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32 Cards in this Set
- Front
- Back
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RISK OF TB DISEASE IN AIDS PT vs NON-AIDS PTS
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10% OVER LIFETIME TO 10% PER YEAR WITH HIV CO-INF
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LARGEST BURDEN OF DX (NEW CASES)
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SE ASIA
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HIGHEST # CASES
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INDIA
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PERCENT OF WORLD INFECTED
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25%
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DISTINGUISH INFECTION FROM DS - DIAGNOSTIC
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SYMPTOMS - fever, cough, night sweats
ABNML CXR |
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TRANSMISSION OF TB
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DROPLET NUCLEI (KIDS>8/AD)
EXPELLED FROM INF TB COUGH, SNEEZE, SPEAK SING CLOSE CONTACTS/HIGHEST RISK TRANS FROM PERSON W INFECTIOUS DX(NOT LTBI) ONE CONTAGIOUS=10-15 INF/YEAR |
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WHAT INCREASES THE PROBABILITY OF TRANSMISSION
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1 INFECTIOUSNESS - org load,
cavitary lesion, cough 2 ENVIRONMENT - air circulate, UV lighting(kills TB), O2 tension 3 DURATION OF EXPOSURE 4 VIRULENCE OF ORG |
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HIV AND TB DATA
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40mill HIV cases WW - 1/3 TB
most HIB/TB in sub saharan Afr 33-50% new TB cases in US in HIV attributible S Africa - 70% TB patients also have HIV co-inf |
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What are symptoms of Pulmonary TB
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productive, prolonged cough(>3wk
Chest Pain Hemoptysis - (spit up blood) |
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Symptoms of Systemic TB
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Fever
Chills Night Sweats Appetite loss Weight loss - v signif in kids Easy fatigability |
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COMMON SITES OF TB DISEASE
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Lungs
Pleura CNS - 2-3 mos Lymphatic sys - 6-12 mos GU sys Bone and joints - late sequela(potts dx) Disseminated (milliary TB) |
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WHAT CAN BE A MARKER FOR TB IN DEVELOPING COUNTRIES (PEARL**)
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PYURIA
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TYPES OF DRUG RESISTANT TB
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1 - develops in person initially infected with resistant organism
2ary - acquired - develops during TB tx due to poor compliance! |
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DRUG RESISTANCE IN TB IS DUE TO A COMSPIRACY AMONG ORG, PT, PHYS AND HEALTH CARE SYSTEM
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Incomplete and poorly managed therapy has caused skyrocketed drug resistance and inc secondary spread of infection
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tb in kids - risk
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disseminated dx and meningitis
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which kids infectious
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>8-10
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difficulty in dxing kids
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lack of smear positive sputum - get first morning gastric aspirates.
induced sputum |
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compare induced sputum to gastric aspirates in kids for getting culture
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1 induced as good as 3 gastric aspirates for getting culture.
use MODS - broth culture for cording |
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what is used to detect TB - GOLD STANDARD
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PPD
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What is Tuberculin skin testing useful for? (3 things in particular)
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Examining person not ill but may be infected (potential LTBI case)
Determining how many in group infected Examining person who has symptoms of TB |
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WHICH GROUPS SHOULD BE TESTED FOR TB
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1 close contacts of known or
suspected TB 2 Foreign born persons where TB common 3 Residents & employees high risk congregate settings 4 HCWs serving hi risk clients |
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WHICH PERSONS AT HIGHER RISK FOR EXPOSURE TO OR INF WITH TB
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Mediclly underserved
hi risk racial or ethnic min pops kids exposed to adults in hi risk ca persons injecting illicit drugs |
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GROUPS AT HIGHER RISK OF DISEASE ONCE INFECTED
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HIV
Recently infected w M tuberculosis certain med conditions illicit drug users person hx of inadequately tx TB |
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DESCRIBE TUBERCULIN SKIN TEST
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Inject intradermally .1 ml of 5TU PPD tuberculin
Produce wheal 6 - 10 mm don't recap needle Universal percautions for inf cont |
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CLASSIFY TB RXN - 5mm
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5 mm is positive for:
HIV+ Recent contacts w TB case fibrotic cxr(consist w old healed TB Organ transplant/immunosup |
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TB RXN - 10mm
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recent arrivals from high prev
IV drug users Residents and emp of hi risk congregate settings Mycobact lab personnel Persons with clinical condition putting them at hi risk Kids <4 or kids exposed to hi risk adults |
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TB RXN - 15mm
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people with no know risk factors
targeting skin testing programs |
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SMEARS AND EXAMS
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get 3 sputum spec for adults for smear and culture.
AFB results in smear should be considered for TB!! |
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WHAT IS MOST COMMON TEST USED IN DEV COUNTRIES TO DETECT TB
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AFB SMEAR!
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If smear is negative, should you do culture?
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YES!
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what do you use to evaluate for TB disease
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med hx
PE Mantoux T skin test chx bacteriologic or histologic exam |
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CHX - where abnormalities seen?
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apical or posterior segments of upper lobe or superior segs of lower lobe
CANNOT CONFIRM DX OF TB |
