DS: Tuberculosis and Other Mycobacterial Infection

Question 1

Risk factor for infection

Answer 1

Recent exposure to person with active TB
Lab personnel
Immigrants from high burden country
Homeless, incarcerated, institutionalized

Question 2

Risk factor for disease

Answer 2

Child <5 years
HIV infected
Abnormal chest radiography
DM, Chronic renal failure, IVDA

Question 3

Diagnosis of symptomatic patient

Answer 3

Chest radiograph
Sputum smear for AFB
Sputum for mycobacteria
Sputum NAAT for M. tuberculosis
Evidence of systemic M tuberculosis ifnection:
—-Interferon gamma release assay
—-TB skin test

Question 4

Screening of Latent M. tuberculosis infection

Answer 4

Question 5

Treatment of Latent M. tuberculosis infection

Answer 5

Question 6

Oral Drug therapy option for pulmonary tuberculosis found to be pan susceptible

Answer 6

daily administration has higher efficacy then other regimen

Question 7

Diagnosing Active TB

Answer 7

Acid-fast bacilli (AFB) microscopy on 3 or more specimen
Liquid +/- solid cultures of each spectrum
NAAT on initial specimen
Sputum collection:
—Expectorated sputum
—Induced sputum
—Flexible bronchscopy

Question 8

Consideration for initial therapy for TB

Answer 8

Question 9

Antitubercular Drugs: Isoniazid (INH)

Answer 9

Question 10

Antitubercular Drugs: Rifampin (RIF)

Answer 10

Question 11

Antitubercular Drugs: Pyrazinaimide (PZA)

Answer 11

Question 12

Antitubercular Drugs: Ethambutol (EMB)

Answer 12

Question 13

Daily and intermittent dosing of 1st line Antituberculosis drugs

Answer 13

Question 14

Pyrazinamide Oral Dosing - Normal renal function

Answer 14

Question 15

Ethambutol Oral dosing - Normal renal function

Answer 15

Question 16

Antimycobacterial dosing with CrCl <30 ml/min

Answer 16

Question 17

DDI - Rifabutin (RFB)

Answer 17

Question 18

DDI - Isoniazide (INH )

Answer 18

Question 19

DDI - Rifampin ( alot of DDI)

Answer 19

Question 20

Baseline/Follow up Testing

Answer 20

Question 21

Adverse Effect from Antimycobacterial Drugs - General

Answer 21

Question 22

Adverse Effect from Antimycobacterial Drug - Specific

Answer 22

Question 23

Hepatotoxicity ffrom Antimycobacterial drugs4

Answer 23

Question 24

Handling interruption in TB therapy

Answer 24

Question 25

Duration of TB Therapy

Answer 25

Question 26

Failure of initial antitubercular therapy

Answer 26

Question 27

Treatment of other types of M. tuberculosis disease

Answer 27

Question 28

Treatment duration of extrapulmonary tuberculosis

Answer 28

Question 29

Treatment of drug -resistant tuberculosis

Answer 29

Question 30

Definition of drug resistance Tuberculosis

Answer 30

Question 31

Implication of drug resistance tuberculosis

Answer 31

Question 32

Treatment option of drug resistance by WHO (longer duration regimen)

Answer 32

Question 33

Treatment option of drug resistance by WHO (longer duration regimen)

Answer 33

total duration 18-20 months 15-17 months after culture conversion Regimen containing amikacin or streptomycin, intensive phase of 6-7 months is suggested

Question 34

Treatments option of drug resistance by Steps (ATS/CDC/ERS/IDSA)

Answer 34

Question 35

Treatment option of drug resistance by WHO (Shorter duration regimen)

Answer 35

Question 36

Treatment option of drug resistance by WHO (Shorter duration regimen) - CONT

Answer 36

Question 37

XDR-TB or intolerant or non responsive TB treatment

Answer 37

Question 38

Treatment of isonazid-resistant TB

Answer 38

Add moxifloxacin or levaquin to daily riifampin, pyrazinamide and ethambutol Pyrazinamide may be shortened to 2 months if - Non cavitary disease, lower burden disease -Pyrazinamide toxicity

Question 39

Special consideration for drugs to treat MDR TB

Answer 39

Question 40

Nontuberculosis Mycobacteria (NTM)

Answer 40

rapidly and slowly growing strains most infection are asymptomatics and /or self limited in nature Risks for infection: - Direct inoculation/inhalation - Compromised immune status (lymphopenia, genetic andiatrogenic supression of interferon gamma, tumor necrosis factor alpha or IL12

Question 41

Nontuberculosis Mycobacteria (NTM) : Rapid growers vs. Slow growers

Answer 41

Question 42

Spectrum of disease due to nonTB mycobacteria (NTM)

Answer 42

Question 43

Diagnostic work up for NTM

Answer 43

Question 44

Treatment infection due to mycobacterium avium

Answer 44

Question 45

Mycobacterium Kansasli.

Answer 45

Question 46

Mycobacterium Abscessus Treatment

Answer 46

Question 47

Mycobacterium Abscessus

Answer 47

Question 48

Mycobacterium Ulcerans

Answer 48

Question 49

Special consideration for drugs used to treat NTM

Answer 49