Tuberculosis Flashcards

1
Q

What is pulmonary TB

A

life threatening infection of the lungs that can disseminate

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2
Q

Why is Tb spreading globally

A

HIVAIDS
Poverty
Lack of health services
New, resistant strains

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3
Q

Who is affected by TB more

A

racial and ethnic minorities

1 death every 15 seconds

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4
Q

how is Mycobacterium Tuberculosis spread

A

through respiratory droplets by people with ACTIVE TB (bacilli in the respiratory droplets)
**Exposure must be prolonged

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5
Q

What 2 things can happen if someone is exposed to TB

A

Don’t develop TB

Immune system responds 2-8 weeks after exposure

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6
Q

What is the immune response to TB exposure

A

Macrophages wall of the bacteria and it remains dormant for years (Latent TB Infx)

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7
Q

Is latent TB infective?

A

No, and its not even symptomatic. but it CAN be reactivated

will have + skin test

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8
Q

What if the immune system fails?

A

Macrophages form granulomas inside which TB multiply

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9
Q

What is in the middle of a granuloma

A

Necrosis (caseating)

over time, it will liquefy, break through the wall, and bacteria will spill out

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10
Q

What happens after a granuloma breaks open

A

Cavitations (large air spaces) form, prefect breading ground for bacteria
Hundreds of bacteria spill out and can disseminate to the rest of the body

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11
Q

What are the stages of TB

A

Primary: 5% become Active (PPTB), 95% become Latent (LTBI)
Secondary: Reactivated TB( LTBI–>Active)

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12
Q

When is secondary TB more common

A

if patient has not received prophylaxis

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13
Q

What is the first indication of HIV

A

Sudden onset TB infection

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14
Q

What constitutes “immunosuppressed” individuals

A
HIV
Substance Abuse
Immunosuppressive therapy
Kids <5
Malnourished
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15
Q

What are RF for TB

A

Immunosuppressed
Crowded living conditions
Exposure to TB through work/travel
Nationality (African, Asian, or Latin American)

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16
Q

It is crucial to preform a TB test prior to starting someone on

A

Immunosuppressive therapy, like Humira

make sure they don’t have LTBI

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17
Q

When is the risk for LTBI–>Active the greatest

A

in the first two years

18
Q

What are symptoms of active TB

A

*Cough >3 weeks, +/- sputum or hemoptysis
CP, fever, chills, fatigue, anorexia, weight loss
–Sx can be absent in mild disease

19
Q

What is a classic TB physical exam finding

A

*Post-tussive rales (just like PNA)

20
Q

What are CXR findings in PPTB

A

*Hilar adenopathy
PE
Hilar or middle lobe infiltrates

21
Q

What are CXR findings in Reactivation TB

A

Apical/upper lobe infiltrate/cavitation

22
Q

What are CXR findings in healed primary TB

A

Ghon/Ranke complex- calcified primary focus with hilar lymph node
(minority of patients)

23
Q

How can you test for TB

A

*Sputum culture (1-8 weeks)
NAT
Sputum smear (supports, doesn’t diagnose)
Biopsy (Necrotizing granulomas)

24
Q

What is proper technique for sputum culture

A

3 morning sputum specimens

25
Q

How does the Mantoux test (PPD) work

A

4-10 weeks after exposure, reaction will develop

Measures undulation, must be read w/in 48-72 hours

26
Q

What should you do if a PPD test comes back positive

A

get a CXR to R/O active disease
(If pt is asymptomatic, it’s probably not TB)
get IGRA blood test (BCG vaccine?)

27
Q

What is PPD recommendation for healthcare workers

A

2 step PPD test recommended
If #1 is negative, come back in 1-3 weeks
If #2 is positive, TB infection in the distant past

28
Q

What can cause a false positive in PPD test

A

Bacillus Calmette-Guerin vaccine

29
Q

What PPD results indicate positive TB

A

Immunocompromised: 5+mm induration
High risk pt: 10+mm induration
Everyone else: 15+mm induration

30
Q

What is an IGRA

A

interferon gamma release assay; blood test, better than a PPD but expensive and no evidence for kids
IF it comes back positive, must r/o TB with a CXR

31
Q

What does County preform

A

TSPOT TB test (a type of IGRA), esp. in anyone who has received an IGRA vaccine
(local labs do the quantiferon TB gold IGRA)

32
Q

What are the advantages of an IGRA

A

only need a single visit, results are not subjective, BCG has no effect

33
Q

When should you report TB to county

A

WITHIN 24 HOURS OF DX

34
Q

How do you treat Active TB

A

Isolated - pressure hospital room, pt wears mask, provider wears respirator
Eventually will get all 4 RIPE drugs (Rifampin- Isoniazid- Pyrazinamide- Ethambutol)

35
Q

How do you treat latent TB

A

only when benefits outweigh the risks

after R/O TB, give prophylaxis to prevent active TB (Isoniazid + B6 for 9 mo.)

36
Q

What must you monitor when giving Prophylactic treatment

A

LFT’s, Isoniazid is hepatotoxic

37
Q

What are complications of TB

A

Immunocompromise (HIV)
Drug resistance (Multi or Extreme)
Miliary TB

38
Q

How can you prevent TB

A

identify those at risk
annual skin test for high risk
prophylaxis for LTBI

39
Q

What are the RIPE drug side effects

A

Rifampin: orange secretions (pee, tears, poop, sweat)
Isoniazid: hepatitis, peripheral neuropathy
Pyrazinamide: hepatotoxic, hyperuricemia
Ethambutol: optic neuritis

40
Q

Why give B6 in addition to Isoniazid when treating prophylactically

A

to counteract the peripheral neuropathy