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72 Cards in this Set
- Front
- Back
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Where does TB place in the leading worldwide cause of death from infection?
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2nd leading cause from infection (there's a new case every second)
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How many ppl in the world are infected today?
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1/3rd of the world's population
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how many ppl do you suppose have latent TB?
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2 billion
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How many ppl died from this in 2006?
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1.5 million
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How many active cases in the world today?
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9 million
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How many deaths are predicted to occur by the yr 2020?
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36 million
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Which country has the highest TB burden?
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India (followed by china, indonesia, nigeria, s. america, bangledesh, ethiopia, pakistan, phillipines, DR Congo, then… #14 Brazil and #22 Afghanistan)
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What is the case-fatality rate?
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50% in untreated cases
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what are the factors that influence predisposition?
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Social, economic, and medical
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Which ethnicities have a 10 X greater predisposition?
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Asians and pacific islanders
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Which ethnicity has a 8 X greater predisposition?
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Non-hispanic blacks
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Which ethnicities have a 5 X greater predisposition?
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Hispanics, Native Americans, and Native Alaskans
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Are there any more countries with nonspecific greater risks?
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Yes, there is also a greater risk in Eastern Europe
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Can you lists examples of certain groups particularly at risk?
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IV drug users, residents of long term care facilities, elderly, racial and ethnic groups, medically underserved (low income), close contacts with infected, Foreign born persons from high risk areas, and people with an Occupational exposure to TB
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Can other species be infected with M. Tuberculosis?
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No, humans are the only known reservoir
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How is TB transmitted?
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Airborne droplet nuclei transmission
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Describe the characteristic of the TB organism
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acid-fast, non-motile, non-spore forming, non-encapsulated, may contain fewer than 10 bacilli
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Where are the organisms deposited once inhaled?
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within the terminal air spaces
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How does TB bacteria reach the regional lymph nodes?
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Macrophages ingests them and transport them there, but they don't die
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If you have HIV, what are your chances of developing Active TB?
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100 X greater than a normal healthy person
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If you have DM, what are your chances of developing Active TB?
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3 x greater than a normal healthy person
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What are other conditions that would increase your chances of developing Active TB after being previously exposed?
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Gastrectomy, Silicosis, Immunosuppressive therapy, low body weight (10% below ideal), CXR findings suggestive of TB with no prior tx, substance abuse, a TB infection within the last 2 yrs.
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What are other sequela that HIV patients are at risk for?
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Extrapulmonary TB
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What are the typical signs and sxs of TB?
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productive cough (75% will have this), fever, weight loss, hemoptysis, chest pain, anorexia, fatigue, night sweats. Adventitious breath sounds, especially over the upper lobes/areas
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Where does non respiratory TB manifest (not on radar for obvious TB, typically found in the elderly or immunocompromised)?
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TB meningitis, Skeletal, Genitourinary, Cutaneous, Hematogenous dissemination
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What are the skeletal signs and sxs of TB?
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Most commonly found in the spine- Pott's dz, back pain or stiffness, extreme paralysis, and arthritis is 1 or any joint
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What are the signs and sxs for TB meningitis?
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HA (both intermittent or persistent), Mental status changes, neurological deficit, chorioretinitis, low grade fever
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What are the signs and sxs for Genitourinary TB?
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Flank pain, dysuria, frequency, epididymitis, scrotal mass, PID (10% of worldwide sterility),
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What are the signs and sxs for Cutaneous TB?
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Ulcers; wart-like lesions
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What are the signs and sxs for Gastrointestinal TB?
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Non-healing ulcers, esophageal dz, PUD, Malabsorption, diarrhea, hematochezia
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What are the signs and sxs for Widespread hematogenous TB (normally found in the immunocompromised)?
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weakness, fatigue, weight loss, HA, fever, cough, generalized lymphadenopathy, hepato/splenomegaly/pancreatitis, mutltiorgan dysfunction, adrenal insufficiency. Close to 100% mortality if untreated
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When do you collect sputum for smears and cultures?
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Early morning, for 3 consecutive days
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What other specimens could you collect if you cant get sputum?
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Gastric aspirate, fiberoptic bronchoscopy, transbronchial biopsy, bronchial washings
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What other biopsies can you get besides pulmonary?
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Bone marrow, liver
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Besides biopsies and sputum smears, what other tests are available in diagnosing TB?
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Blood culture, QTF-G, RNA probes, PCR, and Line probe assay
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What will you find in a stained sputum smear? What does it indicate?
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Acid fast bacilli. It provides the first mycobacteriologic indication of TB dz
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What will you find in a culture?
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"It can identify M. Tuberculosis (which can also be identified with nucleic acid amplification or ""NAA"")"
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Why would you want to monitor blood labs while treating TB?
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INH affects the liver
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Which blood labs would you want to monitor?
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CBC, Chem panels (AST/ALT), Alk phos, Total bilirubin, Uric acid, Creatinine, and you also want to obtain HIV serology
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What will a CXR show in the primary progressive phase of TB?
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Central apical portion or left lower lobe infiltrates; pleural effusion
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What will a CXR show upon reactivation?
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"Cavity formation, noncalcified round infiltrates, rancke complex (50% of the time), Ghon lesions (calcified peripheral nodules), calcified hilar nodes, and homogeneously calcified tuberculomas (""old dz"")"
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What will a CXR show in the case of Miliary TB?
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Millet seed
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What is the initial tx for active TB?
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Intial emperic tx of 4 drugs: INH, Rifampin, Pyrazinamide, and Ethambutol/streptomycin
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After starting the 4 drug therapy, isolation is found to be fully susceptible. What is the next action in the course of tx?
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You can discontinue the Ethambutol/streptomycin
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How long should you continue the patient on the three remaining drugs, before discontinuing the third drug?
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After two months of therapy, pyrazinamide can be stopped
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After Pyrazinamide is stopped, how much longer does the patient continue the INH and Rifampin?
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For a total of 4 months, giving a total of 6 months for the complete tx of active TB
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What if it is discovered that the TB is NOT susceptible (INH resistant)? How does this change the treatment?
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The patient will be on Rifampin, Pyrazinamide, and ethambutol for the total 6 months
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What is the nomenclature for the protective device worn by TB patients?
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The N-95 particulate respirator
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What are complications of pulmonary TB?
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Relapse, Aspergilloma, Carcinoma
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Which particular drug is used to prevent peripheral neuropathies?
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Pyridoxine 25-50mg PO daily. (Rifampin is the alternate choice, or when the pt does not tolerate INH)
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Who gets LFT monitoring?
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"(Generally, everyone on INH), particularly 35 or older, currently with use of ""drug interaction"" meds, alcohol abuse, Hx of discontinuing INH with adverse effects, chronic liver dz, Hx of peripheral neuropathies, pregnancy, IV drug users"
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How often should serial AST/ALT be monitored?
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monthly
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What side effects should you be on the look out for with your patients on INH?
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hepatocellular dz, peripheral neuropathies, adverse rxns with phenytoin (anti-seizure) causes an increase serum concentrations of both drugs
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What side effects should you be on the look out for with your patients on Rifampin?
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Thrombocyptopenia, accelerated clearance of drugs, decrease in effectiveness in OCP's.
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What side effects are associated with the use of Ethambutol?
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Change in visual acuity
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What is the side effect that is associated with the use of Pyrazinamide?
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Hyperuricemia (asymptomatic and NOT and indication for discontinuance)
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What are the side effects associated with the use of streptomycin?
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Dizziness, vertigo, or ataxia
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What additional testing should you perform on pts taking streptomycin?
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Audiometric tests should be performed periodically. Discontinue if there are any audiological changes
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PPD is also known as…
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Mantoux test
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What is the purpose of PPD testing?
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To check for latent TB
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How many units of PPD are administered intradermally?
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5 units
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When is the PPD response read?
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48-72 hours
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What is measured in the determination of a negative vs. positive reading?
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The area of induration, not the redness
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What must be done for anyone who has a positive result?
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All positive readings get a CXR!
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larger than or equal to 5mm results in a positive reading for which patients?
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Close contacts of newly diagnosed TB, HIV pos, Organ Transplant pts, Long term steroid use, fibrotic lesions on CXR (not granulomas)
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Larger than or equal to 10mm results in a positive reading for which patients?
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DM, Hematologic malignancies, Head/Neck carcinoma, Gastrectomy, Jejunoileal bypass, ESRD, Silicosis, malnutrition, IV drug user (known to be HIV NEGATIVE), children under 4 with adult TB exposure, residents and employees of high risk facilities, recent immigrants from high risk countries
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Larger than or equal to 15mm results in a positive reading for what population?
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Everyone else!
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Name two conditions that can result in a false positive PPD reading
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Infection with other mycobacterium or Vaccination with Bacille Calmette-Guerin (BCG)
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What is the BCG vaccine used for?
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Some countries use BCG for vaccine for pediatric TB prevention, but it is considered ineffective in adults
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Is it possible to get a false negative rxn?
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Yes. 10-25% of patients with TB have negative PPD results
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What do you do when you get a false reading, but highly suspect infection?
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You initatie two-step testing. The initial PPD may stimulate (boost) a rxn, then perform a second test 1-2 weeks later. A positive rxn means that the person has been previously infected
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What is the recommended tx for latent TB (a positive skin test and a negative CXR)?
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INH, PO 300mg daily for 9 mo
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