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MOP TB PEDIA > MOP TB > Flashcards

MOP TB Flashcards

1
Q

refers to any person having: two weeks or longer of any of the following – cough, unexplained fever, unexplained weight loss, night sweats; or chest X-ray finding suggestive of TB

A

Presumptive pulmonary tuberculosis

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2
Q

refers to anyone having signs and symptoms
specific to the suspected extrapulmonary site with or without general constitutional signs
and symptoms such as unexplained fever or weight loss, night sweats, fatigue and loss of
appetite

A

Presumptive extrapulmonary tuberculosis

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3
Q

refers to screening using any of the four cardinal TB signs and symptoms. The four cardinal signs and symptoms of TB are at least two weeks duration of cough, unexplained fever, unexplained weight loss and night sweats

A

Symptom-based screening

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4
Q

What are the cardinal signs and symptoms of TB

A

a. cough
b. unexplained fever
c. unexplained weight loss
d. night sweats.

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5
Q

What are the steps involved in the screening of PTB in children <15 years old

A
  1. Unexplained coughing and wheezing for more than 2 weeks
  2. Unexplained fever after excluding malaria and pneumonia
  3. unexplained weight loss not responding to nutritional therapy
  4. Close contact with known TB disease and there is a presence of fatigue, reduced playfulness, decreased activity not eating well
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6
Q

Screening of chest Xray is not routinely recommended for children. What is the exemption?

A

TB household contacts who are 5 years old and above.

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7
Q

What are the signs and symptoms of EPTB in all ages?

A
  1. gibbus deformity, especially of recent onset (resulting from vertebral TB);
  2. non-painful enlarged cervical lymphadenopathy with or without fistula formation;
  3. neck stiffness (or nuchal rigidity) and/or drowsiness suggestive of meningitis, with a sub-acute onset or raised intracranial pressure;
  4. pleural effusion;
  5. pericardial effusion;
  6. distended abdomen (i.e. big liver and spleen) with ascites;
  7. non-painful enlarged joint
  8. signs of tuberculin hypersensitivity (e.g. phlyctenular conjunctivitis, erythema
    nodosum)
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8
Q

When to advice close contacts (contact tracing) for ff up?

A

every six months for the next two years. symptom screening every six months and chest X-ray screening annually

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9
Q

For DS TB contacts, what should be done if active TB ruled out?

A

TB Preventive Treatment

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10
Q

For DR TB contacts, what should be done aside from chest xray?

A

Gene Xpert

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11
Q

What should be done to all household contacts who have no signs and symptoms or with chest X-ray findings not suggestive of TB?

A

educated about TB signs and symptoms and advised to immediately return to the health facility if signs and symptoms of TB develop

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12
Q

What is Previously treated for TB

A

patient who had received one month or more of anti-TB drugs in the past.
Also referred to as Retreatment

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13
Q

What is High risk for multidrug-resistant tuberculosis (MDR-TB)

A

previously treated for TB
new TB cases that are contacts of confirmed DR-TB cases or non-converter among patients on
DS-TB regimens

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14
Q

An induration of at least _____ regardless of bacille Calmette-Guerin (BCG) vaccination status or ____ in Immunocompromised children (e.g. severely malnourished) is considered a positive TST
reaction

A

10 mm and 5 mm

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15
Q

What Chest Xray finding is highly suggestive of TB that will classify as CLINICALLY DIAGNOSED?

A
  1. Markedly enlarged unequal hilar lymph gland (i.e. > 2 cm in size) with or without opacification
  2. Miliary mottling
  3. Large pleural effusion (≥ 1/3 of pleural cavity, usually common in children > 5 years old)
  4. Apical opacification with cavitation (rare in younger children, common in
    adolescents
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16
Q

What are the MDR-TB risk groups?

A

retreatment
contact of DR-TB
non-converter of DS-TB regimen

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17
Q

Who are classified under Drug Resistant TB?

A

MDR-TB risk groups with Xpert result of MTB detected with rifampicin resistance

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18
Q

Who are classified under bacteriologically confirmed TB (BCTB)?

A

low risk for MDR-TB but with an Xpert result of MTB detected with rifampicin resistance

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19
Q

What is Bacteriologically confirmed
rifampicin-resistant TB

A

genexpert positive with resistance to rifampicin

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20
Q

What is Bacteriologically confirmed
multidrug-resistant TB

A

genexpert positive with rifampicin and isoniazid resistant

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21
Q

What is Bacteriologically confirmed
extensively drug-resistant TB

A

genexpert positive with resistance to fluoroquinolone and one second line injectable drug with resistance to rifampicin and isoniazid as well

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22
Q

what is Clinically diagnosed multidrug-resistant TB ?

A

at least one of the ff:
1. negative for MTB complex but with clinical deterioration and/or radiographic findings consistent with active TB

  1. specimen/s with other resistance pattern (i.e. mono DR-TB or poly DR-TB) with clinical deterioration and/or radiographic findings
    consistent with active TB; or
  2. laboratory diagnosis not done due to specified conditions but with clinical deterioration and/or radiographic findings consistent with active TB
  3. diagnosis showing resistance to both isoniazid and rifampicin in a non-NTP-recognized laboratory;
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23
Q

What is monoresistant TB

A

with resistance to one first-line anti-TB drug, except rifampicin

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24
Q

What is polydrug-resistant TB

A

with resistance to more than one first-line anti-TB drug, other than both isoniazid and rifampicin, whether bacteriologically
confirmed

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25
Q

What is serious adverse drug reaction to
rifampicin

A

patient who is positive for MTB complex, but no resistance to any anti-TB drugs, or negative for MTB complex, but has been decided to have TB disease and has serious ADR to rifampicin, thereby requiring a full course of second-line anti-TB treatment similar to BC MDR-TB

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26
Q

What is Relapse

A

previously treated for TB and declared cured or treatment completed, but is presently diagnosed with active TB disease

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27
Q

What is Treatment after failure

A

previously treated for TB but failed most recent course based on a positive SM follow-up at five months or later, or a clinically diagnosed
TB patient who does not show clinical improvement anytime during treatment

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28
Q

What is Treatment after lost to follow-up

A

previously treated for TB but did not complete
treatment and lost to follow-up for at least two months in the most recent course

29
Q

How long is drug-susceptible TB being managed?

A

6 mos

30
Q

How long is extrapulmonary drug-susceptible TB being managed?

A

12 mos

31
Q

How long is drug-resistant TB being managed?

A

9-20 mos

32
Q

Who are included in the 6 mos treatment

A

Pulmonary TB - BC
Pulmonary TB - CD
Extrapulmonary TB BC and CD EXCEPT (CNS, BONES, and JOINTS)

33
Q

Who are included in the 1 year treatment?

A

Extrapulmonary TB of bones joints and CNS whether CD or BC

34
Q

When should the ART started in HIV patient who are already treated with HRZE?

A

first 8 weeks of treatment of HRZE

35
Q

If there is a profound immunosuppression (< 50 CD4 count) in patients with HIV when should the ART started?

A

first two weeks of treatment

36
Q

If at the 5th and 6th month, patient is still SM positive, how will you classify the patient?

A

Treatment failure then repeat genexpert and refer to PMDT

37
Q

When will the patient cleared to work and school?

A

after 1 week of uninterrupted treatment for CD
NEGATIVE SM at least 2 weeks after treatment initiation for BC

38
Q

If the patient miss the doses for 1-2 months what should be do?

A

perform a SM if POSITIVE and the patient has been treated for <5 mos, Continue treatment and prolong to compensate for
missed doses

39
Q

If the patient miss the dose for less than 1 month what should be do?

A

continue the treatment and just prolong it to compensate for missed doses

40
Q

If the patient miss the doses for 1-2 months what should be do?

A

perform a SM if POSTIVE and the patient has been treated for >5 mos, Assign outcome as
“Treatment Failed”

41
Q

If the patient miss the dose for more than 2 month what should be do?

A

Assign outcome as “lost to follow-up”

42
Q

If the patient miss the doses for 1-2 months what should be do?

A

perform a SM if NEGATIVE Continue treatment and prolong to compensate for
missed doses

43
Q

What is the regimen for MDR TB and RR TB that is eligible to standard short all oral regimen?

A

4-6 mos
Levofloxacin - Bedaquilline (6mos) - Clofazamine - Prothionamide - Ethambutol - Pyrazinamide - High dose Isoniazid

5 mos
Levofloxacin - Clofazamine - Pyrazinamide - Ethambutol

44
Q

What is the regimen for MDR TB and RR TB that is eligible to standard long all oral regimen FQ susceptible?

A

6 mos
Levofloxacin - Bedaquilline (6mos) - Linezolid - Clofazamine

12-14 mos
Linezolid - Clofazamine - Cycloserine

45
Q

What is the regimen for MDR TB and RR TB that is eligible to standard long all oral regimen FQ resistance?

A

6 mos
Linezolid - Bedaquilline (6mos) - Delamanid - Clofazamine - Cycloserine

12-14 mos:
Linezolid - Clofazamine - Cycloserine

46
Q

What is the treatment for retreatment MDR TB and RR TB?

A

Construct to have at least 4–5 likely effective drugs

47
Q

Patients who are ___________ shall be referred to the TB Medical Advisory Committee (TB MAC) for _________

A

pregnant and contacts of patients who failed on MDR-TB treatment

design of an individualized treatment regimen (ITR)

48
Q

Children _____________ diagnosed with MDR-TB and RR-TB shall be evaluated for
__________________

A

< 15 years old

eligibility to standard all oral regimens recommended for children

49
Q

Patients who are adults ________ , _______ and _____ are eligible to receive standard short all oral regimen (SSOR)

A

(15 years old or above)
Not pregnant
not a contact of a patient who failed MDR-TB treatment

50
Q

What is the exclusion criteria for standard short all oral regimen?

A
  1. Disseminated TB or severe/intractable EPTB
  2. Confirmed resistance to fluroquinolone
  3. Exposure to levofloxacin(Lfx)/moxifloxacin (Mfx), bedaquiline (Bdq), clofazimine
    (Cfz), prothionamide (Pto) for > 1month
  4. Risk of toxicity or intolerance to any drugs in SSOR as manifested by:
    History of heart disease (heart failure, myocardial infarction, cardiac
    conduction abnormality, arrythmia)
     QTcF > 500 ms
     History of chronic active hepatitis (AST/ALT > 5 times elevated)
    History of chronic renal insufficiency (creatinine clearance < 20 ml/min)
51
Q

What is the exclusion criteria for standard long all oral regimen FQ susceptible?

A
  1. Confirmed resistance to fluroquinolone-levofloxacin (Lfx)/moxifloxacin (Mfx)
  2. Exposure to levofloxacin (Lfx)/moxifloxacin (Mfx), bedaquiline (Bdq), linezulid (Lzd),
    or clofazimine (Cfz) for > 1 month
  3. Risk of toxicity or intolerance to any drugs in SLOR FQ-S
52
Q

What is the Risk of toxicity or intolerance to any drugs in SLOR FQ-S?

A
  1. History of heart disease (heart failure, myocardial infarction, cardiac conduction abnormality, arrythmia)
  2. QTcF > 500 ms
  3. History of chronic active hepatitis (AST/ALT > 5 times elevated)
  4. History of chronic renal insufficiency (CrCl < 20ml/min)
  5. Severe anemia (HgB <8mg/dl)
53
Q

Who are not eligible to both Standard Short all oral regimen and Standard Long oral regimen

A

MDR-TB and RR TB patients with previous exposure to second-line drugs for more than one month (i.e., second-line retreatment cases – relapse, failure, LTFU from previous DRTB
regimens)

who are contacts of an index case who failed MDR-TB treatment.

54
Q

For patients whom design of an effective regimen based on existing recommendations is not possible what should be given?

A

bedaquiline-pretomanid-linezolid as a last resort after consultation to TB MAC

55
Q

What are the situations that requires the off label use of anti TB drugs and should be presented to TB MAC?

A
  1. Use of bedaquiline and delamanid in combination
  2. Extended use of bedaquiline and/or delamanid for more than 24 weeks (six
    months)
  3. Use of bedaquiline and delamanid in EPTB
  4. Use of bedaquiline in children less than 6 years old and pregnant patients
  5. Use of delamanid in children less than 3 years old and pregnant patients.
56
Q

What are the precautions in taking prothiomide?

A
  1. Start in two divided dosage (morning and evening) for the first two weeks of treatment if total daily dose is > 250 mg
  2. Advise patients to only take after light meals
  3. Once tolerance has improved, change dosing to once daily after two weeks
57
Q

if patient is currently taking standing short oral regimen and with noted high dose resistance detected, what is the appropriate thing to do?

A

Continue SSOR

58
Q

if patient is currently taking standing short oral regimen and with noted prothionamide resistance detected, what is the appropriate thing to do?

A

Continue SSOR

59
Q

if patient is currently taking standing short oral regimen and with noted high dose and prothionamide resistance detected, what is the appropriate thing to do?

A

Shift to SLOR FQ-S. Continue dose count
if within 1 month from treatment initiation

60
Q

if patient is currently taking standing short oral regimen and with noted fluoroquinolone resistance detected, what is the appropriate thing to do?

A

Shift to SLOR FQ-R, Restart dose count

61
Q

If LPA result is MTB not detected, invalid for MTB detection, or indeterminate
resistance for any drug, and result is received before treatment or within two
weeks from start of treatment what should be done?

A

recollect sputum specimen for repeat LPA testing and continue initial regimen

62
Q

3 If LPA result is MTB not detected, invalid for MTB detection, or indeterminate
resistance for any drug and treatment is already more than two weeks, what should be done?

A

continue initial regimen and wait for the phenotypic DST result

63
Q

If LPA result is delayed for more than two months or not available and if there is If there is sputum culture conversion and clinical improvement, what should be done?

A

continue the initial regimen

64
Q

If LPA result is delayed for more than two months or not available and If there is no culture conversion at the fourth month of treatment, or no clinical improvement, or with recurrence of TB signs and symptoms, what should be done?

A

repeat DST (both LPA and phenotypic) and consult the case with TB MAC

65
Q

For patients Diagnosed with MDR TB and living with HIV positive patients, what should be started?

A

Antiretroviral treatment (ART).

Anti Koch’s first then ART within 8 weeks of HRZE

66
Q

For HIV positive with (CD4 count of <50 cells) MDR TB patients when should ART be started?

A

within 2 weeks of taking HRZE

67
Q

ART initiation should be deferred in what situation?

A

suspected to have TB meningitis, due to the risk of developing potentially fatal immune reconstitution inflammatory syndrome (IRIS)

68
Q
A

MOP TB PEDIA (1 decks)

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