Term
| What happens if TB is left untreated? |
|
Definition
| It causes progressive tissue destruction and eventually death |
|
|
Term
| What is the leading killer globally? |
|
Definition
|
|
Term
| How many people die each minute in India from TB? |
|
Definition
|
|
Term
| How many people are infected with TB? |
|
Definition
|
|
Term
| How many people die of TB each year? |
|
Definition
|
|
Term
| How many people in the US are latently infected with TB? |
|
Definition
|
|
Term
| What is the lifetime risk of active disease for those with latent TB? |
|
Definition
|
|
Term
|
Definition
| Yes, it must be reported to the local health department |
|
|
Term
|
Definition
Mycobacterium tuberculosis
Mycobacterium bovis |
|
|
Term
| Why do we pasteurize milk? |
|
Definition
| to prevent TB from Mycobacterium bovis |
|
|
Term
| Which organism is used to make the TB vaccine? |
|
Definition
|
|
Term
True/False
The number of cases of TB in foreign born persons increased 5% from 1993-2004, while the cases among US born persons fell 62%. |
|
Definition
|
|
Term
| Name the top 10 countries from which persons are at a higher risk for developing TB (or having latent TB infection). |
|
Definition
| Mexico, Philippines, Vietnam, India, China, Haiti, South Korea, Guatamala, Ethiopia, Peru |
|
|
Term
| What 5 states account for half of all TB cases in the US? |
|
Definition
| California, Florida, Illinois, New York, and Texas |
|
|
Term
| What % of cases of immigrants with TB have lived in the US for more than 5 years? |
|
Definition
|
|
Term
| What is the transmission rate for TB with close contact? |
|
Definition
|
|
Term
| What % of patients (ages 25-44) with TB also have HIV? |
|
Definition
|
|
Term
| When was the tuberculin skin test first developed? |
|
Definition
|
|
Term
| What is the oldest diagnostic test still in use in modern medical practice? |
|
Definition
|
|
Term
|
Definition
| protein purified derivative |
|
|
Term
| Why does a PPD test come back as a false positive in someone who has had the BCG vaccine? |
|
Definition
| it contains over 200 antigens shared with the bacille Calmette-Guerin vaccine (TB vaccine) |
|
|
Term
| How many people have been vaccinated for TB? |
|
Definition
|
|
Term
| What is the QuantiFERON-TB Gold Test? |
|
Definition
| a test based on whole blood ELISA that is approved for in vitro diagnostics by the FDA |
|
|
Term
| How do you read a TST (or PPD)? |
|
Definition
Look and feel for induration. Mark the induration with a pen and measure
>15 mm is +
>10mm in an exposed, diabetic, or kidney disease individual is +
>5mm in an immunocompromised individual is + |
|
|
Term
| Why is Gram stain not helpful with TB? |
|
Definition
| It doesn't stain well with Gram's stain |
|
|
Term
| What does TB's resistance to Gram staining tell us about treatment? |
|
Definition
| drugs that attack the cell wall by binding peptidoglycan will not be very effective |
|
|
Term
| What stain is used for TB? |
|
Definition
| Ziehl-Neelsen stain (ZN); it can pick up 8,000-10,000 organisms per mL |
|
|
Term
| Does a negative ZN smear mean that there is no TB? |
|
Definition
| No, it may still result in a positive culture |
|
|
Term
|
Definition
| It doubles every 20 hours - whereas most bacteria double every 30 minutes |
|
|
Term
| How sensitive is the TST (PPD)? |
|
Definition
|
|
Term
| How specific is the TST (PPD)? |
|
Definition
|
|
Term
| How sensitive is the QuantiFERON test? |
|
Definition
|
|
Term
| How specific is the Quanti-FERON test? |
|
Definition
|
|
Term
| Why should TB screening be offered to all immigrants and refugees as a PPD test? |
|
Definition
a large number of post-arrival follow-ups are never completed by the CDC
reaction in those vaccinated isn't bad and it allows you to check for latent infection
treatment of latent infection is optional and you now have an opening to discuss it with your patients |
|
|
Term
| Who else might you consider routinely screening for TB? |
|
Definition
| any immunocompromised patient, especially those that are institutionalized (nursing home, prison, etc), and any healthcare workers |
|
|
Term
| What do you do if pulmonary TB is suspected? |
|
Definition
Get 3 induced sputum samples on 3 different days
Acid Fast Bacilli smears
cultures
nucleic amplification
Get a CXR in all patients with cough or pulmonary disease
Get fluid from the extrapulmonary site of infection or fine needle biopsy of a mass |
|
|
Term
T/F
T-lymphocytes destroy immature macrophages that are unable to kill bacteria. |
|
Definition
|
|
Term
| Where do M. tuberculosis bacteria multiply? |
|
Definition
| In the macrophage cytoplasm, because they can inhibit the fusion of lysosomes to phagosomes so they aren't killed |
|
|
Term
| What is lipoarainomannan (LAMM)? |
|
Definition
| a principle component of the bacterial cell wall of M. tuberculosis that can block cytokine activation of macrophages |
|
|
Term
| Why is hydrogen peroxide less effetive against Mycobacterium tuberculosis? |
|
Definition
| LAM scavanges superoxides |
|
|
Term
| How is TB infection spread? |
|
Definition
airborne
puncture wound
ingestion |
|
|
Term
| How many bacteria ar cause TB infection? |
|
Definition
|
|
Term
| What 3 factors determine the progression of TB? |
|
Definition
1. The number of organisms inhaled
2. The virulence of the organism
3. The host's cell mediated response |
|
|
Term
| What happens after the bacteria enter the body? |
|
Definition
| Large numbers of macrophages surround the caseous TB foci and form granulomas to contain the organism |
|
|
Term
| What qualifies the latent phase of TB? |
|
Definition
| The infection is under control |
|
|
Term
| What % of patients with latent phase TB will become infected in their lifetime? |
|
Definition
|
|
Term
| What % of those with latent TB infection that do become infected, have it happen within 2 years of exposure? |
|
Definition
|
|
Term
| What % of TB patients should be screened for HIV? |
|
Definition
|
|
Term
| What % of HIV patients should be screened for TB? |
|
Definition
|
|
Term
| What is the most common form of extrapulmonary TB? |
|
Definition
|
|
Term
| What % of TB cases is pleural TB? |
|
Definition
|
|
Term
| What other extrapulmonary sites are found with TB? |
|
Definition
| bone, joint, genitourinary, meningeal |
|
|
Term
|
Definition
| a massive innoculation of organisms enters the blood stream causing widely disseminated progressive disease |
|
|
Term
| What are the 9 desired outcomes with treatment of TB? |
|
Definition
1. Rapid ID of patient with TB
2. Isolation of patient to protect others
3. Collection of smears and cultures
4. Initiation of specific treatment
5. Resolution of s/s of disease
6. Achieve noninfectious state
7. Patient adherence to treatment
8. Cure the patient ASAP
9. ID the strain and check for resistance |
|
|
Term
| What are 3 nonpharmacologic measures to treat TB? |
|
Definition
1. Prevent the spread - report it and isolate patient
2. Use contact info to ID spread of the disease - PPD testing of contacts
3. Restore the patient to normal wt and well being |
|
|
Term
| How many bacteria are present in an asymptomatic patient? |
|
Definition
|
|
Term
| How many bacteria are present in the patient with cavitary pulmonary TB? |
|
Definition
|
|
Term
| What is the naturally occurring resistance rate in bacteria? |
|
Definition
| 1 in 1 million to 100 million |
|
|
Term
| Why do we use combination therapy to treat TB? |
|
Definition
| By using more drugs, we reduce the resistance rate to an almost impossible number. This is important because it only takes 1-3 bacteria to colonize the patient. |
|
|
Term
| How many drugs are typically included in the regimen to treat TB? |
|
Definition
|
|
Term
| How many drugs are approved for the treatment of TB? |
|
Definition
|
|
Term
| Name 4 drugs approved by the FDA to treat TB. |
|
Definition
| quinolones, amikacin, kanamycin, rifabutin |
|
|
Term
| What is the first phase of treatment for TB? |
|
Definition
| 8 weeks of daily therapy with isoniazid, rifampin, ethambutol, and pyrazinamide |
|
|
Term
| What is the second phase of treatment? |
|
Definition
18 weeks (daily, 5x/week, or 3x/week) of meds depending on the initial response
31 weeks for phase 2 if cavitation on initial CXR |
|
|
Term
| What are considered the first line therapies for TB? |
|
Definition
| isoniazid, rifampin, amikacin, and kanamycin, ethambutol, pyrazinamide, rifabutin |
|
|
Term
| What is the action of isoniazid? |
|
Definition
| prevents the synthesis of mycolic acids and mycobacterial cell walls |
|
|
Term
| What are possible side effects of isoniazid? |
|
Definition
| fever, skin rashes, drug induced hepatitis |
|
|
Term
| Why do you need to monitor AST and ALT levels in TB patients taking isoniazid? |
|
Definition
| it can cause drug-induced hepatitis |
|
|
Term
| What is rifampin's mechanism of action? |
|
Definition
| it inhibits RNA synthesis in bacteria |
|
|
Term
| What are the side effects of rifampin? |
|
Definition
| orange color to urine, sweat, tears, and contact lenses; rashes, thrombocytopenia (anemia), and nephritis |
|
|
Term
| What is the mechanism of action of amikacin? |
|
Definition
| binds 30S ribosomal subunits |
|
|
Term
| When is drug resistance a problem with TB? |
|
Definition
| when there are compliance issues |
|
|
Term
| What drugs used to treat TB can cause drug-induced hepatitis? |
|
Definition
| isoniazid, rifampin, pyrazinamide |
|
|
Term
| How many times normal do AST and ALT get before causing symptoms? |
|
Definition
|
|
Term
| What is the maximum that AST, ALT levels can reach? |
|
Definition
|
|
Term
| If AST, ALT levels are elevated, what do you do? |
|
Definition
use 2 or more drugs to replace the hepatitis-causing drug until liver enzymes normalize, then resume again with monitoring
Replace with ethambutol, streptomycin, amikacin, kanamycin |
|
|
Term
| Before TB treatment, what lab tests should you run? |
|
Definition
| ALT, AST, bilirubin, and CBC |
|
|
Term
| Why should TB treatment patients be monitored monthly? |
|
Definition
| adherence to meds, s/s of peripheral neuropathy (caused by isoniazid), symptoms of hepatitis (nausea, emessis, dark urine, abdominal pain), signs of hepatitis (jaundice, hepatomegaly or tenderness). |
|
|
Term
| What happens if you use isoniazid with phenytoin? |
|
Definition
| you get increased levels of both drugs |
|
|
Term
| Which drug should you use in patients on antiretroviral therapy for HIV? |
|
Definition
|
|
Term
| What TB drug should not be used in children and why? |
|
Definition
| ethambutol because of risk of diminished visual acuity |
|
|
Term
| What drug regimen do you use to treat children with TB? |
|
Definition
isoniazid, rifampin, and pyrazinamide
and 4th if there is severe pulmonary disease |
|
|
Term
| How should you treat latent TB in pregnant women? |
|
Definition
| Don't. Wait until after delivery. |
|
|
Term
| When should therapy for active TB infection in pregnant women begin? |
|
Definition
|
|
Term
| What is the 3 drug regimen used to treat active TB in pregnant women? Why are these used? |
|
Definition
isoniazid, rifampin, and ethambutol
they are used because of their lack of teratogenic effects |
|
|
Term
| What is the risk of TB in pregnant women? |
|
Definition
| transmission to the fetus |
|
|
Term
| Can women breast feed while undergoing TB treatment? |
|
Definition
| yes, unlikely to be toxic levels; however, levels are not high enough to treat infant for TB |
|
|
Term
| What drug is given to pregnant and lactating patients with TB who are taking isonizid? |
|
Definition
| pyridoxine because it prevents the neuropathy induced by isoniazid |
|
|
Term
| When do you use pyridoine in TB treatment? |
|
Definition
| pregnant and lactating patients to prevent neuropathy induced by isoniazid and also in HIV and malnourished patients |
|
|
Term
| When a TB patient is in advanced liver disease, which drug(s) do you use? |
|
Definition
|
|
Term
| What medications do you use to treat HIV patients with TB? |
|
Definition
| same drugs as with non-HIV patients, except if the patient is on antivirals, in which case - no rifampin |
|
|
Term
| How many people in the US have latent TB? |
|
Definition
|
|
Term
| What are the high risk groups for latent TB? |
|
Definition
| foreign born, close contacts of TB patients, racial and ethnic minorities, and congregate living |
|
|
Term
| When is the greatest risk for latent TB to become active infection? |
|
Definition
| Within 2 years of exposure |
|
|
Term
| What 3 drugs may increase risk of latent TB becoming active TB? How do they cause this? |
|
Definition
infliximab, etanercept, or adalimumab
they inhibit tumor necrosis factor alpha |
|
|
Term
| What is the treatment for active TB? |
|
Definition
rule out active disease
treat with isonizid, Vitamin B2 pyridoxine, rifampin, or rifabutin |
|
|
Term
| How must isoniazid be taken? |
|
Definition
| on an empty stomach, and no antacids for 2 hours |
|
|
Term
| Why is Vitamin B6 given to latent TB patients? |
|
Definition
| specifically given to pregnant, alcoholics, and malnourished because it prevents neuritis in these populations |
|
|
Term
| With treatment, the lifetime risk of latent TB becoming an active infection drops from 10% to what? |
|
Definition
|
|
Term
| What is the treatment for resistant TB? |
|
Definition
| isoniazid, rifampin, pyrazinamide, + 2 or 3 additional agents |
|
|
Term
| When do most relapses of TB occur? |
|
Definition
| first 6-12 months after completion of therapy |
|
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