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Pulm 2 > Tuberculolsis > Flashcards

Tuberculolsis Flashcards

1
Q

what two-subspecies cause tuberculosis?

A
  • mycobacterium tuberculosis- common, human
  • mycobacterium bovis- rare, humans, cattle, deer, elk
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2
Q
  • bacillus
  • do not show up on gram stain
  • require a special stain: Acid fast stain; ziehl-neelsen stain
  • grow on special media
A

mycobacterium tuberculosis

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3
Q

Risk factors for TB

A

HIV infection

  • Markedly increases risk of acquiring TB
  • risk of TB increases with degree of T-cell suppresion (lower CD4 count)

Contact

  • with a known infectious case of TB

-Immigration from a country where TB is endemic
-immunosuppressed
-injection drug users
-residents and employees of: prisons and jails, nursing homes, hospitals, HIV hospices, homeless shelters

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4
Q

Transmission of TB

A
  • Small droplet particles
  • air infectious even after person leaves
  • close contact increases risk
  • one case will infect 80% of susceptible contacts
  • human crowding marked risk factors
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5
Q

clinical manifestations of TB?

A

Constitutional symptoms

  • anorexia
  • fatigue
  • weight loss
  • afternoon fever
  • night sweats

Focal symptoms

  • productive cough
  • hemptysis
  • chest pain
  • hoarsness
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6
Q

physical exam findings in TB

A
  • may be no findings despite extensive disase
  • chest dullness to percussion
  • rales
  • tubular breath sounds
  • whispered pectoriloquy
  • distant hollow breath sounds (amphoric)
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7
Q

Radiographic manifestations of pulmonary TB?

A
  • Patchy or nodular infiltrates in upper lobes
  • cavity formation
  • hilar adenopathy
  • segmental or lobar infiltrate
  • atelectasis
  • pleural effusion
  • miliary TB
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8
Q

extrapulmonary manifestations of tuberculosis?

A
  • Meningitis
  • bone- osteomylitis (long bones, spine- “Pott’s disease”
  • Gastrointestinal
  • renal
  • genital- esp. female GU tract
  • scofula- isolated lymph node in neck
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9
Q

diagnosis of TB?

A
  • tuberculin skin test
  • interferon gamma release assays
  • sputum smear
  • culture
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10
Q
  • HIV infected persons
  • contacts of patients with TB disease
  • other immunocompromise (>15 mg prednisone/day)
  • fibrotic change on CXR- old TB
A

5mm of induration

High pretest probablility cutoff

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11
Q
  • No known risk factors
  • age 4 or greater
A

15mm of induration

Low pretest probability

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12
Q
  • recent immigrants from high prevalence areas
  • injection drug users
  • children < 4 years
  • children and adolescents exposed to high risk adults
  • residents and employees of prisons/jails, nursing homes, hospitals, underlying medical conditions etc
A

10mm of induration

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13
Q

what could cause a false negative tuberculin skin test

A
  • general illness
  • steroid therapy
  • immunosuppression
  • long duration of infection
  • malnutrition
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14
Q

what causes false positives in tuberculosis?

A
  • non-tuberculosis mycobacteria
  • BCG vaccine does not cause more than 10mm of induration and a positive ppd should not be attributed to the BCG vaccine
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15
Q
  • whole blood assay
  • measures immune response to M. tb antigens
  • no response to non-tuberculosis mycobacteria or BCG
  • less subjective than TST
  • not standardized for children < 5
  • may be falsely negative in active disease; expensive
A

Quantiferon Gold active TB disease

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16
Q

indications for a sputum smear in TB?

A
  • when PPD or IGRA is positive and CXR is abnormal
  • not needed when PPD or IGRA positive and CXR is normal
17
Q
  • requires three specimens from separate days
  • induced with saline under infection control precautions
  • if patient cannot cooperate- gastic aspirates, or bronchioalveolar lavage
  • requires about 10,000organisms/ ml to be psitive
A

Sputum smear

18
Q
  • Done is specialized labs on an body fluid or tissue
  • gold standard
  • special media- lowenstein jensen
  • takes 1-8 weeks to grow
  • molecular probes increase turnaround time
A

Culture

dx of TB

19
Q

first line agents of TB?

A
  • Isoniazid (INH)
  • rifampim (RIF)
  • pyrazinamide (PZA)
  • ethambutol (EMB)
  • streptomycin (STM)
20
Q

Adverse events of Isoniazid?

A
  • Rash, increased ALT/AST
  • hepatitis, peripheral neruopathy (interferes with Vitamin B6 metabolism; presents with numbness and tingling
  • mild CNS effects
  • drug interactions: Dilantin, disulfuram
21
Q

how should you monitor isoniazid?

A
  • Baseline LFTS (monthly or more if abn or symptoms)
  • hepatitis (risk increases with age, the risk increases with alcohol consumption)
  • Vitamin B6- prevents neuropathy
22
Q

Adverse effects of rifampin

A
  • GI upset
  • drug interactions
  • hepatitis
  • bleeding
  • flu-like symptoms
  • rash
  • renal failure
  • fever
  • orange body fluids
23
Q

monitoring of rifampin?

A

baseline LFTS, CPC, plts- adults
monthly if more abn or symtoms

24
Q

adverse effects of Pyrazinamide

A
  • Hepatitis
  • rash
  • GI upset
  • joint aches
  • hyperuricemia
  • gout
25
Q

monitoring of pyrazinamide?

A
  • uric acid, LFTs baseline
  • montly if abn or symptoms
  • may make glucose control more difficult in diabetics
26
Q

adverse effects of ethambutol and monitoring?

A
  • optic neuritis
  • rash

Monitoring

  • baseline and monthly tests of visual acuity and color vision
27
Q

adverse events and monitoring of streptomycin?

A
  • ototoxicity
  • renal toxicity

monitoring

  • baseline hearing and renal function, repeat monthly
  • avoid or reduce dose in adults > 60 yrs
  • injectable only
28
Q

Second line Tb agents

A
  • rifapentene (related to rifampin)
  • fluroquinolones
  • ethionamide
  • amikacin
  • linezolid

mainly used with drug resistant TB

29
Q

treatment of active TB in the initial 2 months and subsequent 4 months

A

Initial 2 months (given daily for 2 weeks per week for 6 weeks)

  • INH
  • RIF
  • PZA
  • EMB* OR STM*

Subsequent 4 months (given 2x per week)

  • INH
  • RIF

6 month duration

30
Q

monitoring treatment of active disease?

A
  • check sputum smear every two weeks until negative
  • send isolate for susceptiblity testing
  • if smear do not convert to negative suspect non-adherence or drug resistance
31
Q

treatmet of latent LTBI?

A

Isoniaziad

  • adults 300mg daily
  • children 10mg/kg/day once daily
  • 9 months duration
  • pyridoxine (vitamin b6) if dietary risk
32
Q

alternative treatment of latent TB

A

Rifampin daily for 4-6 months
INH + rifapentene (once weekly 3 months, DOT only)

33
Q

Monitoring of latent TB infection

A

Monitoring

  • adults- liver panel at baseline and prn during therapy
  • children- Liver panel only if symptoms

Do not repeat PPD - will be positive for life

34
Q
  • Remain infectious until sputum converts to negative
  • should remain at home
  • wear mask when in public/clinic vistis
A

active disease

35
Q

not infectious
no quarantine. or isolation precautions

A

latent TB

negative chest X-ray, asymptomatic

36
Q

prevention of TB?

A
  • screen all at risk patients with PPD
  • identify cases of active disease
  • trace contacts
  • give close contacts prophylactic antibiotics
  • treat cases of LTBI
  • old fashion public health nursing

Pulm 2 (8 decks)

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