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28 Cards in this Set
- Front
- Back
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Risk factors for TB
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male
HIV (TB & HIV work synergistically, HIV increases likelihood of progression to active infection) |
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risk factors for active disease
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greatest risk in first 2 years of infection
< 2 / >65 years of age immunosuppression HIV |
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TB
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mycobacterium
acid-fast bacilli |
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laryngeal TB
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highest transmission
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latent TB
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no transmission
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milliary TB
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high transmission rate
HIV has no effect on transmission |
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TB pathophysiology
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not significant humoral response
CD4 & macrophages produce INF and interluekins 2 & 10 can inhibit apaptotic macrophages and immune responce |
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MTb primary infection
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injested by alveolar macrophages and can reproduce
spread to lymph nodes not held in check can go into blood stream + PPD 90% of patients will not have further manifestations |
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Mtb
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10% reactivation, emerge from granuloma
extrapulmonary usually only in HIV (in lymphatics, pluera) |
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milliary TB
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caused by massive inoculum or severe immunosuppression
millet seeds in lungs |
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PPD >/= 5mm
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HIV +
recent contacts fibrotic changes on CXR |
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PPD >/= 10 mm
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recent immigrants
IVDA resdients of jails NH long-term facilities homeless shelter MTb personnel chronic illness children < 4 all children exposed to a high risk patient |
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PPD >/= 15 mm
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no risk factors
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latent
TB |
only case monotherapy
minimum of 3 months 2-3 years if multi-drug resistant |
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active disease
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3-4 drugs simultaneously
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prevent spread
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isolation for 2 weeks until smear is -
PPE negative pressure rooms UV light or daylight |
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nonpharmcologic therapy
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weight gain via nutrional supplements
surgical removal of tissue |
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drugs
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INH>RIF>EMB>SM>PZA
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INH
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neruotoxicity (vit. B6/pyroxidine to reduce incidence)
age related heptic toxicity take on empty stomach separate from antiacids by 2 hours! DIs wtih warfarin and anti-convulsant meds |
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RIF
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never use as monotherapy
resistance usually means INH resistance stains body fluids red toxic to liver CYP450 inducer |
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PZA
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toxic to liver
uric acid elevations DIs cause additive liver toxicity |
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EMB
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retrobublar neuritis
inability to see green/red decrease visual acutity monitor rigourously! DI, avoid antiacids for 1 hour before |
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latent TB
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+ PPD
low inoculum of bacteria treatment: INH 300 mg PO QD x 9 months benefit seen at 6 months, peaks at 12 months |
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Active Disease Treatment
empiric phase |
INH, RIF, EMB 7 days a week x 56 doses
INH, RIF, EMD 5 days a week (DOT) FOR 4O doses EMB can be D/C once no resistance to RIF/INH PZA requires 56 doses until it can be d/c |
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TB treatment
continueation phase |
due another smear and culture
INH + RIF 7 days/week for 126 doses or 5 days a week DOT for 90 doses INH + RIF twice a week for 36 doses |
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MDR TB suspects
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prior TB therapy
from NY, mexico, Southeast asia homeless, HIV, positive smears after 2 months positive culture after 3-4 months retreatment empircally treat until proven otherwise |
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mycobacteria
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slow growing
special stains and cultures long incubation period |
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XDR-TB
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resistance to INH, RIF, + ONE 2nd line drug
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