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PHAM02 - term 2 > Wk 26: TB > Flashcards

Wk 26: TB Flashcards

1
Q

Which bacteria causes TB?

A

Mycobacterium TB:

  • Aerobic, gram +ve
  • Made of mycolic acid: waxy, waterproof - difficult to penetrate
  • Able to survive macrophage
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2
Q

What are the types of TB?

A
  • Primary
  • Complete clearance
  • Post-primary
  • Active
  • Latent
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3
Q

What is primary TB?

A
  • First infection
  • Silent in immunocompetent individuals
  • Results in granulomatous inflammation - Ghon focus
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4
Q

What is latent TB?

A
  • Bacillus trapped in granuloma
  • Skin prick used to detect
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5
Q

What is active/post-primary active TB?

A
  • Usually reactivation of latent
  • If immunocompromised
  • Results: aggressive immune reacting causing large granulomas called caseation
  • Coughed up in lungs = large cavitating lesion
  • Solid organs: pus filled
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6
Q

What is extrapulmonary TB?

A
  • Sites: lymph nodes, pleura, GI tract, bone + CNS
  • Bacilli transported in blood or lymphatic system
  • Usually in children/immunocompromised
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7
Q

What are the clinical presentation of TB?

A
  • Cough
  • WL
  • Fever
  • Night sweats
  • Fatigue
  • Dyspnoea
  • Chest pain
  • Haemoptysis
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8
Q

How is active TB diagnosed - respiratory?

A
  • Chest x-ray
  • Acid fast bacilli test + sputum cultures
  • Rapid diagnostic NAAT (PCR)
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9
Q

How is active TB diagnosed - non-respiratory?

A
  • Biopsy/needle aspiration
  • Culture any surgical/radiological sample
  • MRI/CT/Ultrasound
  • Chest x-ray
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10
Q

How is pulmonary TB managed in hospital?

A
  • Isolated
  • PPE
  • Negative pressure room if high risk of multi-drug resistant tb
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11
Q

How is pulmonary TB managed in community?

A
  • Avoid work/school/crowded places
  • Wear face mask for first 2 wks
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12
Q

What is the treatment for pulmonary TB?

A
  • Initial: rifampicin, isoniazid, pyrazinamide + ethambutol for 2 months
  • Continuation: rifampicin, isoniazid for 4 months
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13
Q

What is the MOA of rifampicin?

A
  • Bactericidal
  • Blocks RNA polymerase + prevents protein formation
  • Kills slowly replicating bacteria
  • More active than isoniazid in anaerobic env of caseous lesion
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14
Q

What are the adverse effects of rifampicin?

A
  • Red/orange discolouration of body fluids
  • Liver damage: stop if 4x ULN
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15
Q

What is the MOA of isoniazid?

A
  • Inhibits synthesis of mycolic acid
  • Bactericidal
  • Kills rapidly multiplying mycobacteria
  • Red initial bacterial load
  • Caution in severe renal impairment
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16
Q

What are the adverse effects of isoniazid?

A

More likely in slow acetylates + advanced HIV:

  • Hepatotoxicity
  • N+V
  • Hypersensitivity
  • Peripheral neuropathy: supplement vit B6
17
Q

What is the MOA of pyrazinamide?

A
  • Bacteriostatic
  • Only work in acidic pH: macrophage in tuberle
18
Q

What are the adverse effects of pyrazinamide?

A
  • Hepatotoxicity
  • Rashes
  • Urticaria
  • Gout
19
Q

What is the MOA of ethambutol?

A

Bacteriostatic

20
Q

What are the adverse effects of ethambutol?

A

More likely in elderly, impaired renal function + prolonged treatment

  • Optic neuritis: visual alteration, loss of visual acuity + loss of red-green colour discrimination
21
Q

What is treatment interruption?

A

2 wks missed/20% of doses in initial phase:

  • Hepatotoxicity/cutaneous reactions: w/draw + re-introduce
  • Severe/highly active w/ hepatotoxic/cutaneous reaction: continue w/ streptomycin
22
Q

What is multidrug resistance TB + extensive drug resistance TB?

A
  • MDR-TB: resistant to rifampicin AND isoniazid
  • XDR-TB: resistant to rifampicin/isoniazid/fluoroquinolones/kanamycin/amikacin/capreomycin
23
Q

What are the therapies for MDR-TB + XDR-TB?

A
  • Bedaquiline
  • Delamanid
24
Q

What is the MOA of bedaquiline?

A
  • Bactericidal
  • Inhibits mycobacterial ATP synthase proton pump
  • Disables cellular energy dependent processes
25
Q

What is the MOA of delamanid?

A
  • Nitroimidazole
  • Inhibits synthesis of mycolic acid
26
Q

How is latent infection diagnosed?

A
  • Mantoux test: hh contact of active TB, immunocompromised + from country w/ high TB
  • Interferon gamma test used if mantoux positive/unreliable
27
Q

What is the treatment for latent TB?

A

3 months isoniazid and rifampicin OR 6 months isoniazid

28
Q

Who are at an inc risk of developing active TB?

A
  • <5 yrs old
  • Excessive alcohol/IV drug use
  • Solid organ transplant recipients
  • Chemo
  • Biologics
  • HIV, diabetes, CKD
29
Q

Who is offered BCG?

A

High risk under 35 who:

  • Health workers
  • Prison workers
  • From country w/ high prevalence

PHAM02 - term 2 (21 decks)

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