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62 Cards in this Set
- Front
- Back
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4th leading cause of death from infectious disease worldwide
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TB
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States with the highest prevalence of TB
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Texas, California, New York, and Florida- immigration from other countries
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Ethnic group most likely to get TB
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Hispanics
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TB is caused by
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Mycobacterium Tuberculosis
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Where does it attack?
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Mostly lungs, but also kidneys, spine, and brain (military TB)
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TB characteristics
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Slender bacillus with waxy lipid rich outer layer- does not stain well with gram stain
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Stain for TB
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Acid-fast stain- bright red
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How fast does TB grow?
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Slow-growing- smear can be negative but TB can still grow on culture
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TB infectious process
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Airborne particles
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Transmission process
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Person-to-person inhalation (coughing or sneezing)
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Macrophages can wall off infection causing latent TB
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Granulomas or tubercles
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Macrophages rupture and release bacilli
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Active TB
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What happens to the granulomas when an immune status changes?
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Granulomas rupture and spill thousands of infectious bacilli into the airways- cavitation of lungs (cheese-like)
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Symptoms of active TB
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Bad cough > 3 wks
Chest pain Coughing up blood/sputum Fatigue Weight loss Fever, chills, night sweats |
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What form of vaccine is the BCG vaccine?
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Cow form
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Does the BCG vaccine cause an infection?
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Yes- weak one
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What skin test will it produce?
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Positive PPD
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Where is the BCG vaccine mostly used?
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Not in the U.S.- not prevalent enough and doesn't work very well
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Contraindications for BCG
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Pregnancy
HIV Immunocompromised |
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TB test determinations
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Cannot tell if the person has latent or active TB
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PPD skin test- how it's administered
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Intradermally
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PPD skin test- when to get it measured
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48-72 hrs after test
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PPD skin test- what to measure
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INDURATION, not red area
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PPD skin test- results
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Induration > 5 + if:
recent contact with active TB HIV immunocompromised induration > 10 + if: immigrant IV drug user healthcare workers chronic illness (diabetes, cancer, etc) induration > 15: always + |
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TB blood test (Quantiferon TB gold test)
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Advantages:
1 visit results available in 24 hrs results not affected by BCG vaccine disadvantages: blood must be processed 8-30 hrs after collection expensive |
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CDC recommendations
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don't do both skin test and blood test
if infected with TB in the past, do chest x-ray immediately skin test preferred unless BCG vaccine was administered |
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When to report TB to a local health authority?
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active- report w/in 1 day
latent- report w/in 1 week |
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How to diagnose after chest x-ray?
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sputum culure
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Common treatment durations
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daily therapy
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If treatment regimens are not daily
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DOT adminstered- healthcare worker watches patient take the pill if they're not taking meds every day
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Isoniazid dosaging
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1ST LINE
DOT available adjust for renal impairment |
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Isoniazid pharmacokinetics
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slow absorption with food
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Isoniazid ADR
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hepatitis
peripheral neuropathy- depletes body of vitamin B6 |
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Isoniazid DI
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increases levels of phenytoin and warfarin
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Rifampin dosaging
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1ST LINE
DOT available |
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Rifampin kinetics
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absorption slowed with food
excreted through the feces |
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Rifampin ADR
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hypersensitivity- flu-like symptoms
hepatitis GI distress rash orange-red fluid discoloration |
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Rifampin DI
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lowers levels of phenytoin and warfarin, as well as protease inhibitors and NNRTI's in HIV patients
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Rifapentine
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long duration of action
once weekly dosing NOT IN HIV PATIENT |
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Rifabutin
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less potent
CAN BE USED IN HIV PATIENTS |
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Pyrazinamide Dosaging
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1ST LINE
DOT available needs renal adjustment |
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Rifampin MOA
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binds to RNA polymerase preventing RNA synthesis
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Isoniazid MOA
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interferes with the formation of mycolic acids, essential for the bacterial cell wall
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Pyrazinamide kinetics
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well-absorbed
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Pyrazinamide ADR
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hepatitis
GI distress arthralgias increased uric acid- gout NOT FOR PREGNANCY |
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Ethambutol MOA
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inhibits arabinosyl transferase resulting in impaired mycobacterial cell wall synthesis
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Ethambutol dosaging
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1ST LINE
DOT available adjust for renal impairment |
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Ethambutol kinetics
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well-absorbed
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Ethambutol ADR
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blurred vision
red-green color-blindness take with food NOT FOR CHILDREN |
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Ethambutol DI
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avoid antacids w/in 4 hrs of dose
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Latent TB treatment
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Isoniazid for 6-9 months
Rifamycin for 4 months 9 months for everyone- safe bet monotherapy is fine |
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Active TB treatment general
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combination drug therapy
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Multidrug-resistant TB and extensively-resistant TB
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use 2nd line drugs
treatment can last up to 2 yrs |
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2nd line agents for drug-resistant TB
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streptomycin
fluoroquinolones |
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Active TB treatment specifics
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isolation
IRPE- for 2 months, then re-evaluate IR- for 4 months if smear is negative or if smear is positive but there is no cavitation IR- for 7 months if smear is positive and there is cavitation add vitamin B6 |
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Active TB treatment for children
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similar regimen but total treatment time is ALWAYS 9 months
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Monitoring
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get sputum cultures monthly for the first 2 mos
culture determines continuation phase at the end of the 2nd month |
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HIV population
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extend continuation phase to 7 mos no matter what
use rifabutin DOT |
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Pregnancy population
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latent- I for 9 mos
DOT also take vitamin B6 active- IRE (no P) for 2 mos IR for 7 mos no matter what |
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Breast-feeding
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need vitamin B6 supplements if taking isoniazid
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Drugs that multidrug-resistant TB are resistant to
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> 2 1st line drugs (IR)
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Drugs that extensively-resistant TB are resistant to
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IR, fluoroquinolones and > 1 other 2nd line drug
rare |
