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Internal Medicine (IM platinum) > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Etiopathogenesis of TB

A
  • caused by Mycobacterium Tuberculosis
  • Transmission: droplet nuclei
  • 85% lungs
  • Most infectious patients: cavitary pulmonary disease
  • Typical TB lesion
    • epitheloid granuloma with central caseation necrosis
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2
Q

Presumptive TB

A
  • Any person who presents with sx or signs (>15 years old)
    • Cough >2 weeks
    • Unexplained cough of any duration in those with close contact with a known active TB case, high risk group
    • Associated sx: weight loss, fever, hemoptysis, chest/back pain, fatigue, night swets, dyspnea
    • CXR findings suggetive of TB
  • Presumptive EPTB; may have gibbus, neck stiffness, lymphadenopathy, pleural or pericardial effusion, ascites, painful joints, tuberculin hypersensitivity
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3
Q

TB EXPOSURE

A

Individual is in close contact with an active adult TB case, but without signs and symptoms of TB;

  • with negative TST reaction, and
  • no radiologic or laboratory findings suggestive of TB
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4
Q

TB infection or Latent TB infection

A
  • Individuals have no signs, symptoms, Radiologic nor laboratory evidence of TB, but has a positive TST reaction
  • Treatment is not recommended
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5
Q

TB Disease

A

Individual with presumptive TB who is confirmed to have TB by any clinical and diagnostic evaluation

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6
Q

Classification of TB-Disease based on Anatomical Site and bacteriologic Status

A
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8
Q

Classification Based on History of Previous Treatment

A
  • New case
    • Never had treatment or who has taken anti-TB meds <1 month
  • Retreatment case
    • previously treated for at least 1 month
  • Relapse
    • previously treated, was declared cured or completed the treatment, and is now bacteriologically or clinically diagnosed TB
  • Treatment After Failure
    • Previously treated and failed treatment
      • Sputum smear or culture (+) at 5 months or later during treatment
      • Clinically diagnosed patient, no sputum, without clinical improvement anytime during the course
  • Treatment after Lost to follow-up
    • Previously treated but Lost to follow up for >2 months and currently diagnosed TB
  • Previous Treatment Outcome Unknown
    • Previously treated
    • Outcome not documented
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9
Q

algorithm for DX of TB

A
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10
Q

Management of TB

A
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11
Q

Classification based on Drug Susceptibility

A
  • Monoresistant TB
    • only to 1 first line drug
  • Polydrug resistant
    • >1 first line (other than both INH and Rifampicin)
  • MDR-TB
    • both INH and Rifampicin
  • XDR-TB
    • any fluoroquinolone and to at least 3 2nd lne injectable drug (capreomycin, Kanamycin, Amikacin) in addition to MDR
  • RR-TB
    • Rifampicin detected using phenotypic or genotypic methods with or without Resistance to other
    • Rifampicin, whether monoresistance, MDR, PDR, or XDR
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14
Q

Category I

A

New PTB

New EPTB

  • Initial Phase
    • 2 HRZE
  • Continuation
    • 4HR
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15
Q

Category Ia

A

New EPTB (CBS/bones or joints)

  • Initial phase:
    • 2HRZE
  • Continuation Phase:
    • 10 HR
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16
Q

Category II

A

Previously Treated PTB or EPTB (escept CNS, bones or joint)

  • Relapse
  • Treatment after Failure
  • TALF
  • Previous Treatment Outcome Unknown PTOU
  • Other
  • Initial Phase
    • 2 HRZES and 1 HRZE
  • Contunuation Phase
    • 5 HRE
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17
Q

Category IIa

A

Previously treated drug-suceptible EPTB in CNS/bones orjoints

  • Initial Phase
    • 2 HRZES and 1 HRZE
  • Continuation
    • 9HRE
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18
Q

Drug resistant TB

A

Standard regimen Drug Resitant: RR-TB or MDR-TB

XDR TB Regimen

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19
Q

Isoniazid

A
  • inhibits fatty acid synthase and mycolic acid synthesis
  • Excellent bactericidal activity against both intracellualr and extracellualr actively dividing MTB
  • Bacteriostatic against slowly dividing mciroorganisms

5mg/kg

Max: 400 mg

20
Q

Rifampicin

A
  • Binds to and inhibits mycobacterial DNA-dependent RNA polymerase thereby blocking RNA synthesis
  • Has both intracellular and extracellular bactericidal activity, both in dividing and non-dividing MTB
  • Has sterilizing activity
  • Most Active antimycobacterial agent available and therefroe the keystone of 1st line TB

10mg/kg

max 600 mg

21
Q

Minor SIde effects of Drugs

(may continue anti-TB drugs and check doses)

A
22
Q

Monitoring Response to Treatment using follow-up DSSM

A
23
Q

Pyrazinamide

A
  • Exact mechanism is unclear (fatty acid synthetase-I may be the primary target)
  • More active against slowly replicating organisms than against actively repliating organisms
  • Active only in acidic environment (ph<6.0) as are fouund within phagocytes or granulomas

25 mg/kg

max: 2 g

24
Q

Ethambutol

A
  • Inhibits arabinosyltrasnferases involved in cell wall synthesis, which probably inhibits the formation of arabinogalactan and lipoarabinomannan
  • Bacteriostatic antimycobacterial agent which provides synergy with other drugs
  • Least potent against MTB

15 mg/kg

25
Q

Streptomycin

A
  • Inhibits protein synthesis by binding at a site on the 30s mycobacterial ribosome
  • Bactericidal against dividing MTB but has only low level early bactericidal activity

15g/kg

max 1 g

28
Q

Bacteriologically-confirem TB patient (sputum-positve at the beginning of treatment) and smear is smear (-) or culture (-) at the last month of treatment and on at least 1 previous occasion in the continuation phase

A

CURE

29
Q

A patient completes treatment, but does not meet the criteria of “cured: or failure”

  • Bacteriologically confirmed patient who has completed treatment but without DSSM follow-up in the last month of treatment and on at least 1 previous occasion
  • Clinically diagnosed patient who has completed treatment
A

Treatment completed

30
Q
  • For bacteriologically-confirmed TB: patient who is sputum smear positive at 5 months or later during the treatment, or
    • For clinically diagnosed TB: patient for whome sputum examination cannot be done and who does not show clinical improvement during treatment
A

Treatment Failed

31
Q

Sum of “cured: and “treatment completed”

A

Treatment success

32
Q

PAtient whose treatment was interrupted for >=2 consecutive months

A

Lost-to follow up

33
Q
  • A patient for whom no treatment outcome s assigned
  • Includes patients transferred to another treatment facility with outcome unknown
A

Not evaluated

Internal Medicine (IM platinum) (14 decks)

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