Tuberculosis Flashcards
Tuberculosis
Systemic disease caused by m. Tuberculosis. Pulmonary disease is the most common clinical presentation; other sites of involvement include lymphatics, Genito urinary, phone, meninges, peritoneum, and heart
Signs and symptoms of TB
- Weight loss, low-grade fever
- Night sweats
The majority patients are asymptomatic
Fatigue, anorexia
Dry cough progressing to productive and sometimes blood tinged
Lab and diagnostics for TB
*Definitive diagnosis by culture of M. Tuberculosis times three
* chest x-ray that shows small homogenous infiltrate in upper lobes
Acid-fast bacillus mirrors are presumptive evidence of active TB
PPD shows exposure not diagnostic
Management of TB
The local health department should be notified of all cases of TB
Rifampin 600 mg
Isoniazid 300 mg
Pyrazinamide 1.5–2.0gm
Ethambutol 15mg/kg
If the isolate proves to be full acceptable to INH and RIFF you can drop the fourth drug
Continue first three drugs for two months, then four more months of INH and RIF daily
Person with HIV should be treated for nine months
Monitoring therapy for TB
Patients with pulmonary TB should have weekly sputum smears and cultures for the first six weeks after initiation of therapy, then monthly until negative cultures documented. Continued symptoms or positive cultures after three months should raise a suspicion of drug resistance
Baseline evaluation before starting treatment for TB
Liver function studies, CBC, and serum creatinine should be obtained at baseline. Patients with normal baseline studies do not require monthly labs but should be questioned about symptoms of drug toxicity. Patients taking ethambutol should be tested for visual acuity and red green perception
Chemoprophylaxis for TB
IN H for six months if PPD positive
5 mm for HIV patient
10 mm for immigrants, jail, healthcare workers
15 mm for all other people 
