Tuberculosis

Question 1

What is TB?

Answer 1

An infection caused by mycobacterium tuberculosis

Question 2

How is TB spread?

Answer 2

Spread from person to person via droplets in air released by person infected with TB when they cough/sneeze.

Question 3

What are the two types of TB?

Answer 3

Pulmonary TB.

Extrapulmonary TB.

Question 4

TB is subdivided into active TB and latent TB. What does each term mean?

Answer 4

Active - Evidence of symptomatic and progressive disease of lungs and/or other organs.
Latent - State of persistent immune response to stimulation by bacterium antigens but patient is asymptomatic and not infectious.

Question 5

Who discovered mycobacterium tuberculosis as the causative agent of tuberculosis?

Answer 5

Dr Robert Koch.

Question 6

Who is at risk of TB?

Answer 6

• born in high prevalence area.
• children under 5.
• close contact of infected individual.
• living conditions e.g. poor/crowded housing.
• untreated/inadequately treated TB.
• co-morbid conditions.
• poor health, hygiene, nutrition.
• immunosuppressed.
• deprived population.

Question 7

What 3 factors can cause a poorer prognosis in individuals with TB?

Answer 7

Increasing age
More extensive disease
HIV co-infection

Question 8

List the complications from TB.

Answer 8

Reduced quality of life.
Transmission to others.
Drug resistance.
Post TB bronchiectasis, COPD, heart failure.
Death.

Question 9

Differentiate between extrapulmonary and pulmonary TB.

Answer 9

Pulmonary is TB which infects the lungs.

Extrapulmonary is TB which is present in locations outside of the lungs with symptoms specific to the site involved.

Question 10

TB commonly grow in lungs - pulmonary TB. What are the signs and symptoms of this?

Answer 10

A bad cough that lasts 3 weeks or longer.
Pain in the chest.
Coughing up blood or sputum.

Question 11

What are some non-chest related TB symptoms?

Answer 11

Weakness/fatigue
Weightloss
No appetite
Fever
Chills
Sweating at night

Question 12

What are the 5 ways TB can be diagnosed?

Answer 12

Rapid molecular test
Mantoux test
Microbiological investigation
Chest X-Ray
Interferon gamma release assay test (IGRA)

Question 13

The classifications of TB = primary disease, latent infection and post primary disease. What is primary disease?

Answer 13

Defined as progression from sub-clinical infection to active disease within 5 years after infection.

Question 14

The classifications of TB = primary disease, latent infection and post primary disease. How does post primary disease occur?

Answer 14

Following treatment, disease can return in a small number of people as not all bacteria have been killed.
- can happen due to interruptions in treatment.

Question 15

List the 5 aims of treatment.

Answer 15

Cure without relapse.
Prevent death.
Stop transmission.
Prevent drug resistance.
Given by physicians with training and expertise.

Question 16

Give 5 reasons as to why resistance develops.

Answer 16

Treatment interruptions.
Lack of availability of high quality drug.
Unreliable drug supply.
Issues with compliance.
Incorrect treatment regimen given.

Question 17

Describe the initial phase of treatment of TB.

Answer 17

4 drugs used to reduce bacterial population as rapidly as possible and prevent emergence of drug resistant bacteria. This phase is continued for 2 months

Question 18

Describe the continuation phase of treatment of TB.

Answer 18

After initial phase, treatment is continued daily for a further 4 months.
- longer treatment needed in meningitis, spinal cord involvement and drug resistance.

Question 19

Define drug resistant TB.

Answer 19

Resistance to first line anti-TB drug.

Question 20

Define multi-drug resistant TB (MDR-TB).

Answer 20

Resistance to isoniazid and rifampicin.

Question 21

Define extensively drug resistant TB (XDR-TB).

Answer 21

Resistance to isoniazid, rifampicin, fluroquinolone and a second line injectable agent.

Question 22

Who is at risk from getting MDR-TB?

Answer 22

• those who do not take medicine regularly.
• those who take the incorrect dose.
• those who develop TB again, after having TB treatment in the past.
• those who come from areas in which TB-drug resistance is common.
• those is close contact with someone with drug-resistance TB disease.

Question 23

What is one side effect of each drug:

Rifampicin, Ethambutol, Pyrazinamide, Isoniazid.

Answer 23

Rifampicin = urine discolouration.
Ethambutol = visual disturbances/impairment.
Pyrazinamide = aggravated gout.
Isoniazid = peripheral neuropathy.

Question 24

Why is adherence to TB drugs a problem?

Answer 24

Duration of treatment
No. of tablets used
Side effects
Social circumstances
Lack of knowledge of medicine and disease

Question 25

In what groups can adherence be an issue?

Answer 25

Prisoners	
Homeless
History of poor compliance
Alcoholics
Drug abuse
Mental Illness

Question 26

What is the result of DOT?

Direct Observation Therapy

Answer 26

Improve adherence 
Better outcomes for the patient 
Reduce treatment failures
Reduce drug resistance 
Reduce relapse 
Patient be monitored regularly for S/E’s and response to treatment 
Reduce transmission