TB, Leprosy Flashcards
Pillar in the END TB Strategy
- for equitable access*
1: integrated, patient-centered TB care and prevention
2: Bold policies and supportive systmes
3: intensified research and innovatiotn
Principles in the END TB strategy
- success will depend on*
1: government stewardship and accountability, with monitoring and evaluation
2: building a strong coalition with civil society and communities
3: protecting and promoting human rights, ethics and equity
4: adaptation of the strategy and targets at country level, with global collaboration
TB LAMP should not be used for
Children
PLHIV
MDR-TB risk groups
Clinical diagnosis of TB in children
3 out of 5 S/sx of TB Exposure Positive tuberculin test Abnormal chest radiograph Other lab findings
MDR TB definition
Resistance to at least BOTH isoniazid and rifampicin
XDR TB definition
Resistance to any fluoroquinolone, AND resistance to at least one of 3 2nd line injectable aminoglycosides (amikacin, streptomycin), in addition to being MDR-TB
Gibbus deformity
Most often develops in young children as a result of spinal TB and is the result of collapse of vertebral bodies
- form of structural kyphohsis typically found in te upper lumbar and lower thoracicc vertebrae, where one or more adjacent vertebrae become wedged
- also assoc’d with congenital causes like achondroplasia, creitnism and some mucopolysaccharidoses
Old TB regimen
Cat I: 2HRZE / 4HR
Cat Ia: 2HRZE / 10HR
Cat II: 2HRZES / 1HRZE / 5HRE
Cat IIa: 2HRZES / 1HRZE/ 9HRE
MINOR S/E of TB DRUGS
GI intolerance Mild or localized skin reactions Orange urine Pain at injection site Burning sensation in the feet due to peripheral neuropathy *give pyridoxine 50-100mg daily for treatment, 10mg daily for prevention Arthralgia due to hyperuricemia Flui-like symptoms (rifampicin)
Major s/e of tb drugs
- Severe skin rash
- Jaundice d/t hepatitis
- Impairment of visual acuity
- Hearing impairment (streptomycin)
- Oliguria or albuminuria (strep / rif)
- Psychosis (iso)
- Thrombocytopenia, anemia, shock (rif)
When to stop TB tx with regards possible hepatitis
ALT>3x upper limit of normal + symptoms
ALT>5x upper limit of normal even in the absence of symptoms
Alternative tx regimens for chronic liver dse
2SHRE / 6HR,or
9RE, or
2SHE / 10HE
Anti TB drugs that are adjusted in the presence of renal failure
Pyrainamide, ethambutol, streptomycin
HIV and TB
Priority: treat TB before HIV
Options:
1 - defer ART until completion of TB treatment (6 months)
2 - defere ART until completion of the intesinve phase of TB tx (2 months), and then using Ethambutol and Isoniazid in the continuatiotn phase
3 - treat TB with a Rifampicin-containing regimen, and for HAART, use only Efavirenz + 2 NRTIs
Isoniazid Preventive therapy (IPT)
Isoniazid for 6 months shall be given to the ff:
- Children < 5 y/o w/o s/sx of TB and w/o radiographic findings suggestive of TB, and who are household contacts of
- a bacteriologically-confirmed TB cas REGARDLESS of TST results; or
- a clincinally-diagnosed TB case (if the child has (+) TST) - PLHIV with no s/sx of TB regardless of age 🧐
