Tuberculosis and Tuberculous Meningitis -

Question 1

Etiology- Mycobacterium tuberculosis:

Answer 1

With the exception of M. pinnipedii, all of the species in the Mycobacterium tuberculosis complex have been shown to cause disease in humans

Question 2

Which Mycobacterium is the most prevalent?

Answer 2

M. tuberculosis is by far the most prevalent

Question 3

How is the mycobacterium found in the environment, and does it cause disease?

Answer 3

Mycobacteria commonly found in the environment rarely cause disease in humans and are not spread from person to person

Question 4

MOTT =

Answer 4

Mycobacteria other than tuberculosis

Question 5

When does MOTT cause disease?

Answer 5

Mycobacteria other than tuberculosis (MOTT) most often cause disease in individuals with weakened immune systems

Question 6

What are the most common MOTT?

Answer 6

Mycobacterium avium and M. intracellulare are the more common MOTT sometimes seen in patients co-infected with HIV

Question 7

Where are the most TBs located?

Answer 7

85% of all TB cases are pulmonary

Question 8

Extrapulmonary TB occurs in places other than the lungs, including the:

Answer 8

• Larynx
• Lymph nodes
• Brain and spine
• Kidneys
• Bones and joints

Question 9

When does miliary TB occur?

Answer 9

Miliary TB occurs when tubercle bacilli enter the bloodstream and are carried to all parts of the body

Question 10

How is the transmission of TB?

Answer 10

• Transmission occurs when an infectious person coughs, sneezes, laughs, or sings
• Prolonged contact needed for transmission

Question 11

Probability of transmission depends on:

Answer 11

• Infectiousness
• Type of environment
• Length of exposure
• Susceptibility

Question 12

Long text about transmission. Read it. To lazy to flashcard it at the moment :P

Answer 12

• When a person with TB disease of the lungs or larynx coughs, sneezes or sings, droplet nuclei containing the TB bacilli are expelled into the air
• These droplets or particles, called droplet nuclei, are about 1 to 5 microns in diameter - less than 1/5000 of an inch
• Droplet nuclei can remain suspended in the air for several hours, depending on the environment
• The average TB patient generates 75,000 droplets per day before therapy
• This falls to 25 infectious droplets per day within two weeks of effective therapy

Question 13

One cough can release….

Answer 13

3,000 droplet nuclei

Question 14

One sneeze can release…

Answer 14

tens of thousands of droplet nuclei

Question 15

What is the percentage of infected people that will develop TB in their life?

Answer 15

10% of infected persons will develop TB disease at some point in their lives

Question 16

Persons at high risk for developing TB disease fall into 2 categories:

Answer 16

• Those who have been
  recently infected
• Those with clinical conditions that increase their risk of progressing from LTBI to TB disease

Question 17

LTBI =

Answer 17

Latent TB Infection

Question 18

How does Latent TB Infection (LTBI) occur?

Answer 18

• occurs when a person breathes in bacteria and it reaches the alveoli of lung
• immune system keeps bacilli contained and under control
• Person is not infectious and has no symptoms

Question 19

When does the TB disease occur?

Answer 19

• Occurs when immune system cannot keep bacilli contained
• Bacilli begin to multiply rapidly
• Person develops TB symptoms

Question 20

LOOK AT THE TABLE ON SLIDE 12

Answer 20

ABOUT DIFFERENCES BETWEEN LTBI AND TB DISEASE!!!

Question 21

Symptoms of TB

Answer 21

• Productive prolonged cough*
• Chest pain*
• Hemoptysis*
• Fever and chills
• Night sweats
• Fatigue
• Loss of appetite
• Weight loss

*Commonly seen in cases of pulmonary TB

Question 22

Patients should be considered infectious if they:

Answer 22

• Are undergoing cough inducing procedures
• Have sputum smears positive for acid-fast bacilli (AFB) and:
  
  • Are not receiving treatment
  • Have just started treatment,
  • Have a poor clinical or bacterial response to treatment
• Have cavitary disease

Question 23

Who are not considered infectious?

Answer 23

Extrapulmonary TB patients are not infectious

Question 24

Patients are not considered infectious if they meet all these criteria:

Answer 24

• Received adequate treatment for 2-3 weeks
• Favorable clinical response to treatment
• 3 consecutive negative sputum smears results from sputum collected on different days

Question 25

Evaluation for TB:

Answer 25

• Medical history
• Physical examination
• Mantoux tuberculin skin test
• Chest x-ray
• Bacteriologic exam (smear and culture)
• Nucleic acid amplification technology
• IFN –gamma release assays

Question 26

The two aims of TB treatment are:

Answer 26

• To prevent morbidity and death by curing TB while preventing the emergence of drug resistance
• To interrupt transmission by rendering patients noninfectious

Question 27

Treatment of Latent TB Infection:

Answer 27

• Daily Isoniazid therapy for 9 months
  
  • Monitor patients for signs and symptoms of hepatitis and peripheral neuropathy
• Alternate regimen - Rifampin for 4 months

Question 28

Treatment of TB Disease:

Answer 28

• slide 19