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Pharmacotherapeutics > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Definition of Tuberculosis

A

communicable infectious disease caused by Mycobacterium tuberculosis which produces silent, latent infection or a progressive active disease, regarded as leading infectious killer disease

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2
Q

Diagnosis of TB in children

A

• Tuberculin Skin Test (TST)
• Chest X-ray
• microscopy
• culture of sputum, fluid, and tissue samples

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3
Q

Cause of TB

A

Mycobacterium tuberculosis bacilli

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4
Q

Transmission:

A

Spread through micro-sized droplet nuclei during coughing and sneezing

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5
Q

risk of infection with cavitary and laryngeal TB

A
  • Cavitary pulmonary TB-Patients with cough can infect one person per month until treated
  • Laryngeal TB-Even talking can spread M. tuberculosis, increasing transmission risk
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6
Q

Immune System Role

A

Tasked with recognizing and suppressing M. tuberculosis

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7
Q

Key Cell Types

A

Macrophages
CD4 T-Lymphocytes (Helper lymphocytes)
CD8 T-Lymphocytes (Cytotoxic/suppressor lymphocytes)

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8
Q

Macrophages’ Function

A
  • Present antigens
  • activate interleukins
  • secrete interferons
  • and activate other macrophages to destroy M. tuberculosis.
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9
Q

Cytotoxic T-Lymphocytes

A

Responsible for destroying cells harboring Mycobacterium

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10
Q

Immuno-regulatory Role of T-Lymphocytes

A

T-Lymphocytes contribute to the host’s resistance to developing infection.

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11
Q

HIV Impact

A

In HIV, destruction of CD4 T-Lymphocytes increases the risk of developing active TB disease

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12
Q

Risk factors for TB


A
  • Previous exposure to pulmonary TB case
  • History of previous TB
  • Immune status
  • Close contacts to TB patients
  • Race and ethnicity
  • Age, gender, and occupation
  • HIV status
  • Location and place of birth
  • Urban vs rural areas
  • Underprivileged patients
  • Recalcitrant patients
  • History of working at mines
  • History of diabetes, smoking, alcoholism, malnutrition
  • Prolonged treatment with steroids
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13
Q

Diagnosis of TB


A
  • Sputum smear microscopy
  • microbiology culture and sensitivity
  • molecular assays like GeneXPert, chest X-ray
  • clinical presentation evaluation
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14
Q

M. tuberculosis


A

Bacilli causing TB, transmitted from person to person through microsize droplet nuclei dispersed through coughing and sneezing

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15
Q

Risk factors for TB in children


A
  • History of recent contact with TB case
  • Age
  • Time since exposure/infection
  • Immune status
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16
Q

Monitoring parameters for adverse drug reactions


A
  • Adherence to therapy
  • Adverse drug reactions specific for each medication
  • Smear test q 1-2 weeks to be negative in ~ 2 weeks
  • Sputum culture q 2-3 months to be negative at 2 months
  • Liver function tests
  • Serum creatinine
  • Eye examinations
17
Q

Management of TB: 1st Line Medicine


A
  • Isoniazid (H)
  • Rifampicin (R)
  • Pyrazinamide (Z)
  • Ethambutol (E)
  • Streptomycin (S)
18
Q

Risk factors for TB


A
  • Prolonged treatment with steroids
  • History of recent contact with TB case
  • Age i.e. the very young < 3 years
  • Time since exposure/infection (TB disease likely to develop within 1 year)
  • Immune status – increased risk of TB disease if have HIV infection, malnutrition, immune suppressive therapy e.g. chemotherapy, corticosteroids
19
Q

Goal of management of TB


A
  1. Prompt resolution of signs and symptoms of disease
  2. Cure the patients (in a short period of time)
  3. Restore quality of life
  4. Prevent morbidity and mortality
  5. Prevent relapse and development of drug resistance
  6. Prevent TB transmission to others
20
Q

Prophylaxis for TB patients


A

Children: Isoniazid
HIV positive children and adults: Cotrimoxazole – daily dosing

21
Q

Fixed Combination First-line Anti-TB Agents in Paediatrics

A

Recommended regimen for TB
* New patients < 30 kg: 2HRZE/4HR
* New patients ≥ 30 kg: 2HRZE/4HRE
* Retreatment: 2HRZES/1HRZE/5HRE

22
Q

Non-Pharmacological management of TB

A
  1. Prevention of spread of disease through isolation and infection control guidelines
  2. Contact investigation/tracing
  3. Replenishment to normal weight
23
Q

Clinical presetation

A
  • Generalized symptoms:
    – Loss of appetite
    – Weight loss
    – Malaise
    – Fever ≥ 2 weeks
    – Night sweats
  • As disease progresses:
    – Persistent cough – productive cough ≥ 2 weeks
    – Shortness of breath, chest pains or hemoptysis
24
Q

Physical exams and radiological findings consistent with TB

A
  • Physical examination: lungs
  • Abnormal with crepitations
  • CXR – radiographic findings:
    – Patchy or nodular infiltrate in apical areas of upper
    lobe or superior segment of lower lobes
    – Cavitation ∓ fluid (as disease progresses)
25
Q

Clinical presentation: Paediatric

A
  • Weight loss or failure to thrive
  • Enlargement of lymph nodes (> 1 x 1 cm)
  • Cough for ≥ 2 weeks
  • Fever for ≥ 2 weeks
  • Fatigue, reduced playfulness
  • Profuse night sweats ≥ 2 weeks
  • Physical examination
    – Cough, wheezing, respiratory distress
    – Haemoptysis – rare in children w/ PTB

Pharmacotherapeutics (6 decks)

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