Chapter 27: TB Flashcards
Identify the risks factors for TB (8)
- Homeless
- Residents of inner-city neighborhoods
- Foreign-born persons
- Living or working in institutions
- IV injecting drug users
- Overcrowded living conditions
- Poverty, poor access to health care
- immunocompromised
List 4 causes of multidrug resistant tuberculosis.
- Incorrect prescribing,
- lack of public health case management,
- pt nonadherence to the prescribed regimen
- lack of funding for education and prevention
Describe the characteristics of Mycobacterium tuberculosis
Characteristics: gram-positive, aerobic, acid-fast, bacillus usually spread person to person by airborne droplets expectorated when breathing, talking, singing, etc.
Describe Mycobacterium tuberculosis and transmission of this bacteria.
number of organisms expelled into the air, concentration of organisms, length of time of exposure, and immune system of the exposed person
Describe how tuberculosis infiltrates the body and develops into a primary TB infection.
Bacteria are inhaled, inflammatory response occurs, if adequate immune response infection does not progress to disease
Contrast primary, reactivation, and latent TB infections.
- Primary: Bacteria are inhaled, inflammatory response occurs, if adequate immune response infection does not progress to disease
- Reactivation: TB occurring 2 or more yrs after the initial infection
- Latent: occurs in a person who does not have active TB disease. These ppl have positive skin tests but are asymptomatic
Describe clinical manifestations of pulmonary TB. (4)
- Takes 2-3 wks to develop symptoms
- Initial s/s: dry cough that becomes productive
- Other: fatigue, malaise, anorexia, wt loss, low-grade fever, night sweats
- Late s/s: dyspnea and hemoptysis
Give an example of extrapulmonary TB and its manifestations.
Dependent on the organs affected: renal TB -> dysuria and hematuria, bone and joint TB -> severe pain, TB meningitis -> HA, vomiting, lymphadenopathy (lymph node swelling).
Review the 2 complications: miliary TB
widespread dissemination of the mycobacterium. The bacteria spread through the bloodstream to several distant organs. Occurs with primary TB or reactivation of LTBI. Fatal if untreated. Manifestations progress slowly and vary depending on which organs are infected (fever, cough, lymphadenopathy). May include hepatomegaly or splenomegaly.
Review the 2 complications: pleural TB
specific type of extrapulmonary TB, can result from either primary disease or reactivation of a latent infection. (manifestations: chest pain, fever, cough, and presence of unilateral pleural effusion are common)
Explain what a positive test reaction to tuberculin skin test means and what are the actions after an initial positive test. (3)
*Indication: induration - a palpable, raised, hardened area or swelling (not redness) at the injection site means the person has been exposed to TB and has developed antibodies.
*If the initial test is positive, the person needs further evaluation for active disease.
*A positive reaction to a subsequent test could be a new infection or the result of the boosted reaction to an old infection
Cite the advantage and disadvantage of using the QuantiFERON-TB Gold in-tube test as a screening tool for TB. (5)
- available in a few hours
- Require only 1 visit
- Are not subject to reader bias
- Have no booster phenomenon, are not affected by prior bacillus Calmette-Guerin (BCG) vaccination
- Dis: expensive
Discuss what is the gold standard test for diagnosing TB infection.
cultures
Describe the initial and continuation drug therapy used to treat active TB infections
- Initial (8wks to 3 mon): 4 drugs
- Continuation (18 wks): 2 drugs (isoniazid and rifampin)
Cite the major factor that influences emergence of multidrug resistant TB
Non Adherence to drug therapy
