterium tuberculosis
- ○acid fast, aerobic bacteria
- ○grows rapidly - divides every 15-20 hours
2
Q
How is TB spread?
A
- ○droplets expelled when someone with active TB coughs, sneezes, speaks
- ○TB NOT spread through:
- ■shaking hands
- ■sharing drinks
- ■kissing
- ■sharing toothbrushes
- ○pulmonary TB most common
3
Q
Pathogenesis of TB
A
- •droplets with bacilli inhaled and travel to alveoli
- •macrophages in alveoli ingest bacilli
- •macrophages attract phagocytes to form a shell (granuloma) around bacilli
- •most bacilli are destroyed or controlled - latent TB
- •process can take up to 8 weeks
- •some bacilli survive and multiply intracellularly
- •they are released when macrophage dies - active TB
- •macrophages attract phagocytes to form a shell (granuloma) around bacilli
- •disseminated through lymphatic system and bloodstream
- •other immune cells, such as dendritic cells, may become involved
- •extrapulmonary TB
4
Q
Epidemiology: TB by the numbers
***
A
- •in 1989, the CDC announced a goal of eradication of TB in the US by 2010
- •Also part of the Millennium Development Goals
- •Status of TB in the US per CDC reports:
- •since 1992, incidence rates have ↓ by 3-10%/year
- •9,565 total TB cases reported in 2013
- •in 2014, total cases for ages 0-24 was 1421
- •in 2013, 555 affected persons (0.2%) died from TB
- •Worldwide, rates are quite higher:
- •9.6 million new cases in 2014
- •1.0 mil = children
- •TB is listed as a leading cause of death
- •in 2014, 1.5 million died worldwide from TB
- •140,000 = children
- •9.6 million new cases in 2014
5
Q
Mapping TB: in the US
***
A
6
Q
For the Provider: Questions to ask to assess risk for TB
A
- •where are you from?
- •if not US: when do you move here?
- •have you or someone you know ever had a positive PPD or TB test?
- •have you or someone you know ever had TB? Been treated for TB?
- •have you traveled outside of the US?
- •If so, when, how long, where?*
- •do you work/reside in a crowded place (jail or homeless shelter)?
- •is there anyone at home who is immunocompromised?
- *AAP guidelines say >1wk in high risk area puts individual at risk vs. WHO says >1mo
7
Q
For the Provider: Questions to ask to assess risk for infection
A
- •Are you (child) currently experiencing any of the following?:
- •cough
- •coughing up blood
- •fever
- •weight loss or failure to thrive
- •tiredness/lethargy
- •feeling sick
- •night sweats
- *However young children often do not show these symptoms
8
Q
For the provider: •Other potentially helpful questions:
A
- •have you (child) ever had the BCG vaccine?
- •have you (child) ever had a chest x-ray? why and results?
- •are/have you (child) taken medications?
- •which medications? why?
9
Q
High risk for TB
***
A
- •close contact with person(s) with known/suspected TB
- •foreign-born individuals from high risk countries: Africa, Asia, Latin America, Eastern Europe
- •travel abroad
- •individuals who reside or work in congregate settings: jail, homeless shelter
- •health care workers
- •immunocompromised patients
- •certain populations including medically underserved, low-income, and those who abuse drugs/alcohol
10
Q
Signs and Symptoms of Pulmonary TB (more common)
on ROS
***
A
- ○a bad cough lasting 3+ weeks (dry or productive)
- ○chest pain
- ○coughing up blood or sputum
- ○weakness/fatigue
- ○loss of appetite
- ○weight loss
- ○chills
- ○fever
- ○night sweats
11
Q
Signs and Symptoms of Pulmonary TB (more common)
on exam
***
A
- ○VS: fever
- ○LAD
- ○actelectasis
- ●*may have no symptoms!!*
12
Q
What is Extrapulmonary TB?
***
A
- ●less common than pulmonary TB but is common in pts with both HIV and TB
- ●often disseminated through blood
- ●if CNS involvement, can cause meningitis
13
Q
Sx of extrapulmonary TB on ROS and exam
***
A
- ○LAD (chronic or generalized)/lymphadenitis
- ○malaise
- ○headache
- ○fever
- ○personality changes
- ○back pain
- ○abdominal pain
- ○vomiting or diarrhea
- ○melena or blood in urine…
14
Q
Active vs. Latent TB
A
- •so far what we have discussed is active… recap:
- •active infection with s/s present
- •can spread disease
- •Latent:
- •TB is present but the immune system has fought off active infection
- •no s/s to indicate its presence
- •might only be picked up incidentally or if asked the right questions
- •person is not infectious and cannot spread TB to others
- •when the immune system can no longer fight off TB, latent stage → active infection
15
Q
What is Reactivation TB?
Who is at risk?
A
- •AKA chronic, secondary, or post-primary tuberculosis
- •occurs in previously infected individual who had not fully healed
- •can go undiagnosed for a long time (years)
- •presents with similar symptoms but may have additional complications from long-term disease
- •are at risk for reactivation if:
- •immunocompromised or comorbid condition
- •recent TB infection (within the past 2 years)
- •was not treated properly for TB in the past
16
Q
Image summary: TB
A
17
Q
Differentials for TB
A
- •Depending on the presentation consider…:
- •cancer
- •GERD
- •FUO
- •Lymphadenopathy/lymphadenitis
- •fibrotic lung disease
- •anorexia nervosa
- •other infections (pneumonia, CMV, histoplasmosis)
- •other chronic conditions (diabetes, HIV, lupus)
18
Q
Screening Tests for Tuberculosis
A
26
Q
Negative vs Positive Film Findings - Child
A
HILAR LAD in pic #2
27
Q
Negative vs Positive Film Findings -Adolescent
A
2 is upper lobe infiltrates
29
Q
Algorithm: what to do if suspicion for active pulmonary TB
A
- If children < 4yo or high suspicion of active TB >>TREAT before getting back culture results
- -Younger children have risk for rapid disease progression
- -Example = abnormal chest x-ray, positive TST, positive smear
- If low suspicion is low >> wait for cultures before treating
- -Example = abnormal chest x-ray, negative TST, negative smear
- Graph source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068897/figure/F1/
