Term
| What key resistance issues are seeing some States tuberculosis mortality rates increase? |
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Definition
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Term
| How does tuberculosis rank for infectious cause of death worldwide? |
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Definition
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Term
| What tuberculosis vaccine is used commonly worldwide where tuberculosis prevalence is high? |
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Definition
| Bacille Calmette-Guerin - live vaccine from M. bovis |
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Term
| How does tuberculosis Gram stain? |
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Definition
| It does not Gram stain, all Mycobacteriaceae are acid fast bacilli (AFB) |
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Term
| What is the primary route of infection for tuberculosis? |
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Definition
| inhalation of respiratory droplets produced by actively infected individuals activities of coughing, sneezing, singing, talking, etc. |
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Term
| What are the 3 possible outcomes for inhaled MTB? |
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Definition
| host kills MTB, active infection, MTB is walled off to dormant state by host defenses |
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Term
| what is the most common outcome when a person is exposed to MTB? |
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Definition
| MTB is walled off into a dormant state |
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Term
| What persentage of those with LTBI will eventually develop active infection? |
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Definition
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Term
| If TB "breaks out" of containment, when will this usually occur? |
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Definition
| within the first 1 - 2 years after LTBI |
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Term
| What century saw tuberculosis as the leading cause of death in the US? |
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Definition
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Term
| What are risk factors for LTBI becoming active infection? |
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Definition
| HACCeK D - HIV, Age, Cancer, CKD, DM |
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Term
| What are the symptoms of LTBI? |
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Definition
| often asymtomatic, persistent productive cough, hemoptysis |
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Term
| What might be seen or heard on physical exam for someone with LTBI? |
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Definition
| rales, rhonchi, clubbing of fingers |
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Term
| What are the 2 primary methods of identifying LTBI? |
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Definition
| tuberculin skin test (TST or PPD), interferon-gamma release assays (IGRAs) |
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Term
| When should use 2 step testing for LTBI? |
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Definition
| for initial testing of adults who will be retested periodically (e.g., health care workers) |
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Term
| What might cause a false positive TST? |
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Definition
| other Mycobacteria, BCG vaccine, poorly administered / interpreted test |
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Term
| What might cause a false negative TST? |
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Definition
| anergy (immunocompromised), time frame (truly infected patient might take 2 - 12 weeks to display a positive result) |
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Term
| For which individuals is >= 5mm induration used as the positive TST cutoff? |
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Definition
| 10 IMMIGRANTS 4 HIRE including "CHICAs" - Chronic Immunosuppression (medications including > 15 mg of prednisone / day for > 1 month), HIV+, Close Contacts of person(s) with TB, Abnormal X-ray suggesting TB |
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Term
| For which individuals is >= 10mm induration used as the positive TST cutoff? |
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Definition
| "10 IMMIGRANTS 4 HIRE" including CHICAs - recent IMMIGRANT (from high risk country) within 5 years, Health care workers, Intravenous drug abusers, Residents / Employees of High Risk settings |
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Term
| For which individuals is >= 15mm induration used as the positive TST cutoff? |
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Definition
| persons with no risk factors for TB |
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Term
| What are the advantages of the interferon-gamma release assays (IGRAs)? |
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Definition
| DECENT test - Detection Earlier (24 hours), Cost Effective, Not Tricked by BCG vaccine or interpretation error. |
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Term
| What are the regimens for LTBI treatment? |
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Definition
| INH x9 months (1st line), INH x6 months (2nd line), Rifampin x4 months (3rd line) |
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Term
| What is the short list for INH drug interactions? |
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Definition
| phenytoin and numerous HIV medications |
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Term
| Which regimen for LTBI should HIV+ patients receive? |
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Definition
|
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Term
| What is the the adult qd dosing for INH in LTBI treatment? |
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Definition
| 5mg / kg / dose (max 300mg / dose) |
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Term
| What is the adult 2-3x/week direct observed therapy (DOT) dosing for INH in LTBI treatment? |
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Definition
| 15mg / kg / dose (max 900mg / dose) |
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Term
| The most notable side effects of INH affect what organ? |
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Definition
|
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Term
| What INH liver side effects are there, ranging for mild to severe? |
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Definition
| asymptomatic elevation of aminotransferases, clinical hepatitis, fatal hepatitis |
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Term
| What factors increase the risk for clinical hepatitis when using INH? |
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Definition
| several factors are MAD HELP for increasing risk of clinical hapatitis - other Hepatotoxic Medications, Age, Pre-existing Liver Disease, EtOH use |
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Term
| What monitoring should be done for INH? |
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Definition
| baseline LFTs repeated monthly even if asymptomatic, check ofor signs and symptoms of liver disease |
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Term
| What is the short list for signs and symptoms of liver disease? |
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Definition
| abdominal pain, anorexia, dark urine, yellowing of skin / sclera |
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|
Term
| What are the adverse effects of INH? |
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Definition
| LACEd with GIN - Liver, Anemia, CNS Effects, GI Intolerance, Neuropathy (peripheral) |
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Term
| Which INH adverse effect is dose related and how is it mediated? |
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Definition
| peripheral neuropathy mediated via INH interfence with pyridoxime (B6)metabolism |
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|
Term
| What is the supplemental dosing of pyridoxime when taking INH? |
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Definition
|
|
Term
| What are the risk factors for peripheral neuropathy associated with INH? |
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Definition
| several factors are MAD non-HEP risk factors for peripheral neuropathy - Malnutrition, Alcoholism, DM, HIV, ESRD, Pregnancy |
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Term
| What are the windows of compliance for the LTBI regimens? |
|
Definition
9 month INH : 270 doses in 12 months
6 month INH : 180 doses in 9 months
4 month rifampin : 120 doses in 6 months |
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|
Term
| What select patients / cases can use 3rd line LTBI treatment of rifampin x4 months? |
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Definition
| intolerant of INH, known / suspected strain of INH-resistant TB, patient who can't / won't complete at least 6 months INH |
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|
Term
| What is the adult qd dosing for rifampin in LTBI treatment? |
|
Definition
| 10mg / kg / dose (max 600mg / dose) |
|
|
Term
| What is the short list of drug interactions with rifampin? |
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Definition
| HOW does rifampin interact with drugs? - HIV medications (numerous), OCs, Warfarin |
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Term
| Other than drug interactions, what are the other adverse effects of rifampin? |
|
Definition
| HOT FLASH - Hepatotoxicity, Orange discoloration of bodily fluids, Thrombocytopenia, FLu-like sysmptoms including gi effects, rASH |
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|
Term
| What baseline labs are recommended before starting rifampin regimen? |
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Definition
| take A CAB to the base of rifampin mountain - AST, CBC, ALT, Bilirubin |
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|
Term
| Why are LTBI treatment completion rates so low? |
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Definition
| LUST RAPE - Lack of Understanding by patient, Absence of Symptoms, Toxicity of Regimen, Prolonged (duration) Event |
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Term
| What are the symptoms of active TB? |
|
Definition
| FAWN'S mother was a HiPPY - Fever, Anorexia, Weight loss, Night Sweats, Hemoptysis, Persistent Productive cough, Yucky feeling (malaise) |
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Term
| What is the gold standard for diagnosis of active TB? |
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Definition
| sputum culture of at least 3 morning samples over 3 consecutive days |
|
|
Term
| How long does it take to ID TB by culture? |
|
Definition
|
|
Term
| How long does it take to obtain TB sensitivity? |
|
Definition
|
|
Term
| When should susceptibility be repeated when treating active TB? |
|
Definition
| when not responding to therapy or when positive cultures despite 2 months of therapy |
|
|
Term
| What are the risk factors for drug resistant TB? |
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Definition
| RICH - Regimen inadequate > 2 weeks, Immigrant from high risk resistance area, Contact with persons with drug resistant TB, History of treatment with TB medications |
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Term
| What are the goals of therapy when treating active tuberculosis? |
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Definition
| TIPP of D ICEberg - Treat (cure), Isolate (minimize transmission), Proper Pharmacotherapy (proper Drug / Dosing, Interactions of drugs avoided / minimized, Counseling (proper),Effects (adverse) avoided / minimized |
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Term
| What is regimen 1 for active TB treatment? |
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Definition
| INH + RIF + PZA + EMB x2 months, repeat smear and culture, then INH + RIF x4 months if AFB negative, INH + RIF x7 months if AFB positive, can DC EMB early if TB is confirmed sensitive to INH and RIF |
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Term
| What % of PZA patients may experience arthralgias? |
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Definition
|
|
Term
|
Definition
|
|
Term
| What are the adverse effects of ethambutol (EMB)? |
|
Definition
| RA ra RE kick 'em in the kNEe - RAsh, REtrobulbar NEuritis |
|
|
Term
| What is regimen 2 for active TB treatment? |
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Definition
| for patients who should not receive PZA: INH + RIF + EMB x2 months, repeat smear and culture, then INH + RIF x7 months [can be qd, 2x/wk (DOT), 3x/wk(DOT)], can DC EMB early if TB is confirmed sensitive to INH and RIF |
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|
Term
| What are the side effects of pyrazinamide (PZA)? |
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Definition
| VAN HAGAR - Vomiting, Anorexia, Nausea, Hepatotoxicity, Arthralgias, Gouty ARthritis |
|
|
Term
| What monitoring should be done while taking ethambutol? |
|
Definition
|
|
Term
|
Definition
| resistance to both INH and RIF |
|
|
Term
| What are the normal substitute combinations when TB is MDR? |
|
Definition
| (FQ + PZA) or (EMB + PZA) |
|
|
Term
|
Definition
| resistant to INH + RIF + FQs + at least one injectible 2nd line anti-TB drug (capreomycin, kanamycin, or amikacin) |
|
|
Term
| What should all active TB treated patients be tested for within 2 months? |
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Definition
|
|
Term
| When properly treating active TB when should cultures and smears be negative? |
|
Definition
|
|
Term
| When treatment failure is suspected during active TB treatment how many new agents should be added? |
|
Definition
|
|
Term
| What is the main reason for active TB treatment failures? |
|
Definition
|
|
Term
| What is the main reason for development of reistance during active TB treatment? |
|
Definition
|
|
Term
| What is the window for 6 month active TB treatment? |
|
Definition
| 6 months comleted in 12 months |
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