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36 Cards in this Set
- Front
- Back
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TB stats? world population? new cases in 2014? US patients? disproportionate to who? |
world population? 1/3 new cases in 2014? 9.6 million new TB cases world wide. US patients? 11 million people have it, disproportionate to who? malnourished, homeless and marginally housed. |
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how is TB transmitted? |
aersolized. can remain in air for hours. may reach terminal air passages when inhaled. 3000 inoculi in 1 cough |
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how does TB survive in the body? |
immunocompetent host TB survives in areas of high O2/blood flow. apecies of lung. Can survive in ghon compolex until host becomes immunocomprimised. immunocompromised hosts the TB can spread rapidly. |
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primary pulmonary TB numbers vs primary TB numbers. |
primary pulmonary TB is 10% of infected patients. 90% are primary TB. |
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primary TB site and spread? |
primary infects the middle and lower lungs most commonly. spreads hematogenously before immune response generated. severe cases lead to progressive primary TB. |
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primary TB infections site, spread and immunity development? |
tubercle bacilli reach alveoli and are ingested by macrophages and T cells. macrophages and T cells surround organism and form granulomas. within 3 to 6 weeks hosts develops immunity to reinfections, but may not be able to eliminate what is in the lung. It can hide in other organs like the spine, meninges and kidneys. |
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secondary TB or postprimary/reactivation TB info? |
latent TB is more infectious than primary ds due to cavitation. |
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where does laten TB usually reactiveate? how many of them die if untreated? |
reactivates in apical and posterior segments of upper lobes. extent of lung involvement varies. up to 1/3 of untreated patients die within a few weeks. |
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Why do PPD's? __ % of latent TB patients will reactivate to active TB. __ % of TB in adults is reactivation. up to __ % of HIV patients will develop active TB. |
10% of latent TB patients will reactivate to active TB. 90% of TB in adults is reactivation. up to 50% of HIV patients will develop active TB. |
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clincal features of malaise,anorexia, weightloss, fever, and night sweats with dry then productive with blood tinged sputum is what? |
TB |
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dx of TB? |
–Mtuberculosis fromcultures or by DNA or RNA amplification techniques. Threeconsecutive morning sputum specimens (admit them so they don’t spread it) . Acid-fastbacilli on sputumsmear does not confirm a diagnosis. Bronchoscopy-ifthey are negative on sputum but you still suspect TB-bronchoscopy. |
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TB CXR in active ds. |
Smallhomogeneous infiltrates –Hilarand paratracheal lymph node enlargement –Segmentalatelectasis –+/-pleural effusion –Cavitationwith progressive primary tuberculosis |
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CXR of resolved TB |
–Densenodules in the pulmonary hila –Upperlobe fibronodular scarring–Bronchiectasiswith volume loss –Ghon (calcified primary focus) –Ranke(calcified primary focus and calcified hilar lymph node) |
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reactivation TB patterns on radiographs |
miliary pattern |
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how to read PPD? what does it tell you. |
diameter not erythema. tells you about exposure. No difference in reaction in active vs latent. |
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situations in which you have a + PPD? HIV close contact with active contagious TB case. abnormal CXR. immunosuppressed patient. |
> or equal to 5 mm |
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situations in which you have a + PPD? clinical condition with reactivation potential. > 4 years old. foreign born. resident or employee of high risk nature. |
> or equal to 10 mm |
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situations in which you have a + PPD? healthy person with no risk |
> or equal to 15 mm |
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dx of TB gld standard |
Quantiferon-TB gold in tube assay. >95% specific & 80% sensitive for latent TB. preferred over TST because TST no good once BCG vaccinated. Good for patient who won't come back to have their TB test read. |
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DOT is what and what is it for? |
directly observed therapy. Patients who need to be observed doing their treatment. For all drug resistant TB patients. |
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Tx of TB in HIV negative patients. |
6 months. 2 months of RIPE. 4 months of RI. 3 months beyond documented negative sputum. So it could be shorter if neg sputum. |
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what else to give with isoniazid? |
pyridoxine which is Vit B-6 25 to 50 mg per day. |
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tx pf drug resistant TB |
6 months of RIPE. or 12 months of RE multi drug resistant TB needs an expert and at least 18 to 24 months of a 3 drug regimen. |
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tx of extra pulmonary TB |
6 months. 2 months of RIPE. 4 months of RI. 3 months beyond documented negative sputum. So it could be shorter if neg sputum. add on corticosteroid therapy to prevent cardiac constriction and meningitis. |
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what to do before TB tx? |
get baseline: BBHCCC bilirubin. BUN. hepatic enzymes. Creatinine. CBC. consider Hep b, c and HIV. |
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what to do during TB tx? |
–Monthlyquestioning for symptoms of drug toxicity Rash, numbness in hands or feet, jaundice, abdominal pain,nausea, vomiting, or anorexia. |
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Tx of latent TB |
3 options. 1- 6 months of isoniazid daily 300 mg/daily or 900 mg/biweekly. 2- isoniazid and rifampin for 3 months. rifampin 600 mg and 300 mg INH daily 3- Rifampin for 4 months 600 mg daily. |
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tx for MDRTB? |
two drugs in which the infecting organism has demostrated susceptibility. HIV pos treated for 12 months. |
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prognosis of TB tx patients? |
almost all cured. relapse rate less than 5% with good med regimens. main tx failure is nonadherence. |
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lung abscesses are what? how do they happen |
•Pulmonaryparenchymal necrosis and cavitation resulting from infection. high microorganism burden. inadequate clearance. |
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whos ar rsik for lung abscesses |
aspiration is most common. periodontal ds. alcoholism. |
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most common bacteria for lung abscesses? how does each present? |
anaerobic= insidious. aerobic are worse however= acute. |
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symptoms of lung abscess |
cough, super purulent sputum, pleuritic chest px, fever and hemoptysis. rales. fetid breath and poor dentition |
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CXR on lung abscesses |
•Most Commonly:posterior segment of upper lobes and superior segments of lower lobes.Basically where the aspirate drains to. |
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dx of lung abscess? tx? |
clinical symptoms. ID predisposing conditions. CXR. or CT. tx with clindamycin 150 to 300 mg every 6 hours for several months. surgery for refractory hemoptysis. remember than aerobic is not affected by clindamycin. |
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prognosis of lung abscess |
typical primary lung abscess (including alcoholics and IVDU) cure rates90–95% higher mortality with immunocompromised. significant comorbidities and infection with p aeruginosa, staph a and k pneumoniae. |
