TB - Waldron Flashcards by Lindsey Dutton

what is an ancient human disease caused by mycobacterium tuberculosis

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what is the most common presentation of TB

pulmonary disease - arguably most concerning

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what patients are particularly vulnerable to death due to TB

HIV patients

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what type of stain is used for m. tuberculosis

Ziehl-neelsen stain
“ghost cells” neither gram + nor gram -, very poor reaction wtih Gram Stain

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what makes m. tuberculosis able to survive under extreme conditions

hip lipid content of cell wall
makes it higher infectivity with resistance to several antibiotics

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what are major risk factors for TB

socio-economic factors
immunosuppression
occupational

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How is TB spread

inhalation of infected aerosolized droplets
only person with active TB can spread TB bacteria to others - usually spread from cough, speaking or singing

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What are the first line medicatiosn for TB

Rifampin (RIF)
Isoniazid (INH)
Pyrazinamide (PZA)
Ethambutol (EMB)
Rifapentine (RPT)

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what are second line medications for TB

Kanamycin (d/c in US)
streptomycin
capreomycin
amikacin
levo/moxi/gaitifloxacin

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What are the MDR-TB medicatiosn

Bedaquiline
Linezolid
Delamanid
Pretomaanid

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If a patient is prescribed INH what else should they recieve

Pyroxidine (Vit B6) 25-50mg/day

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What are the SE of isoniazid

Asx AST/ALT elevations, clincial Hepatitis, pheripheral neurotoxicity, hypersensitivity

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what are the SE of Rifampin

orange discoloration of body fluids - especially urine.
pruritus, n/v, flu-like sxs, hepatotoxicity

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what are the SE of Rifapentine

orange discoloration of body fluids - especially urine.
pruritus, n/v, flu-like sxs, hepatotoxicity

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what are the SE of Pyrazinamide

polyarthralgias
acute gout
rash
photosensitive dermatitis
hepatotoxicity

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what are the SE of ethambutol

Retrobulbar neuritis

what are the SE of fluoroquinolones

QT prolongation

what causes drug resistance

failure to complete full course of TB treatment
meds not available or poor quality

what are granulomas

aggregation of multi-nucleated giant cells surrounding mycobacterium particle
presentation on exams: caseous or cheese-like (due to mycolic acid concentration in cell walls); caseating necrosis

what is the diagnostic histopathological hallmark of TB

granulomatous cavitation

What is the presentation of LTBI

latent TB
no symptoms, do not feel sick and cannot spread to others
will have positive TST or IGRA
capable of developing active disease if host immunosuppression and/or not treated for latent TB

what is it called when people develop TB after long period of latency

secondary tuberculosis

what are the different types of drug resistant TB

multi-drug resistant TB (MDR TB)
Pre-Extensively Drug-Resistant TB (pre-XDR TB)
Extensively Drug-Resistant TB (XDR TB)

what is Ghon focus

primary TB usually localized to middle portion of the lungs

What is the presentation of TB disease

(active) cough min 3 weeks duration, f/c, chest pain, hemoptysis, weakness/fatigue, no appetite, nocturnal sweating may spread TB to others usually has skin or blood test indicating Tb infection may have abnormal CXR or positive sputum culture needs treatment

What is the presentation of latent TB

no symptoms, cannot spread TB usually has skin or blood test indicating TB infection normal CXR and negative sputum culture needs treatment

What is miliary TB

pulmonary or systemic dissemination of tubercles in active disease CXR: millet shaped lesions, 1-3% all TB cases

what is disseminated TB

may also be seen int he spine, the CNS or bowel

who is at high risk of being infected and should get tested

exposure immigrants from TB endemic countries live or work in high-risk settings infants, children and adolescents exposure to adults at increased risk heathcare workers

what is the skin test for TB

Mantoux tuberculin skin test (TST aka PPD) preferred for children < 5 yo

what is the blood test for TB

Interferon-gamma release assay (IGRA) -QuantiFERON TB Gold Plus (PFT-Plus) - T-SPOT TB test (T-SPOT) preferred test

if a patient tests positive for TB what should they have at minimum for follow up

CXR and consider ID consults

What are the healthcare worker screenings for TB

TB risk assessment TB symptom eval TB test with additional testing as needed based on results

what are the primary meds used to treat latent TB

Isoniazid (INH), Rifapentine (RPT), Rifampin (RIF)

what are the most common possible regimens for latent TB

INH and RPT once weekly for three months (3HP) INH and RIF once daily for 3 months (3HR)

what is the treatment for active TB

4-month RPT-MOX regimen for drug susceptible TB RIF + MOX _ Isoniazid + pyrazinamide at least 5-7 weekly doses should be administered under direct observation meds are administered once daily with food

what is the RIPE TB for drug susceptible TB

6,9 months Rifampin (RIF), Isoniazid (INH), Pyrazinamide (PZA), Ethambutol (EMB) intensive 2 month phase then continuation phase for 4-7 months - good for everybody

what TB treatment medicatiosn are contraindicated in pregnancy

streptomycin kanamycin amikacin capreomycin fluorquinoloens

what is a category A for TB treatment during pregnancy

Isoniazid