Week 5 TB Flashcards
Inhaled Droplets of Mycobacterium
Tuberculosis
Infection can occur in
2-20 weeks
___________ occurs and TB__________ lymphocytes kill the bacilli
Phagocytosis, specific
Are the bacteria live or dead bailli?
Both form granulomas in the lung tissue
Over time these granulomas form a
Fibrous Mass
At center of fibrous mass
Called Ghon tubercle
What happens to fibrous mass?
Becomes necrotic, calcifies, and forms a collagenous scar.
Infection becomes latent at this point
If weakened immune system, the latent TB can _____-
Become infectious again
The Ghan tubercle does what?
Ulcerates and the bacilli push out into the bronchioles where they can become airborne droplets
More scar tissue develops due to
Increase inflammatory responses, more tubercles form and bronchopneumonia develops
Common Symptoms of TB
Cough with sputum and blood- Hemoptysis
Chest Pain
Weakness
Weight Loss
Fever
Night Sweats
Prevalence
High in minorities
71% of known cases are those born outside of US
Higher in DM, CAncer, and HIV
Higher in homelessness and incarceration
Cali ranked #4
Alaska #1
How is TB spread?
Droplets
Exposure time and proximity to a person with active TB
What is the Tx of latent TB?
Treated so it does not become active
Isoniazid
Rifapentine
Rifampin
- 3-4 months of once weekly- isoniazid and rifapentine
4 months of daily rifampin
3 months of daily isoniazid and rifampin
Make sure Pt finishes regimens
Rifampin has ?
Hepatotoxicity
Hepatoxicity side effects
Upper stomach pain, tiredness, loss of appetite, dark urine, clay colored stools, jaundice
Rifampin has a
Narrow therapeutic range
Protect from light
Take WITHOUT food
Red orange discoloration of mucous fluids and body fluids
Anti TB that is a hydrazide derivative
Isoniazid
Hydrazide Derivative
Interferes with metabolism of bacterial proteins, nucleic acids, carbs, and lipids
Isoniazid
Hepatoxic and Nephrotoxic
Affects Nervous system- Peripheral Neuritis
May be relieved by Vitamin B6 (pyroxidine)
Rifapentine
Rifamycin Derivative- Binds to and inhibits the mycobacterial DNA dependent RNA polymerase
Always used in conjunction with other antituberculosis agents
Hepatoxic
Anemic affects
Take WITH food
Urine, sweat, sputum, tears, and breast milk may have red- orange discoloration
Active TB care involves
IV fluids- CV support
Ventilation- Cardiopulmonary Support
IV- Antibiotics- Treat infections-RIPE
Rifampin, Isoniazid, Ethambutol, Pyrazinamide)
After Tx or to rule out active Pt have 3 negative sputum cultures
True
Ethambutol
Miscellaneous Anti- TB agent
Inhibits synthesis of one or more metabolites in susceptible bacteria resulting in impairment of cellular metabolism, arrest of multiplication, and cell death
Nephrotoxic
May cause vision problems- Decreased visual acuity, constriction of visual fields, central and peripheral scotomas, and loss of red and green color
May take with food
Always used in conjunction with other Anti TB agents
Synthetic niacinamide derivative
Pyrazinamide
Disrupts membrane energetics and inhibit membrane transport function in susceptible M. Tuberculosis
Hepatotoxic
Joint pain or muscle pain
Gout flare ups
Hyperuricemia
Prevents renal excretion of urates
Pt Education on TB
Educate importance on compliance
Antibiotic Resistance
Worsening Condition
It is a community health issue and jail time served if refused
DOT Therapy
Staff of local health department meet regularly with patients who have TB to watch them take their medications
Helps complete Tx in least amount of time
TB testing includes
The Mantoux Skin Test
Intradermal Injection of TB
Read between 48-72 hours
If positive only tells the person has been affected with TB
Does not indicate active disease
Chest X ray or sputum cultures are needed for positive skin TB test
BCG Vaccine
Bacille Calmette -Guerin
Not recommended in the United States - administered in 3rd world countries
Does not fully prevent TB
Contributes to false positive TB test skin
Prevention of TB
N 95 mask for droplet precautions
PAPR- Powered Air purifying System
Annual TB skin test
Chest X ray for previous positive skin TB test
IGRA- Interferon Gamma Release Assay
- Blood test to detect latent TB - Detects T lymphocytes
TB Signs and Symptoms
Progressive Fatigue
Malaise
Anorexia
Wt. Loss
Chronic Cough
Night Sweats
Hemoptysis- Advanced State
Pleuritic Chest Pain
Low Grade Fever
Tx of TB
TB medications for 6 months or longer
Decreased Activity
Resp isolation until negative sputum
Frequently Outpatient Tx
Dx of TB
TB skin Test
Chest X Ray
Sputum Studies
3 Specimens collected on different days
RIPE
Rifampin
Isoniazid
PZA
Ethambutol
