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26 Cards in this Set
- Front
- Back
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Who is most at risk for TB? |
immigrants homeless/prisoners IV drug users immunocompromised <4 yrs old |
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What vaccine is used for TB? |
BCG - attenuated strain of M. bovis - not for HIV or SCID - variable efficacy (mostly used in other countries & can make future TB test +)(works better for kids) |
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Tb causes ______________, cervical lymphatenitis. It is the number one cause of lymphatenitis |
scrofula
(eroding lymph nodes in neck) |
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Tb also causes _____________ of the thoracic spine |
Potts Disease |
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Mycobacterium Tuberculosis is an obligate aerobe, and does NOT gram stain. How does it stain |
acid-fast bacilli |
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How is Tb transmitted? |
if ACTIVE it is transmitted via respiratory drops
(once ingested, alveolar macrophages quaritine it in granulomas until it becomes active) |
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How can you check for a latent (inactive) TB infection? |
using a skin PPD test + if > 15 normal person > 10 immigrant or younger than 4 > 5 HIV or exposed to active Tb individual |
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When would you use the two step tuberculin skin test? |
booster phenomenon individual with LTBI (latent Tb) if a first test is positive *no previous Tb skin test |
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What could lead to a false +? false -? |
false +: BCG vaccine, other mycobacteria
false -: corticosteroid therapy, renal failure, HIV |
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what is the MOST SPECIFIC Tb test, especially recommended for LTBI? When can you not use it? |
Quantiferon - Gold (blood antibody test)
in immune compromised pts |
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Clinical Presentation of Tb |
weight loss Hemoptysis (cough) Wheezes/rhonchi pleural effusion |
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What are the progressive steps in Tb diagnosis? |
1. PPD skin test (if postitive-->) 2. CXR (if abnormal--->) 3. Evaluate for active TB (QFN-G)
(if CXR is normal, consider treatment for LTBI) |
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Besides QFN-gamma, how else can active Tb be diagnosed? |
NAA (nucleic acid amplification) biopsy/culture acid fast staining (not always accurate) |
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What 4 factors should you consider when determining ACTIVE (not latent) Tb diagnosis? |
1. concentration of bacilli 2. infectivity 3. duration of exposure to Tb + indiv. 4. environment (close quarters w/ infected) |
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What is likely to be seen on a CXR for a TB + patient? |
cavitary lesions (posterior segment of upper lobe or apical lower lobe) hilar lymphadenopathy pleural effusion ghon complex
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What are the first line drugs used to treat TB? (give all for 4 months or until culture -) |
RIPE rifamin isoniazid ethambutol pyrazinamode |
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__________ causes peripheral neuropathy & should be give w/ a Vit B6 supplement |
isoniazid |
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_________ causes thrombocytopnia hypersensitivity & changes the color of urine |
rifampin |
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________ causes eye problems (visual acuity, floating) |
ethambutol
(E for eye) |
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________ causes hepatitis & should be avoided in pregnancy if possible |
pyrazinamide |
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What are the 2 common second line drugs? Which should be avoided in pregnancy? |
streptomycin (avoid in pregnancy)
flouroquinolones |
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Once a - culture has been obtained, you should continue treatment with what 2 drugs for an additional 4-7 months? |
isoniazid rifampin |
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* When should isoniazid be given prohylactically? |
*ANYONE who is in contact w/ an ACTIVE TB patient -new TST conversion over past 2 yrs -PPD+ pt w/ HIV -PPD+ (unknown duration) in pt younger than 35 -pt w/ x-ray evidence on inactive TB
(used to prevent latent tb--> becoming active)* |
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In pediatric pts, which first line drug should be excluded from treatment? |
ethambutol ^ risks decreased visual acuity |
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In pregnant pts, which first line drug should be excluded? |
pyrazinamide (if possible) && streptomyxin
(give pyridoxine w/ isoniazid to prevent neuropathy) |
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T/F HIV increases the likelihood of TB transmission |
FALSE |
