Tuberculosis Flashcards by Jamaira Belmes

Caused by bacteria of the Mycobacterium tuberculosis complex

Tuberculosis

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The most potent risk factor for TB among infected individuals

HIV co-infection

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Most commonly involved in primary TB

MIDDLE AND LOWER LUNG ZONES

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Lesion forming after initial infection; usually peripheral and accompanied by transient hilar or paratracheal lymphadenopathy

Ghon focus

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Ghon focus, with or without overlying pleural reaction, thickening, and regional lymphadenopathy

Ghon complex

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TB in young children - almost invariably accompanied by

HILAR OR PARATRACHEAL LYMPHADENOPATHY due to the spread of bacilli from the lung parenchyma through lymphatic vessels

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Reactivation or secondary TB

Postprimary (Adult-Type) Disease

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Postprimary (Adult-Type) Disease is usually localized to the

apical and posterior segments of the upper lobes

substantially higher mean oxygen tension (compared with that in the lower zones) favors mycobacterial growth

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Produced d.t. massive involvement of pulmonary segments or lobes with coalescence of lesions

caseating pneumonia

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HEMATOLOGIC FINDINGS: Postprimary (Adult-Type) Disease

mild anemia
leukocytosis
thrombocytosis with a slightly elevated erythrocyte
sedimentation rate and/or C-reactive protein level

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MC presentation of extrapulmonary TB in both HIV-seronegative and HIV-infected patients

Lymph Node TB (Tuberculous Lymphadenitis)

presents as painless swelling of the lymph nodes

at posterior cervical and supraclavicular sites (scrofula –past name)

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Reflects recent primary infection

pleural TB

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Results from the hematogenous spread of primary or postprimary pulmonary TB or from the rupture of a subependymal tubercle into the SUBARACHNOID SPACE

tuberculous meningitis

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Miliary or Disseminated TB

• due to hematogenous spread of tubercle bacilli
• CHILDREN: consequence of primary infection
• ADULT: recent infection or reactivation of old disseminated foci

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Pathognomonic of miliary TB

choroidal tubercles (eye)

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A presumptive TB case that is either bacteriologically confirmed or clinically diagnosed by the attending physician

Active TB

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Refers to a case of tuberculosis involving the LUNG parenchyma.

Pulmonary TB

A patient with both pulmonary and extrapulmonary tuberculosis should be classified as a
case of pulmonary TB.

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Refers to a case of tuberculosis involving organs other than the lungs (e.g. larynx, pleura, lymph nodes, abdomen, genito-urinary tract, skin, joints and
bones, meninges)

Extrapulmonary TB

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Refers to a patient from whom a biological specimen,
either sputum or non-sputum sample, is positive for TB by smear microscopy, culture or rapid diagnostic tests (such as Xpert MTB/RIF, line probe assay for TB, TB LAMP).

Bacteriologically confirmed TB (BCTB)

Refers to a patient for which the criterion for bacteriological confirmation is not fulfilled but diagnosis is made by the attending physicians on the basis of clinical findings, X-ray abnormalities, suggestive histology and/or other biochemistry or
imaging tests

Clinically diagnosed TB (CDTB)

Refers to a patient who has never had treatment for TB or who has taken anti-TB drugs
for less than one month.

Preventive treatment is not considered as previous TB treatment

New Case

Refers to a patient who had received one month or more of antiTB drugs in the past

Also referred to as Retreatment.

Previously Treated for TB

Previously treated for TB, new TB cases that are contacts of confirmed DR-TB cases or non-converter among patients on DS-TB regimens

High risk for multidrug-resistant tuberculosis (MDR-TB)

Resistance to rifampicin detected using phenotypic
or genotypic methods, with or without resistance to other anti-TB drugs

It includes any resistance to rifampicin, whether monoresistance, multidrug resistance, polydrug resistance or extensive drug resistance

Rifampicin-resistant TB (RR-TB)

The time from collection of first sputum sample to initiation of treatment for TB

Turnaround time (TAT) The desired turnaround time is five working days (also referred to as Program TAT).

Previously treated for TB and declared cured or treatment completed, but is presently diagnosed with active TB disease

Relapse

Previously treated for TB but failed most recent course based on a positive SM follow-up at five months or later, or a clinically diagnosed TB patient who does not show clinical improvement anytime during treatment

Treatment after Failure

Previously treated for TB but did not complete treatment and lost to follow-up for at least two months in the most recent course

Treatment after lost to follow up

Previously treated for TB but whose outcome in the most recent course is unknown

Previous treatment outcome unknown

Patients who do not fit any of the categories listed above or previous treatment history is unknown (this group will be considered as previously treated also)

Patients with unknown previous TB treatment history

PTB or EPTB (except central nervous system [CNS], bones, joints) whether new or retreatment, with final Xpert result: MTB, RIF sensitive MTB, RIF indeterminate New PTB or new EPTB (except CNS, bones, joints), with positive SM/TB LAMP or clinically diagnosed, and: Xpert not done* Xpert result is MTB not detected

2HRZE/4HR

EPTB of CNS, bones, joints whether new or retreatment, with final Xpert result: MTB, RIF sensitive MTB, RIF indeterminate New EPTB of CNS, bones, joints, with positive SM/TB LAMP or clinically diagnosed, and: Xpert not done* Xpert result is MTB not detected

2HRZE/10HR

Side effects of Isoniazid

Burning sensation in the feet due to PERIPHERAL NEUROPATHY -Give PYRIDOXINE (Vit B6) 50–100 mg daily for treatment; it can also be given 10 mg daily for prevention Psychosis and convulsion

Side effects of Isoniazid

MINOR Burning sensation in the feet due to PERIPHERAL NEUROPATHY -Give PYRIDOXINE (Vit B6) 50–100 mg daily for treatment; it can also be given 10 mg daily for prevention Gastrointestinal intolerance - give drugs at bedtime or with small meals MAJOR Jaundice due to hepatitis Psychosis and convulsion

Side effects of Rifampicin

MINOR Gastrointestinal intolerance - give drugs at bedtime or with small meals Orange-colored urine - reassure the patient Flu-like symptoms (fever, muscle pains, inflammation of the respiratory tract) - pyretics MAJOR Oliguria or albuminuria due to renal disorder Jaundice due to hepatitis Thrombocytopenia, anemia, shock

Side effects of Pyrazinamide

MINOR Gastrointestinal intolerance - give drugs at bedtime or with small meals Jaundice due to hepatitis Arthralgia due to hyperuricemia

Ethambutol

Impairment of visual acuity and color vision due to optic neuritis

A patient with bacteriologically confirmed TB at the beginning of treatment and who was smear- or culture-negative in the last month of treatment and on at least one previous occasion in the continuation phase.

Cured

A patient who completes treatment without evidence of failure but with no sputum smear negative results in the last month of treatment and on at least one previous occasion, either because tests were not done or because results are unavailable. This group includes clinically diagnosed patients who completed treatment.

Treatment Completed

A patient whose sputum smear or culture is positive at five months or later during treatment. Treatment terminated because of evidence of additional acquired resistance (e.g. RIF resistance on Xpert at 2nd month) A patient for whom follow-up sputum examination was not done (e.g. child or EPTB) and who does not show clinical improvement anytime during treatment. Severe uncontrolled adverse drug reaction

Treatment Failed

A patient who dies for any reason during the course of treatment.

Died

A patient whose treatment was interrupted for at least two consecutive months. A patient diagnosed with active TB but was not started on treatment (i.e., initial LTFU).

Lost to follow-up (LTFU)

A patient for whom no treatment outcome is assigned. This includes patients transferred to another facility for continuation of treatment but the final outcome was not determined.

Not Evaluated

Isoniazid

5 mg/kg, max 400 mg (-) FAS and mycolic acid synthesis excellent BACTERICIDAL BACTERIOSTATIC against slowly dividing organisms

Rifampicin

10 mg/kg, max 600 mg binds to and (-) mycobacterial DNA dependent RNA polymerase --> blocking RNA synthesis both intracellular and extracellular BACTERICIDAL w/ STERILIZING activity MOST ACTIVE antimycobacterial agent available KEYSTONE of the 1st LINE TB TREATMENT

Pyrazinamide 25 mg/kg, max 2 g

Fatty acid synthetase I more active against SLOWLY replicating organisms active only in ACIDIC environment

Ethambutol 15 mg/kg

(-) arabinosyltransferases involved in cell wall synthesis BACTERIOSTATIC LEAST POTENT