Matc - Objectives Exam 3 - Tuberculosis

Front 1

15. Describe the treatment for tuberculosis including the following pharmacologic agents for "isoniazid".

Back 1

Treatment for active infection includes the use of 2-4 drugs for 6 to 9 months. They are: Isoniazid (INH) with Rifampin (Rifadin) is used for the first 9 months. These agents can cause GI upset and turn the urine and other body fluids red-orange.

Front 2

15. Describe the treatment for tuberculosis including the following pharmacologic agents for "rifampin"

Back 2

Treatment for active infection includes the use of 2-4 drugs for 6 to 9 months. Rifampin (Rifadin) with INH is used for the first 9 months. These agents can cause GI upset and turn the urine and other body fluids red-orange.

Front 3

15. Describe the treatment for tuberculosis including the following pharmacologic agents for "pyrazinamide"

Back 3

Treatment for active infection includes the use of 2-4 drugs for 6 to 9 months. Rifampin (Rifadin), and INH are supplemented with this "pyrazinamide" to help combat the active infection.

Front 4

15. Describe the treatment for tuberculosis including the following pharmacologic agents for "ethambutol"

Back 4

Treatment for active infection includes the use of 2-4 drugs for 6 to 9 months. Rifampin (Rifadin), and INH are supplemented with this "ethambutol" to help combat the active infection.

Front 5

15. Describe the treatment for tuberculosis including the following pharmacologic agents for "streptomycin"

Back 5

Treatment for active infection includes the use of 2-4 drugs for 6 to 9 months. Rifampin (Rifadin), and INH are supplemented with "streptomycin" to help combat the active infection.

Front 6

15. Describe the treatment for tuberculosis including the following pharmacologic agents for "rifampetine"

Back 6

Treatment for active infection includes the use of 2-4 drugs for 6 to 9 months. Rifampin (Rifadin), and INH are supplemented with "rifampetine" to help combat the active infection.

Front 7

16. Name two Mycobacterium organisms responsible for causing the disease referred to as atypical tuberculosis.

Back 7

Mycobacterium avium intracellular and Mycobacterium kansasii. They are contained within soil and/or water. NO person to person transmission. Seen in patients with immunosuppressed immune systems like AIDS. No characteristic features. MAI responds poorly to therapy and may result in disseminated disease in AIDS that may prove fatal. Mycobacterium kansasii responds well to typical TB drug therapy.

Front 8

1. Define mycobacterium tuberculosis disease.

Back 8

*** Mycobacterium tuberculosis organism enters humans in 3 ways: 1. Respiratory tract (airborne-cough, sneeze and laugh.) MOST Common. 2. GI tract 3. Open wound in skin.

Front 9

q

Back 9

a

Front 10

3. Describe the characteristics of Mycobacterium tuberculous bacilli.

Back 10

Gram positive bacillus look like rods. They are referred to as acid-fast bacilli (AFB) because it has a cell wall with a high lipid and wax content that resists decolonization by acid or alcohol when stained. These organisms require special culture media. They are highly aerobic organisms; thrive in areas of the body with high oxygen content such as: apex of lungs, kidneys, braind and ends of long bones.

Front 11

4. Identify those conditions, which increase susceptibility to infection with tuberculosis.

Back 11

Conditions leading to susceptibility are: 1. People with impaired cellular immune response (ex. elderly, organ transplant patients, HIV, malnourished, alcoholics) 2. Third World countries (poverty, overpopulation, poor nutrition, inadequate health care) and 3. Nursing homes, prisons, homeless shelters, anyone living in overcrowded conditions.

Front 12

5. Explain the etiology for tuberculosis.

Back 12

People with impaired cellular immune response are at greatest risk. Those include: elderly, organ transplants, HIV-infected, malnourished and alcoholics. I Third world countries due to poverty, overpopulation, poor nutrition and inadequate health care are risks. As well as people in institutional housing like nursing homes, prisons, homeless shelters (living in overcrowded conditions).

Front 13

6. Compare and contrast primary infection with post primary infection and reactivation tuberculosis.

Back 13

Answer

Front 14

7. Describe the pathophysiology of primary and post primary or reactivation tuberculosis.

Back 14

Primary infection/Primary Tuberculosis- Inhalation of droplet nuclei that get past mucocilliary escalator and implants in the alveoli. It then migrates throughout the body by way of the lymph and circulatory systems. Causes an inflammatory response similar to acute pneumonia. Large outpouring of WBC's and macropages move into the infected area and engulf, BUT NOT FULLY KILL, the bacilli causing: pulmonary capillaries to dilate, interstitum to fill with fluid, alveolar epithelium to swell from the edema fluid, eventually the alveoli become consolidated (filled with fluid, polymorphonuclear leukocytes and macrophages). If bacilli are not contained by macrophages, the lung tissue that surrounds infected area produces a protective cell wall called a tubercle or granuloma that encases the bacilli in an attempt to confine it to that area. Because of that, center of the tubercle frequently breaks down and fills with necrotic tissue resembling dry cottage cheese called "caseous lesion or "caseous granuloma". If bacilli are controled (either by patients immunologic defense or anti-TB drugs), fibrosis and calcification ultimately replace the tubercle during the healing process leaving a calcified scar behind. ------ 2. Post primary/Reactivation tuberculosis - May also be termed Secondary Tuberculosis or Reinfection Tuberculosis. Factors responsible for reactivation not fully understood but believed to be due to conditions that weaken local and systemic body defenses such as: old age, nutritional status, alcoholism, chronic debilitating disorders, Immunosuppressive treatment and AIDS patients.

Front 15

8. Define Ghon complex.

Back 15

Initial lung lesion seen on a CXR is alled a Ghon nodule. The combination of the initial lung tuberculosis lesion and the affected lymph node is called a Ghon complex. Infection process takes 3-8 weeks and results in conversion to positive TB skin test.

Front 16

8. Define anorexia.

Back 16

Taber's dictionary --- Loss of appetite. Anorexia as seen in depression, malaise, commencement of fevers, disorders of the GI system and alcoholism and addiction.

Front 17

8. Define granuloma

Back 17

A chronic inflammatory lesion most commonly caused by histoplasmosis, a fungal infection. it is characterized by an accumulation of macrophages; epithelioid macrophages, with or without lymphocytes. Granulomas most often occur in the lungs.

Front 18

8. Define caseation.

Back 18

Tabers dictionary - 1. The process in which necrotic tissue is converted into a granular amorphous mass resembling cheese. 2. the precipitation of casein during coagulation of milk.

Front 19

8. Define metastatic.

Back 19

Taber's dictionary - Movement of bacteria of body cells from one part of the body to another. The transfer of diseased cells from one organ to part of another.

Front 20

8. Define cachexia.

Back 20

Debiliated, emaciatede, malnourished patient.

Front 21

9. Explain why most primary infections usually occur in lower lung fields while most reaction infections usually occur in upper lung fields.

Back 21

Answer

Front 22

10. Define and describe miliary tuberculosis.

Back 22

Also called Disseminated/Extrapulmonary Tuberculosis. It is an infection caused by a large number of bacilli being freed into the blood sand lymphatic system causing it to disseminate into non-lung sites. Miliary disease symptoms are high fever, malaise, cough, dysmpea, weight loss, anorexia and headache.

Front 23

11. Identify signs and symptoms typically seen in tuberculosis.

Back 23

Resp book. p 256 - Clinical data increased tachypnea, increased HR and B/P. Chest pain with decrased chest expansion, cyanosis, digital clubbing, peripheral edema and venous distention. With severe TB, other signs include distended neck veins, pitting edema, enlarged and tender liver. ^^^ Cough, Sputum production and Hymoptysis chest assessment findings are increased tactile and vocal fremitus, dull percussion note, bronchial breath sounds, crackles, rhonchi,wheezing, pleural friction rub and whispered pectoriloquy.

Front 24

12. Describe the radiographic findings typically seen with tuberculosis.

Back 24

Xray is indispensable for diagnosis along with skin test. There is increased opacities, infiltrates, cavity formation (possible pleural effusion if pleura involved. Including calcification and fibrosis; Hilar lymph node enlargement, Atelectasis and enlarged right heart(which may develop as a secondary problem with advanced stages of TB).

Front 25

13. Identify the laboratory tests used to confirm the present of tuberculosis.

Back 25

Tuberculin skin test reaction. Purified protein Derivative (PPD) is an Intradermal tuberculin injection (Mantoux test). Included in laboratory findings is a sputum culture with acid fast bacilli, 3 samples are collected from 3 separate days often after waking hours. Culture can take from 6-8 weeks. A polymerase Chain Reaction (PCR) assay can be done to circumvent this issue. A QuantiFERON-TB Gold test was approved by FDA in 2005 including blood test used to test for TB, which includes latent TB! ABG's generally are not abnormal. Cavitating disease results in loss of blood vessel as well as lung tissue, therefor ventilation/perfusion mismatch does NOT result. Mild to moderate TB presents with increased pH, decreased PCO2 and PO2 (resp alkalosis). Meanwhile, Extensive and end-stage TB may present as chronic ventilatory failure with hypoxemia with normal pH, increased PCO2, HCO3 and decreased PO2 (resp. acidosis).

Front 26

14. Define PPD and identify the definitions of a postive skin test reaction.

Back 26

PPD stands for Purified Protein Derivative. It is an intradermal tuberculin injection (mantoux test). ---- < 5mm induration is considered negative except with HIV, organ transplant pts, personnel who've had recent close contact with an infected TB, and patients with chest radiographs suspicious of fibrotic, healed lesions typical with TB. *** 5-9mm indurtion is considered suspicious and retesting may be required. *** >10mm induration is considered positive for those who have risk factors; are prisoners, prison employees, nursing home patients and staff, homeless shelter residents and staff, IV drug users and lastly hospital and other healthcare workers.

Front 28

How is TB diagnosed?

Back 28

< 5mm induration is considered negative except with HIV, organ transplant pts, personnel who've had recent close contact with an infected TB, and patients with chest radiographs suspicious of fibrotic, healed lesions typical with TB. *** 5-9mm indurtion is considered suspicious and retesting may be required. *** >10mm induration is considered positive for those who have risk factors; are prisoners, prison employees, nursing home patients and staff, homeless shelter residents and staff, IV drug users and lastly hospital and other healthcare workers.

Front 29

What is definition of tuberculosis?

Back 29

A contagious chronic bacterial infection that primarily affects the lungs, although it may involve almost any part of the body. Clinically, it is classified as either 1. Primary Tuberculosis, 2. Post-primary Tuberculosis or 3. Disseminated Tuberculosis.

Front 30

What is Primary TB?

Back 30

Primary TB (also called the primary infection stage) follows the patients first exposure to the TB pathogen. Primary TB begins when the inhaled bacilli implant in the alveoli. As the bacilli multiply over a 3-4 week period, the initial response of the lungs is an inflammatory reaction that is similar to any acute pneumonia.

Front 31

What is Postprimary TB?

Back 31

Post primary TB (also called reactivation TB, reinfection TB or secondary TB) is a term used to describe the reactiation of TB months or even years after the initial infection has been controlled.

Front 32

What is Disseminated TB?

Back 32

Disseminated TB (also called extrapulmonary TB, miliary TB and tuberculos-disseminated) refers to infection from TB bacilli that escape from a tubercle and travel to sites other throughout the body by means of the blood stream or lymphatic system. The TB bacilli that gain entrance to the bloodstream usually gather and multiply in portions fo the body that have a high tissue oxygen tension. Most common is apex of the lungs, lymph nodes, kidneys, long bones, genital tract, brain and meninges.

Front 33

What does Genital TB do to males?

Back 33

It damages the prostate gland, epididymis, seminal vesicle and testes.

Front 34

What does Genital TB do to women?

Back 34

It damages the fallopian tubes, ovaries and uterus.

Front 35

What are other common areas that Genital TB can spread to?

Back 35

The spine as well as the hip, knee, wrist and elbow can be invovled.

Front 36

Can TB bacilli affect the meninges?

Back 36

Yes. Over time, the infection may cause mental deteriration, permanent retardation, blindness and deafness.

Front 37

Etiology and Epidemiology of TB:

Back 37

TB is one of the oldest diseases known to man and remains one of the most widespread diseases in the world. Unmistakable evidence has been provided from mummies from the Stone Age, ancient Egypt and Peru that TB is as ancient as human disease. In early writings, the disease was called "consumption", "Captain of the Men of Death" and "white plague". In the 1900 century, it was re-termed tuberculosis.

Front 38

Primary infection is often referred to what other name?

Back 38

Primary infection/Primary Tuberculosis

Front 39

Post Primary/Reactivation Tuberculosis is also known as what?

Back 39

Called Secondary Tuberculosis or Reinfection Tuberculosis.

Front 40

Tranmission of TB is by what means?

Back 40

Person to person via droplet nuclei. Aerosolized droplets produced from talking, sneezing, coughing, singling, etc. Aerosol evaporates leaving small particles known as droplet uclei suspended in air. <10 microns in diameter. 1 - 5 microns will reach and be retained in alveoli, where Primary TB begins. These particles can main suspended for long periods of time to be inhaled by others. Particles are killed quickly by UV rays, therefore infection outdoors is extremely rare.

Front 41

Transmission of TB - pros and cons.

Back 41

Infection requires close, prolonged contact in confined space. Crowded conditions with poor ventilation, prisons, submarines, long airline flights. People with un-diagnosed and untreated TB are most likely sources. *** Casual contact usually will not result in infection. *** There is NO chance of infection from contact with contaminated surfaces such as eating utensils, clothing, reaerosolization of contaminated dusts are not a likely source. Anti-tuberculosis drugs loses its effectiveness after a few weeks.

Front 42

What is Mycobacterium bovis?

Back 42

Is generally seen in cattle. It is the consumption of infected milk. Mycobacterium bocis is not considered ATYPICAL TB. It is NOT common in this country due to milk pasteurization, but does occur in third world countries.

Front 43

Pathophysiology of Tubercolis:

Back 43

a

Front 44

What does a Physical Exam show for Primary Infection/Primary Tuberculosis?

Back 44

Usually unremarkable, usually asymptomatic. Change from negative to positive TB skin test. When symptoms are present: there is low grade fever, listlessness, lost of appetite and sometimes coughing.

Front 45

What does a physical exam show for Postprimary/Reactivation Tuberculosis?

Back 45

Pleural effusion in some patients (dullness to percussion), impaired (rales) breath sounds, fever during evenings, moderate weight loss, symptoms dependent upon location, entend and dureation of disease.

Front 46

What are the classic signs of "consumption" that are not typically seen in the U.S.?

Back 46

High fever, drenching night sweats, cachexia, chronic cough and hemoptysis.

Front 47

What are the classic signs of Disseminated/Extrapulmonary Tuberclosis?

Back 47

- Miliary disease - High fever, malaise, cough, dyspnea, weight loss, anorexia and headache.

Front 48

What are the pulmonary function findings regarding TB?

Back 48

Pulm function testing is rarely done on a suspected TB patient due to contamination potential of equipment. ----- TB present as a RESTRICTIVE DISORDER with normal expiratory flows and decreased lung volumes.

Front 49

What is the Pharmacologic treatment regarding TB?

Back 49

Treatment for active infection includes Isoniazid (INH), Rifampin (Rifadin), Ethambutol, Streptomycin, Pyrazinamide as well as Prophylactic Pharmacologic treatment. This is given to infected persons without disease but potential risk for developing disease (known or suspected HIV, close contact with active case, recent converter, Radiographic evidence of prior deisease, medical condition that increases risk. Other therapys provided are: Oxygen Therapy PRN, Bronchopulmonary Hygiene therapy PRN, Hyperinflation therapy PRN, and mechanical vendilation PRN with special filter with terminal cleaning policy.

Front 51

2. Compare and contrast tuberculous disease without infection with tuberculous disease. This is WITH TUBERCULOUS DISEASE.

See other card for tuberculous disease without infection.

Back 51

2. Whereas tuberculous disease must mean that they are clinically active. It must mean they can be reativated with TB even years after the initial infection has been controlled. Even though, most patients with primary TB recover completely from a clinical standpoint, it is important to note that tubercle bacilli can remain dormant for decades. Although, at any time, TB can become reactivated, especially in patients with depressed immune systems. Most new TB cases are associated with the following risk factors: malnourishment, nursing homes, prisons, homeless shelters, those living in overcrowded conditions, immunosuppressed patients (organ transplants), Cancer, HIV and alcoholism.

Front 52

2. Compare and contrast tuberculous disease without infection with tuberculous disease. This is WITHOUT INFECTION.

Back 52

1. Tubercolis disease without infection is when the TB is dormant or latent. The bacilli are controlled or isolated within tubercles causing immunity to develop. The patients do not feel sick nor have any TB-related symptoms. They still are infected with TB but do not have a "clinically active" TB. They often remain dormant for the life of the host until it gets reactivated by a change in immunity.

Front 53

What is Prognosis of a TB patient?

Back 53

Very dependent on compliance. With complianace of therapy, disease (not infection) can be cured. Often due to adverse side effects of drugs and poorly educated patients, patients do not continue therapy long enough to cure disease which can often result in drug resistant strains of organisms.

Front 54

What is Atypical TB?

Back 54

Mycobacterium avium intracellulare and Mycobacterium kansasii. Contained within soil and/or water. No person to person transmission. Seen in pts with suppressed immune systems AIDS. No characteristic features. MAI responds poorly to therapy and may result in disseminated disease in AIDS which may prove fatal. Mycobacterium kansasii responds well to typical TB drug therapy.