Tuberculosis Control Program BUMEDINST 6224.8 Flashcards
What is the Tuberculosis Control Program instruction?
BUMEDISNT6224.8
How many cases of tuberculosis occur annually in the United States?
20,000
What is the most sensitive and specific test available for identifying those who are infected with Mycobacterium tuberculosis?
The tuberculin skin test with purified protein derivative (PPD) administered by the Mantoux method.
What bacterium causes tuberculosis?
Mycobacterium tuberculosis
What preventive therapy is the most effective measure to prevent the development of tuberculosis disease in a newly infected person?
Isoniazid (INH)
True or False. Preventive treatment totally eliminates the risk of tuberculosis.
False. Although preventive treatment reduces the risk of disease, it does not totally eliminate it.
What term describes that the person has symptoms, signs, radiographic, or laboratory evidence of pulmonary, meningeal, miliary, or extra pulmonary tuberculosis?
Active Disease
What term describes that the person has no symptoms, signs, or radiographic evidence of active disease, but does have evidence of infection, as indicated by the presence of a positive tuberculin skin test?
Tuberculosis infection
True or False. For the purposes of the Tuberculosis Control Program, all individuals who have a positive tuberculin skin test are considered to have a tuberculosis infection.
True.
What method described a tuberculin skin test using a syringe and needle to inject purified protein derivative (PPD) of tuberculin?
Mantoux method
What term described an area around the site of tuberculin injection that is raised and firm to the touch?
Induration
What term described a person with an area of indurations to a 5 TU tuberculin skin test when read 48 to 72 hours after administration?
Tuberculin reactor
What term describes a person with an area of induration of less than 5 mm to a 5 TU tuberculin skin test?
Tuberculin non reactor
What vaccines are made from live attenuated mycobacteria strains are commonly used in some countries in an attempt to prevent vaccines from becoming infected with tuberculosis?
BCG (Bacillus Calmette-Guerin) vaccines
What city and state is NAVENPVNTMEDU TWO in?
Norfolk, VA
What city and state is NAVENPVNTMEDU FIVE in?
San Diego, CA
What city and state is NAVENPVNTMEDU SIX in?
Pearl Harbor, HI
What city and state is NAVENPVNTMEDU SEVEN in?
Naples, Italy
What is the only approved tuberculin skin test material for the Mantoux test?
The premixed Tween-80-stabilized intermediate strength PPD (5 TU equivalent)
Why is multiple-puncture tuberculin tests (e.g., Tine or Monovac tests) not used except on the specific recommendation of the area NAVENPVNTMEDU?
They produce significant numbers of both false-positive and false-negative test results.
What type of syringe and needle is used for the administration of a Mantoux test?
A disposable 1 ml tuberculin syringe graduated in 0.1 ml intervals and fitted with a 25-guage 5/8 inch needle.
What aspect of the forearm is the intra-dermal injection made?
Volar
How many hours after administration of a tuberculin skin test must it be examined?
48 to 72 hours
How is the indurations measured?
In millimeters at its widest transverse diameter (across the arm).
Where is the test result entered in the medical treatment record?
SF 601 under SENSITIVITY TESTS
How must the test result be entered in the medical record?
Date, type of tuberculin and its strength, and the diameter of induration in millimeters, written by hand; do not use rubber stamps or automatic imprinting devices.
How must the complete absence of induration be entered on the SF 601?
“Zero mm.”
What must be done if a person returns more than 72 hours after PPD application and the induration is zero to 14 mm?
Make an entry of “not read” on the SF 601. Immediately apply a PPD test on the opposite arm
What must be done if a person returns more than 72 hours, (but before or on the 10th day), after PPD application and the induration is 15 mm or greater?
The reaction is significant. Enter the induration and the time interval since test application on the SF 601. Manage the person as a tuberculin reactor per Evaluation and Preventive Therapy (Chemoprophylaxis) of Tuberculin Reactors
What must be done if a person returns more than 10 days after PPD application?
Make an entry of “not read” on the SF 601 regardless of the size of any induration. Immediately apply a PPD test on the opposite arm.
True or False. Do not under any circumstances report a skin test result as “zero mm” if the test was not read by a qualified MDR
True
What medical conditions have been reported to increase the risk of tuberculosis?
Silicosis, gastrectomy, jejeunoileal bypass, weight of 10 percent or more below ideal body weight, chronic renal failure, conditions requiring prolonged high-dose corticosteroid therapy or other immunosuppressive therapy, some hematologic disorders (e.g., leukemia and lymphomas) and other malignancies.
What is the antibiotic regimen of choice for tuberculosis preventive therapy?
INH in an oral daily dose of 300 mg for adults and 10 mg/kg (not to exceed 300 mg) for children
How long should tuberculin reactors with no risk factors for the development of tuberculosis disease receive INH therapy?
6 months of continuous therapy with INH
How long should tuberculin reactors with HIV infection and persons with stable abnormal chest radiographs consistent with past tuberculosis receive INH therapy
12 months of continuous therapy with INH
What are contraindications to preventive therapy with INH?
Previous history of INH-associated liver injury, history of a severe adverse reaction to INH, and acute or active liver disease of any etiology.
True or False. Baseline liver function tests are not required for INH recipients under age 35.
True, but they should be done if clinically indicated
What actions must be taken upon discovery of an active case of tuberculosis disease in the command?
Initiate Disease Alert Report (MED 6220-3). Locate patient’s close contacts. Screen contacts and screen again 3 months later. Maintain records of summary results. Clinically evaluate possible secondary cases for tuberculosis disease
Which hospitals are designated to act as contact points for pulmonary medicine or infectious disease consultation and patient transfer if needed
NAVHOSP Oakland,CA; NAVHOSP Portsmouth, VA; NAVHOSP San Diego, CA; and NAVHOSP Bethesda, MD.
How is tuberculosis transmitted?
By small airborne droplets or droplet nuclei from person to person in close contact or possibly through ventilation systems, such as on ships
