Tuberculosis

Front 1

Def of tubeculosis?

Back 1

1/Def:
_Bact. infected disease transmitted by Mycobacterium Tuberculosis.
_Incr since 1985 due to:
*HIV, immigrant student
*Deterioration of med
*Multi drugs resistance strains(MDR-TB)
*Resistance fr. not taking drugs as prescribed
*Using other substances, inadequate follow up

Front 2

what do you need to protect the society?

Back 2

DOT: direct observation therapy

Front 3

Who is at risk ?

Back 3

2/Who at risk?
*Immuno compromise
*Homeless
*Elderly, nursing homes
*CA pt.
*Prisioners
*IV drug abuse
*Asia, Africa, Latin American Immigrants
*Health care worker

Front 4

What is the etiology of tuberculosis?

Back 4

4/Etiology:
*TB=communicable disease
*Aerobic, gram positive Acid Fast Bacillus
*Airborne with inhalation
*Particle small enough to reach aveoli & penetrate lung tissue
*Spread by coughing, laughing, singing, talking and sneezing.
**Primary 1st in: lung(located apesis near the pleura of lower lobe), kidney, bone, cerebral cortex congenital, lymp node, adrenal gland (can be everywhere).
**Sequence of spread:
+ronchopneumonia develop in lung tissue by TB bacilla. Many Bacilla survive macrophages=>carry to regional bronchopulmonary lymph node via lymphatic Sx=>circulating blood.
+Bacilla may spread rapidly through the body b4 the cell madiated immune response available. Most primary TB heal over in monts (forming scar or lesions_these lesion containing living bacilli, can reactivate-even after many year and cause secondary infection.
+Host has lifelong relationship with TB

Front 5

When the reactivation occur?

Back 5

5/Reactivation occur:
_When resistance lower, advanced age, immuno suppression, malnutrition, ETOH & drugs, Diabetes, renal,genetic predisposition.

Front 6

TB 's Diagnostic procedures

Back 6

7/ Diagnosis Procedures:
_Monitor TB in Cow, diary products
_TB mimics other disease, X-Ray alone not a definitive test, can occur concurrently with other pulmonary disease.
_Assess pretest result and Hx of exposure:
+Skin Test:body immune response produce Hypersensitivity 3-10 wks after exposure and once acquired-sensitivity to Tubercullino tend to persist through LIFE.
**A (+) Rnx= present of TB infection(exposed). it is not indicate whether it is active, dorminate or causing illness.
**A (-) Rnx=not exposure, or depression of cell mediated immunity as in HIV.
**Testing & reading:not wheal=>not OK=>need to repead test.Read in 48-72h. Measure bump(inderation) report in mm(>=5 mm:normal person;>10 mm:health care provider)
**2 step plan( TB VAx):1st:get base line, prevent false(negative); 2nd:between 1-2 wks fr the 1st.
+The Calcification of lungs(upper lobe and lung lesions).
+Gastric washing:
+CSF, pus from abcess
+DNA finger printing
+Sputum specimen for Dx.(need enough amount to have productive smear, 10000ml of bacteria).
+Chest X-Ray:important but not definitive because other disease can mimic TB:multinodular lymp nodes, calcification of lung's lesion occurs after many years
+Anergy Pannel Testing:(APT):failure to response to any infection. DECR immune Sx, not response to TB skin test (symptom of TB, mump, candida and others).False(-):if APT not definitive=>X-Ray, Sputum, Isolation, Wait till result fr. 3 sputum in 3 separate days.

Front 7

TB' s diagnostic tests?

Back 7

1/ Skin test:
2/ Chest X-ray
3/Allergy pannel testing

Front 8

Treatment of Tuberculosis
_Short term
_Longterm

Back 8

1/ Short term: Medication
****Tubeculin convertor(4 meds):
_INH (isoniazid)
_Rifampin
_Pyrazinamide
_Enthambutol or Streptomycin
***Pt start all 4 meds to prevent resistance organism becuz bacilli is difficult to kill
***Tx continue long enough to eliminate dormant bacilla
9/Long term Tx:uninterupted, chemotherapy is important=>must complete all 4 meds.
_3 options:
+DOT required( daily/2-3X per week).Enthambutor d/c if susceptibility to INH/Rifapin.Pyrazinamid d/c after 8 wks.Tx duration=6M or at least 3M after sputum convert to negative.
+Daily INH, Rifampin and pyrazinamide.Enthambutol for 2wks=>DOT(2X/wk)=>duration:6wks. Isoniazid(INH) & Rifamine DOT_2X/wk wihtin 16 wks.

+DOT(3X/wk and all 4 meds for duration of 6 months
_weekly sputum test
_Therapy not working=> at least 2 meds added. After 1 year:liver fnx test
_Not treat=>pt can't go to society.

Front 9

Sign and symptoms:

Back 9

COUGH, FATIGUE, ANOREXIA, WT. LOss, HIGH/LOW grade FEVER, CHILL, SWEAT, DYSPNEA, HEMOLYSIS, CHEST PAIN, TIGHTNESS & CRACKLE.

Front 10

Tuberculosis's prevention

Back 10

10/ Prevention:
_N95 mask.Known TB pt.=>use negative Pressure Room. Coughing use tissue & sleave(dispose properly). Staff waer well fitting mask(thicker). If exposed: INH 300 daily for 6-12M (kill dormant bacillar)
_INH 300 mg/daily/6-12 months recommended for: newly Dx infected, (+) skin test, no symptom. Live with Tb ppl. Skin test react(abnormal chest X-Ray, inactive TB.Possitive skin test plus Diabetes, Aids, Steroid.Less than 35 yrs old, skin test react, X-ray
normal.
***VAX: BCG( bacilli calmette Guerin). Live intinuated cacine. Does not prevent/reduce chance of natural infection. Does reduce seriousness clinical symptoms
***Other ways of spreading :irritating wound(splashes on mucus membrane)