TUBERCULOSIS Flashcards
• A DISEASE CAUSED BY AN AEROBIC BACTERIA CALLED
MYCOBACTERIUM TUBERCULOSIS
• DISCOVERED BY ROBERT KOCH IN MARCH 24,1882
• AFFECTS THE LUNGS MOST OFTEN(PULMONARY);
• MAY ALSO AFFECT OTHER PARTS OF THE BODY SUCH AS BONES, INTESTINES, KIDNEY, MENINGES OF THE BRAIN, LIVER, LYMPH NODES
TUBERCULOSIS
- ROD-SHAPED, THIN, ACID-FAST, NON-SPORE-FORMING, STRICT AEROBE
- CAN SURVIVE FOR SEVERAL HOURS IN RESPIRATORY DROPLETS
- CAN BE DESTROYED IN 20 MINUTES AT 60 DEGRESS AND 5 MINUTES AT 70 DEGRESS CELSIUS
- VERY SENSITIVE TO DIRECT SUNLIGHT ( CAN BE KILLED IN 5 MINUTES),MAY SURVIVE IN THE DARK FOR YEARS
MYCOBACTERIUM TUBERCULOSIS
TYPES OF TUBERCULOSIS
- ACUTE CLINICAL ILLNESS DIRECTLY FOLLOWING INFECTION LATENT TB
- EVIDENCE OF EXPOSURE WITHOUT ACTIVE DISEASE
- POSSIBLE PERSISTENCE OF DORMANT BACILLI FOR YEARS
- NONINFECTIOUS
PRIMARY TUBERCULOSIS (TB)
TYPES OF TUBERCULOSIS
- REACTIVATION OF PREVIOUSLY ACQUIRED INFECTION CAUSED BY PREVIOUSLY DORMANT BACILLI (10% REACTIVATION RISK)
- OFTEN INFECTIOUS
SECONDARY TB (AKA ADULT-TYPE TB OR REACTIVATION TB)
TYPES OF TUBERCULOSIS
POSITIVE SKIN TEST WITH NO EVIDENCE OF ACTIVE
INFECTION
LATENT TB
RISK FACTORS OF TB
A. CLOSE CONTACT WITH INFECTED PERSON • POVERTY • HOMELESSNESS • DRUG ABUSE • INCARCERATION • RESIDENCE IN NURSING HOME OR LONGTERMCARE FACILITY
B. LIVING / EXPOSURE TO ENDEMIC AREA (PHILIPPINES!)
TRANSMISSION OF TB
• THROUGH AIR
• TRANSMITTED BY AEROSOL/DROPLET, INHALATION THROUGH COUGHING/SNEEZING A PERSON WITH TB
(AEROSOLIZED RESPIRATORY DROPLETS)
• DROPLETS INHALED BY SUSCEPTIBLE PEOPLE
SIGNS AND SYMPTOMS OF PULMONARY TB
• COUGH, PRODUCTIVE OR NOT, OF TWO WEEKS OR MORE, WITH OR WITHOUT:
- F EVER
- E ASY FATIGABILITY
- W EIGHT LOSS
- B LOODY SPUTUM(HEMOPTYSIS)
- A NOREXIA
- N IGHT SWEATING
- S HORTNESS OF BREATH
CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)
HAS BEEN TREATED BEFORE WITH ANTI-TB DRUGS FOR AT LEAST ONE MONTH.
- PREVIOUSLY TREATED FOR TB AND DECLARED CURED OR
TREATMENT COMPLETED, BUT IS PRESENTLY DIAGNOSED WITH ACTIVE TBDISEASE
RELAPSE
CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)
HAS NEVER HAD TREATMENT FOR TB OR HAS TAKEN
ANTI-TB DRUGS FOR LESS THAN ONE MONTH
NEW
CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)
HAS BEEN TREATED BEFORE WITH ANTI-TB DRUGS FOR AT LEAST ONE MONTH.
- PREVIOUSLY TREATED FOR TB BUT FAILED MOST
RECENT COURSE BASED ON A POSITIVE SMEAR AT FIVE MONTHS OR LATER,OR A CLINICALLY DIAGNOSED PATIENT W/O CLINICAL IMPROVEMENT ANYTIME
TREATMENT AFTER FAILURE
CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)
PREVIOUSLY TREATED FOR TB BUTDID NOT COMPLETE TREATMENT AND LOST TO FOLLOW-UP FOR AT LEAST TWO MONTHS IN THE MOST RECENT COURSE
RETREATMENT: TREATMENT AFTER LOST TO FOLLOW-UP
CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)
PREVIOUSLY TREATED FOR TB BUT WHOSE OUTCOME IN THE MOST RECENT COURSE IS UNKNOWN
RETREATMENT: PREVIOUS TREATMENT OUTCOME UNKNOWN
CLASSIFICATION OF TB
(BASED ON HISTORY OF PREVIOUS TREATMENT)
PATIENTS WHO DO NOT FIT ANY OF THE CATEGORIES LISTED ABOVE OR PREVIOUS TREATMENT HISTORY IS UNKNOWN
RETREATMENT: PATIENTS WITH UNKNOWN PREVIOUS TB TREATMENT HISTORY
- REFERS TO DISEASE OUTSIDE THE LUNGS
- IT IS SOMETIMES CONFUSED WITH NON-RESPIRATORY DISEASE
- IS AN INFECTION CAUSED BY TUBERCULOSIS BACTERIA THAT HAVE SPREAD BEYOND THE LUNGS
EXTRA-PULMONARY TUBERCULOSIS
EXTRAPULMONARY SITES OF TB
- LYMPH GLANDS AND ABSCESSES PARTICULARLY AROUND THE NECK (40%)
- PLEURA (20%)
- SKELETAL (POTTS) / ORTHOPAEDIC SITES SUCH AS BONES AND JOINTS (10%)
- GU TRACT- DIFFERENT SITES AFFECTED
- IN WOMEN: UTERUS
- IN MEN: EPIDIDYMIS
- RENAL DISEASE
- BRAIN (TB MENINGITIS)
CLINICAL PRESENTATION:
EXTRA-PULMONARY TUBERCULOSIS
• LYMPH GLANDS (TUBERCULOUS LYMPHADENITIS; SCROFULA)
- DEVELOP SINGLY OR IN CHAINS
- BECOME SWOLLEN PAINFUL AND MAY HAVE A RUBBERY
TEXTURE
CLINICAL PRESENTATION:
PLEURAL TB
- FEVER
- PLEURITIC CHEST PAIN
- DYSPNEA
- DULLNESS TO PERCUSSION/ABSENCE OF BREATH SOUNDS
CLINICAL PRESENTATION:
TB OF UPPER AIRWAYS (LARYNX, PHARYNX, AND/OR EPIGLOTTIS)
- HOARSENESS
- DYSPHONIA
- DYSPHAGIA
- CHRONIC PRODUCTIVE COUGH
CLINICAL PRESENTATION:
SKELETAL TB
WEIGHT-BEARING JOINTS ARE AFFECTED MOST COMMONLY.
> SPINE IN 40% OF CASES
> HIPS IN 13%
> KNEES IN 10%
CLINICAL PRESENTATION: SPINAL TB (POTT'S DISEASE, TUBERCULOUS SPONDYLITIS)
- OFTEN INVOLVES ≥ 2 ADJACENT VERTEBRAL BODIES
- BACK PAIN
- NEUROLOGIC SIGNS OF SPINAL CORD COMPRESSION, INCLUDING PARAPLEGIA
- LOWER THORACIC AND UPPER LUMBAR VERTEBRAE USUALLY AFFECTED IN ADULTS
CLINICAL PRESENTATION:
MILIARY TB
- DUE TO HEMATOGENOUS SPREAD OF TUBERCLE BACILLI
- LESIONS ARE USUALLY YELLOWISH
GRANULOMAS 1–2 MM IN DIAMETER THAT RESEMBLE MILLETSEEDS - CHEST XRAY: MILIARY RETICULONODULAR PATTERN
When can be done a Chest X-ray when sputum exam is negative
simultaenously or after
DIAGNOSIS OF TB
- Epidemiology
- Radiograph
- Tuberculin Skin Test
- Sputum Smear
- Adenosine Deaminase(ADA)
- EPIDEMIOLOGY (HX OF CLOSE CONTACT)
- ABNORMAL RADIOGRAPH (UPPER-LOBE INFILTRATES & CAVITIES)
- POSITIVE TUBERCULIN SKIN TEST (TST) AMONG CHILDREN
- POSITIVE SPUTUM SMEAR
- DETERMINATION OF ADENOSINE DEAMINASE (ADA) FOR PLEURAL TB
Gold standard in Diagnosing TB
MOLECULAR DIAGNOSTIC TEST
TREATMENT GOALS OF TB:
- TO INTERRUPT TRANSMISSION
- INITIAL/BACTERICIDAL PHASE
- TO CURE
- CONTINUATION/STERILIZING PHASE
TREATMENT PRINCIPLES OF TB:
- MULTIPLE DRUGS: TO PREVENT EMERGENCE OF RESISTANCE
* LONG DURATION: TO PREVENT RECURRENCE
DRUG REGIMEN OF TB
- ISONIAZID(H), 5
- RIFAMPICIN (R), 10
- PYRAZINAMIDE (Z), 25
- ETHAMBUTOL (E), 15
- STREPTOMYCIN(S)
Drug in TB that can cause Orange/red colored urine
Rifampicin
Drug in TB that can cause optic neuritis
Ethambutol
Drug in TB that can cause hearing impairment
Streptomycin
TB Classification based on drug-susceptibility testing:
RESISTANCE TO ONE FIRST-LINE ANTI-TB DRUG (FLD) ONLY
MONORESISTANT TB
TB Classification based on drug-susceptibility testing:
RESISTANCE TO MORE THAN ONE FIRST – LINE ANTI – TB DRUG (OTHER THAN BOTH ISONIAZID AND RIFAMPICIN)
POLYRESISTANT TB
TB Classification based on drug-susceptibility testing:
RESISTANCE TO RIFAMPICIN DETECTED USING PHENOTYPIC OR GENOTYPIC METHODS, WITH OR WITHOUT RESISTANCE TO OTHER ANTI-TB DRUGS.
RIFAMPICIN RESISTANT TB (RR – TB)
TB Classification based on drug-susceptibility testing:
RESISTANCE TO AT LEAST ISONIAZID AND RIFAMPICIN, WITH OR WITHOUT RESISTANCE TO OTHER ANTI-TB DRUGS.
MULTIDRUG – RESISTANT TB (MDR – TB)
TB Classification based on drug-susceptibility testing:
MDR – TB WITH RESISTANCE TO ANY FLUOROQUINOLONE AND TO AT LEAST ONE OF THE THREE SECOND – LINE INJECTABLE DRUGS (CAPREOMYCIN, KANAMYCIN, AND AMIKACIN)
EXTENSIVELY DRUG – RESISTANT TB (XDR – TB)
ART SHOULD BE STARTED WITHIN THE FIRST ___ OF TB TREATMENT FOR PROFOUNDLY IMMUNOSUPPRESSED PATIENTS WITH CD4+ T CELL COUNTS OF <50/UL
2 WEEKS
ALL HIV-INFECTED TB PATIENTS, REGARDLESS OF CD4+ T CELL COUNT, ARE CANDIDATES FOR ART, WHICH OPTIMALLY IS INITIATED AS SOON AS POSSIBLE AFTER THE DIAGNOSIS OF TB AND WITHIN THE FIRST ___ OF ANTI-TB THERAPY
8 WEEKS
IS MOST WIDELY USED IN SCREENING FOR LTBI
SKIN TEST WITH TUBERCULIN PPD (TST)
COMMON IN IMMUNOSUPPRESSED PATIENTS AND IN THOSE WITH OVERWHELMING TB
vFALSE-NEGATIVE REACTIONS
INFECTIONS WITH NONTUBERCULOUS MYCOBACTERIA AND BCG VACCINATION
FALSE-POSITIVE REACTIONS
Tx for Latent TB infection
Isoniazid/ Rifampin
- WHO-APPROVED TREATMENT REGIMEN, AVAILABLE IN SE ASIA
* TB CAN BE CURED IF THE FULL COURSE OF THE PRESCRIBED DRUGS IS TAKEN REGULARLY, AND WITHOUT INTERRUPTION
DOTS (DIRECTLY-OBSERVED TREATMENT)
PREVENT TB TRANSMISSION
- ENSURING GOOD VENTILATION
- MAINTAINING A CLEAN ENVIRONMENT
- CONSULTING A PHYSICIAN REGULARLY
- EATING HEALTHY FOOD
- EXERCISING REGULARLY
- PRACTICING THE RIGHT WAY TO COUGH
Vaccine to prevent TB
BCG VACCINE AT BIRTH
