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Tropical Bacteria > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

How many people develop TB each year and how many die from it?

A

10 million cases of active be TB
1.7 million deaths
Global incidence is falling by 2% each year

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2
Q

What causes TB?

A

Mycobacterium tuberculosis

M. Bovis can also cause TB

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3
Q

How is TB transmitted and what factors increase transmisibility?

A

Airborne droplet
Susceptibility (age, HIV etc)
Exposure
Infectiousness (bacillary load, AGPs, cavitation)
Environment (low UV, ventilation, overcrowding)

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4
Q

After exposure to TB what proportion of patients with clear with innate immunity and what proportion will become latent?

A

70% clear

30% latent

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5
Q

After latent TB has occurred what proportion will clear the infection with adaptive immunity?

A

Over 90%

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6
Q

What is the BCG and who gets it?

A

Live attenuated vaccine from M bovis
Provides protection against military and TBM in children.
Given to all children in high TB prevalence countries unless HIV +be

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7
Q

What are the risk factors for developing active TB?

A 
HIV 
TB exposure in last 2yrs
<2yrs old
Malnutrition
DM
Alcohol
Poverty
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8
Q

What are the symptoms of pulmonary TB?

A 
Cough
Fever
Haemoptysis
Weight loss
Very few clinical chest signs
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9
Q

What are the symptoms of lymphatic TB?

A

Neck or axilla, often solitary LN
Tender, slightly warm and fluctuant
May have sinus formation
PCR and smear +ve, also histology

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10
Q

What are the symptoms and signs of pleural TB?

A

Pleural effusion
Straw coloured exudate
PCR +ve, smear -ve

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11
Q

What are the signs and symptoms of TB meningitis?

A 
Prodrome then reduced GCS
CN palsies common
Seizures from tuberculomas
High opening pressure
PCR+ve, culture +ve
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12
Q

What are the signs and symptoms of GU TB?

A

Anywhere along tract
Sterile pyuria - culture positive
Infertility in women
Epididymitis

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13
Q

What are the signs and symptoms of pericardial TB?

A

Large globular heart

Tamponade- pulsus paradoxus

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14
Q

What are the signs and symptoms of MSK TB?

A

Most commonly spine-Potts disease
Back pain, tender and fever
Gibbus formation from wedge collapsed vertebrae

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15
Q

What e the diagnostic tests for TB and when are they useful?

A

Sputum smear -2xsamples in clinic with LED fluorescence microscopy
GeneXpertMTB/RIF- resistance, under 2hrs, more sensitive than smear (+ve in 75% of smear -ve)
Line probe assay- test for resistance in smear +ve
Urinary LAM- best for advanced HIV
Culture- gold standard but slow

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16
Q

What are tuberculin skin tests used for?

A

Epidemiological surveys to determine TB prevalence
Identification of candidates for LTBI Tx

Tells you previous, latent or active TB or BCG

17
Q

What are IGRAs used for?

A

Latent TB testing, no false +ves from BCG but may be negative in HIV

18
Q

What is the treatment for TB?

A

Rifampicin isoniazid pyrazinamide and ethambutol for 2 months then RI for 4 months
TBM and TB bone- RI for 10months

DOT
Fixed dose tablets

19
Q

What are the side effects of the standard TB drugs?

A

R- interacts with OCP + ART (need to increase dolutegravir dose), orange discolouration, liver tox
I- peripheral neuropathy, liver tox
P- liver tox, arthralgia
E- ocular tox

20
Q

How do you manage drug induced liver injury in TB?

A

Dx if ALT 5x upper limit or 3x upper limit with Sx

Stop Tx and restart with R+E, if no worse add in I, then a fluoroquinolone if still ok

21
Q

What are the different levels to drug resistant TB?

A

MDR- resistance to R+I
Pre XDR- MDR + a fluroquinolone
XDR- MDR + a fluroquinolone+ a group A drug
TDR- resistance to all first and second line drugs

22
Q

What proportion of TB patients have MDR and where are they?

A

5%
20% among retreatment cases
China, India, Soviet Union and Eastern Europe

23
Q

Who can use the shorter regimen for MDR-TB and what is it?

A 
No fluroquinolone resistance, no extrapulmonary TB, less than 1 month exposure to any of the drugs already
Bedaquiline (or amikacin)
Ethionamide
Isoniazid
Pyrazinamide
Levofloxacin/moxi
Ethambutol
Clofazimine
BEIPLEC for 4-6months
PLEC for 5 months
24
Q

What is the longer regime for MDR TB?

A 
Individualised depending on resistance
5 drugs for 8months then 4 for 1yr
3 from group A
At least one group B
Group C when A or B can't be used
25
Q

What are the group A and B drugs for MDR TB?

A 
A
Levo or moxi
Bedaquiline 
Linezolid
B
Clofazimine
Terizidone
26
Q

What are the group C drugs in MDR TB?

A 
Ethambutol
Delaminid
Pyrazinamide 
Meropenem
Amikacin
Ethionamide
27
Q

Who gets treated for latent TB?

A

HIV +ve
Household contacts if symptomatic (but no active TB), or asymptomatic and under 5yrs or over 5yrs with a positive TST/IGRA

28
Q

What is the treatment for latent TB?

A

Isoniazid and pyridonxine daily for 6 months
Or
Weekly rifapentine and isoniazid for 3 months

29
Q

How does active case finds in TB work?

A

Systematic screening of PLHIV, household contacts, prisoners
Screen with
-cough, fever, night sweats, weight loss? For HIV
-Sx, CXR, RDT

30
Q

What is the WHO definition of cured from TB?

A

A bacteriologically confirmed TB that’s smear or culture negative in the last month and on one other occasion

31
Q

What is the WHO definition of Tx completed in TB?

A

Completed Tx without evidence of failure but also no evidence of cure

32
Q

What is the WHO definition of Tx failed?

A

Smear or culture is positive at month 5 or later

33
Q

Which countries account for 2/3 of new TB cases?

A 
India
China
Indonesia
Phillipines
Pakistan
Nigeria
Bangladesh
SA
34
Q

What are the pillars of the WHO End TB Strategy?

A
  1. Integrated patient centred care and prevention
    - early Dx incl. drug resistance and screening
    - Tx all and Pt support
    - TB/HIV collaboration
    - preventative Tx of high risk and vaccination
  2. Bold policies and supportive systems
    - political commitment with adequate resources
    - engagement of communities
    - universal health coverage and case notification
    - poverty alleviation
  3. Intensified research and innovation
    - develop new tools and strategies
    - research to optimise implementation
35
Q

What are the indicators of the WHO End TB strategy?

A

95% reduction in TB deaths by 2035 (from 2915)
90% reduction in TB incidence
Zero TB affected families facing catastrophic costs due to TB

Tropical Bacteria (19 decks)

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