Tuberculosis Flashcards
Rasmussen’s aneurysm
Complication of PTB - rupture of dilated vessel in a cavity leading to massive hemoptysis
Ghon lesion
Small calcified nodule in primary PTB
Most potent risk factor for PTB
HIV coinfection
MDR-TB
Resistance to isoniazid and rifampicin
XDR-TB
Resistance to:
- Isoniazid and Rifampicin
- Fluoroquinolones
- 1 Aminoglycoside (amikacin, capreomycin or kanamycin)
Highly infectious TB
Cavitary PTB and laryngeal TB
10^5 to 10^7 AFB/ml
Ranke complex
Healed lesions in lung parenchyma and hilar lymph nodes which may later undergo calcification
Most common extrapulmonary TB
TB Lymphadenitis
LN > pleural > genitourinary > bone and joints > meninges > peritoneum > pericardium
Diagnostics for TB lymphadenitis
FNAB or excision biopsy
Diagnostics for pleural TB
Thoracentesis
Adenosine deaminase
Pleural biopsy
Diagnostics for genitourinary TB
Urinary: Isolate in culture of 3 morning urine specimen
Genital: Biopsy or culture
Most commonly affected joints by TB
Spine
Weight-bearing joints: Spine > Hips > Knees
Most commonly affected part of the spine by TB in adults
Lower thoracic and upper lumbar
Most commonly affected part of the hip joint by TB
Head of femur
Diagnostics for bone and joint TB
Aspiration or biopsy
Most commonly affected cranial nerve in TB meningitis
Ocular nerves due to involvement of meninges at the base of the brain
Diagnostics for TB meningitis
Gold standard: CSF culture
Preferred initial test: Xpert MTB/RIF assay
Most commonly affected part of the GIT by TB
Terminal ileum and cecum
Diagnostics for GIT TB
Biopsy (including peritoneum)
Diagnostics for TB pericarditis
2D echo-guided pericardiocentesis
Type of TB where glucocorticoid administration is life-saving
TB meningitis and TB pericarditis
Pathognomonic of miliary TB
Choroidal tubercles
Diagnostics for miliary TB
Bronchoalveolar lavage and transbronchial biopsy, liver or bone-marrow granuloma biopsy
Acute septicemic form of miliary TB
Nonreactive miliary TB
IRIS (immune reconstitution inflammatory syndrome) or TB-IRD (TB immune reconstitution disease)
Exacerbations in symptoms, signs and laboratory or radiographic manifestations of TB associated with administration of ART
Increased risk if earlier start of ART + lower baseline CD4
Dyes in AFB microscopy
Traditional: Ziehl-Neelsen basic fuschin
Modern labs: Auramine-rhodamine
Initial diagnostic test for new PTB case
AFB microscopy
Initial diagnostic test for MDR-TB, HIV-associated TB, TB meningitis, retreatment cases, failure cases
Xpert MTB/RIF assay
Definitive diagnostics for PTB
Isolation of M. tuberculosis from a specimen
Resistance genes for each anti-TB drugs
Rifampicin - rpoB Isoniazid - katG, inhA Pyrazinamide - pncA Ethambutol - embB Fluoroquinolones - gyrA-gyrB Aminoglycosides - rrs
Boosting phenomenon and True conversion for TST
Boosting phenomenon: Spurious TST conversion resulting from boosting of reactivity on subsequent TST 1-5 weeks after the initial test
True conversion: After BCG vaccination in a previously TST-negative person in close contact of an infectious patient
Diagnostics for latent TB infection
Low- and middle-income: TST
Others: IGRA
Definition and Treatment for TB Category I
All new cases of PTB, all extrapulmonary TB except meninges, bone and joint
2HRZE / 4HR
Definition and Treatment for TB Category Ia
TB of the meninges, bone and joints
2HRZE / 9HR
Definition and Treatment for TB Category II
Retreatment of Category I
2HRZES / 1HRZE / 5HR
Definition and Treatment for TB Category IIa
Retreatment of Category Ia
2HRZES / 1HRZE / 9HR
Primary drug resistance to TB
Resistant strains in a patient with no treatment more than a month
Secondary drug resistance to TB
Resistant strains in a patient who has been taking or has taken anti-TB drugs for more than a month
Daily dose and max dose for each anti-TB drugs
Isoniazid: 5mkd, max 400mg Rifampicin: 10mkd, max 600mg Pyrazinamide: 25mkd, max 2000mg Ethambutol: 15mkd, max 1000mg Streptomycin: 15mkd, max 1200mg
Extended TB therapy
Indicated for:
- cavitary PTB
- silicotuberculosis
- delayed sputum-culture conversion (culture-positive at 2 months)
- pyrazinamide not included in initial treatment regimen
Extend up to a total of 9 months
Reduced TB therapy
May be done for sputum culture-negative PTB
Reduced to a total of 4 months
Persons at high risk of vitamin B6 deficiency
Alcoholics, malnourished, pregnant, lactating, chronic renal failure, DM, HIV infection
Monitoring schedule by AFB smear examination
New PTB cases: 2nd, 5th, 6th months
**if not converted by 2nd month, repeat AFB smear on the 3rd month instead
Retreatment cases: 3rd, 5th, 8th months
TB cured
Completed treatment PLUS
2x AFB sputum smear-negative if new PTB case
3x AFB sputum smear-negative if MDR-TB
TB treatment completed
Finished treatment but no confirmation bacteriologically
TB treatment failed
- AFB sputum smear-positive on the 5th month
2. Became smear-positive on the 2nd month when previously smear-negative
PTB treatment for patients with compensated liver cirrhosis
- 2HES / 10HE
- 2HRES / 6HR
- 9HRE
PTB treatment for post-solid organ transplant patients
2HZE / 12-18HZE
Most common significant adverse reaction to anti-TB drugs and what to do when it occurs
Hepatitis
Discontinue anti-TB drugs if AST/ALT
- 3x elevated plus symptomatic
- 5x elevated even if asymptomatic
Stop pyrazinamide permanently
Contraindication for each anti-TB drugs
Rifampicin: autoimmune thrombocytopenia
Pyrazinamide: Gouty arthritis (but not for asymptomatic hyperuricemia), severe liver failure
Ethambutol: Optic neuritis
Streptomycin: Ototoxicity
New TB case
Patients with less than 1 month TB treatment
TB retreatment
Patients with more than or equal to 1 month TB treatment, excluding prophylaxis or LTBI
Definition and treatment for TB relapse
Patients who had completed TB treatment previously and is with positive AFB sputum smears
All 1st line drugs + streptomycin pending drug susceptibility testing
Lost to follow-up
Patients with more than or equal to 2 consecutive months interruption of treatment
When are TB patient deemed non-infectious
Bacteriologically-confirmed: After more than or equal to 14 days treatment
Clinically-diagnosed: After more than or equal to 5 days treatment
Treatment regimen if with INH resistance
6RZE
Treatment regimen if with RIF resistance
2HES / 10HE
Treatment for latent TB infection
6H
