Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Tuberculosis NTP guidelines > NTP guidelines > Flashcards

NTP guidelines Flashcards

1
Q

Presumptive Pulmonary TB

A

any person having:
1. 2 weeks or longer of any of the ff: cough, unexplained fever, unexplained weight loss

  1. chest xray findings suggestive of TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

presumptive extrapulmonary TB

A

signs and symptoms specific to extrapulmonary sites with or without general constitutional signs and symptoms such as unexplained fever, weight loss, nights sweats, fatigue or loss of appetite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

4 cardinal signs and symptoms of TB

A 
2 weeks
cough
unexplained fever
weight loss 
night sweats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

children in TB guidelines is referred to as

A

less than 15 years old

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

For those who do not have any of the cardinal signs/symptoms above or experienced
it for less than two weeks, offer chest X-ray screening if one has not been conducted
in the past year

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

TB risk factors

A

contacts of TB patients;
b. those ever treated for TB (i.e. with history of previous TB treatment);
c. people living with HIV (PLHIV);
d. elderly (> 60 years old);
e. diabetics;
f. smokers;
g. health-care workers;
h. urban and rural poor (indigents); and
i. those with other immune-suppressive medical conditions (silicosis, solid organ
transplant, connective tissue or autoimmune disorder, end-stage renal disease,
chronic corticosteroid use, alcohol or substance abuse, chemotherapy or other
forms of medical treatment for cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
Ask for the following signs and symptoms
(lasting for ≥ 2 weeks):
1. cough
2. unexplained fever
3. unexplained weight loss
4. night sweats
A

If >/=1 is present —> Presumptive TB

If NONE –> Do Chest xray –> if suggestive of TB –>classify as Presumptive TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When should we do symptom screening and chest xray in people living with HIV?

A

At the time of diagnosis of HIV and annually

If with signs and symptoms and chest xray finding of TB –> collect sputum sample –> request for Gene Xpert MTB/Rif assay

Every visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

screening for pulmonary TB (PTB) in children

< 15 years old:

A

Ask if the child has TB signs and symptoms. Identify as presumptive TB if the child has at least one of the three main signs and symptoms suggestive of TB:

a. coughing/wheezing of two weeks or more, especially if unexplained (e.g. not
responding to antibiotic or bronchodilator treatment);
b. unexplained fever of two weeks or more after common causes such as malaria or pneumonia have been excluded; and
c. unexplained weight loss or failure to thrive not responding to nutrition therapy

Ask if the child is a close contact of a known TB case. If the child is a contact,
the presence of fatigue, reduced playfulness, decreased activity, not eating well or
anorexia that lasted for two weeks or more should also be considered and identify
them as a presumptive TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

All patients with chest X-ray findings suggestive of TB should be identified as presumptive
TB. Sputum should be collected for an Xpert MTB/RIF test.

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chest xray screening in DS-TB contacts should be done in the ff:

A

All 5 years old and above (symptom
screening only for < 5 years old)
• If chest X-ray not available, do symptom
screening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chest xray should be done in DR-TB contacts in the ff:

A

All contacts
• If chest X-ray not available, do
Xpert test directly for all contacts.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Diagnostic test in DS-TB contacts and DR-TB contacts

A 
DS-TB contacts: Xpert, if not available SM/loop mediated
isothermal amplification (TB LAMP)

DR-TB contacts: Xpert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should be given in DS-TB contacts?

A

If active TB ruled-out : Consider TB preventive treatment (TPT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should be done in DR-TB contacts?

A

TPT currently not recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In DS-TB contacts, follow up should be done

A

Every six months for two years
(Symptom screen every six months, chest
X-ray every year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In DR-TB contacts, follow up should be done

A

Every six months for two years
(Symptom screen every six months,
chest X-ray every year. If chest X-ray
not available, do Xpert test directly.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

refers to a patient from whom a biological specimen,
either sputum or non-sputum sample, is positive for TB by smear microscopy, culture or
rapid diagnostic tests (such as Xpert MTB/RIF, line probe assay for TB, TB LAMP).

A

Bacteriologically confirmed TB (BCTB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

refers to a patient for which the criterion for bacteriological
confirmation is not fulfilled but diagnosis is made by the attending physicians on the basis
of clinical findings, X-ray abnormalities, suggestive histology and/or other biochemistry or
imaging tests.

A

Clinically diagnosed TB (CDTB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

refers to a patient who has never had treatment for TB or who has taken anti-TB drugs
for less than one month. Preventive treatment is not considered as previous TB treatment.

A

New

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

refers to a patient who had received one month or more of antiTB drugs in the past. Also referred to as Retreatment

A

Previously treated for TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

resistance to rifampicin detected using phenotypic
or genotypic methods, with or without resistance to other anti-TB drugs. It includes any
resistance to rifampicin, whether monoresistance, multidrug resistance, polydrug resistance
or extensive drug resistance

A

Rifampicin-resistant TB (RR-TB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

All presumptive TB patients who are at high risk for MDR-TB shall be referred for Xpert MTB/
RIF testing. If not accessible, a sputum transport system shall be used or patient shall be
referred to the nearest health facility with DR-TB services for screening

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
primary diagnostic test for PTB and EPTB in adults and children
A rapid diagnostic test (RDT), such as Xpert MTB/RIF
26
shall be used only as an adjuvant when there is doubt in making a clinical diagnosis of TB in children
Tuberculin skin test (TST), also known as purified protein derivative (PPD) test or Mantoux test
27
considered a positive TST reaction
An induration of at least 10 mm regardless of bacille Calmette-Guerin (BCG) vaccination status or 5 mm in immunocompromised children (e.g. severely malnourished)
28
If sputum or non-sputum specimen tested by Xpert MTB/RIF, SM or TB LAMP shows MTB detected or positive result, classify as
bacteriologically confirmed PTB or EPTB
29
Approach to diagnosis of TB in children (< 15 years old) | in Presumptive TB
Ask to expectorate sputum OR gastric lavage sample, if available Do Xpert MTB/Rif MTB Positive +/ Rif Resistance -->BCTB MTB Negative / Cannot Expectorate --> Request Chest X-ray if not done --> Strongly suggestive of TB with clinical S/S --> Clinically diagnosed TB ``` If Normal or uncertain --> Consider giving broad spectrum antibiotics. Follow-up after 2 weeks. IF S/S persists, • If contact of a known TB case, may classify as CDTB • If not a contact, perform TST If TST (+), may classify as CDTB. If TST (−) or unavailable but S/S persistent, • Refer to specialist for further investigation and management (less likely to be TB) • If referral not possible, attending physician to decide based on best clinical judgment (consider if clinically unstable or if with other risk factors for TB). If treated as active TB, classify as CDTB. ```
30
If chest X-ray finding is strongly suggestive of TB based on the following (Fig. 6), classify as clinically diagnosed TB
Markedly enlarged unequal hilar lymph gland (i.e. > 2 cm in size) with or without opacification ο Miliary mottling ο Large pleural effusion (≥ 1/3 of pleural cavity, usually common in children >5 years old) ο Apical opacification with cavitation (rare in younger children, common in adolescents.
31
Chest X-ray findings strongly suggestive of PTB in < 10 years of age
Signs and symptoms: Persistent fever, weight loss, cough, and irritability Right hilar lymphadenopathy Chronic pneumonia Miliary pattern
32
Chest X-ray findings strongly suggestive of PTB 10–18 years of age
Signs and symptoms: Persistent fever, adynamia, and expectoration (bloody sputum) Pulmonary cavitations Pleural effusion
33
Diagnose EPTB either bacteriologically or clinically
4.1 EPTB can be confirmed bacteriologically using Xpert MTB/RIF. 4.2 For presumptive EPTB cases where it is not possible to get body fluid or tissue sample, give an antibiotic trial and follow-up after one to two weeks. 4. 3 EPTB can be assessed as clinically diagnosed TB by the health facility physician based on signs and symptoms, imaging studies, histology or other laboratory tests. 4. 4 As necessary, refer presumptive EPTB to health facilities capable of performing appropriate diagnostic procedures.
34
For patients with Xpert result: MTB without rifampicin resistance classify as
classify as drug susceptible TB (DS-TB).
35
Positive for MTB using rapid diagnostic modalities (i.e. Xpert MTB/RIF) with resistance to rifampicin
Bacteriologically confirmed rifampicin-resistant TB (BC RR-TB)
36
Positive for MTB complex with resistance to at least both isoniazid and rifampicin from an NTP-recognized laboratory
Bacteriologically confirmed multidrug-resistant TB | BC MDR-TB
37
Positive for MTB complex with resistance to any fluoroquinolone (FQ) and to at least one second-line injectable drug (e.g. amikacin, streptomycin), in addition to multidrug resistance from an NTPrecognized laboratory
Bacteriologically confirmed extensively drug-resistant TB (XDRTB) (BC XDR-TB)
38
A patient with at least one of the following: •specimens tested in an NTP-recognized laboratory that is negative for MTB complex but with clinical deterioration and/or radiographic findings consistent with active TB; or •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 •laboratory diagnosis not done due to specified conditions but with clinical deterioration and/or radiographic findings consistent with active TB; or •diagnosis showing resistance to both isoniazid and rifampicin in a non-NTP-recognized laboratory; and there has been no response to a course of empiric antibiotics and/or symptomatic medications; and who has been decided by the TB Medical Advisory Committee (TB MAC) to have TB disease requiring a full course of second-line antiTB chemotherapy similar to BC MDR-TB.
Clinically diagnosed multidrugresistant TB | CD MDR-TB
39
A patient with resistance to one first-line anti-TB drug, except rifampicin whether bacteriologically confirmed (regardless of the date of collection, with or without radiographic abnormalities) or clinically diagnosed
monoresistant TB
40
A patient with resistance to more than one first-line anti-TB drug, other than both isoniazid and rifampicin, whether bacteriologically confirmed (regardless of date of collection, with or without radiographic abnormalities) or clinically diagnosed
polydrug-resistant TB
41
previously treated for TB and declared cured or treatment completed, but is presently diagnosed with active TB disease
relapse
42
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
Treatment after failure
43
previously treated for TB but did not complete | treatment and lost to follow-up for at least two months in the most recent course
Treatment after lost to follow-up
44
previously treated for TB but whose outcome | in the most recent course is unknown
Previous treatment outcome unknown
45
patients who do not fit any of the categories listed above or previous treatment history is unknown (this group will be considered as previously treated also)
Patients with unknown previous TB treatment history
46
PTB or EPTB (except central nervous system [CNS], bones, joints) whether new or retreatment, with final Xpert result: ο MTB, RIF sensitive ο MTB, RIF indeterminate
Regimen 1 | 2HRZE/4HR
47
• New PTB or new EPTB (except CNS, bones, joints), with positive SM/TB LAMP or clinically diagnosed, and: ο Xpert not done* ο Xpert result is MTB not detected
Regimen 1 | 2HRZE/4HR
48
• EPTB of CNS, bones, joints whether new or retreatment, with final Xpert result: ο MTB, RIF sensitive ο MTB, RIF indeterminate
Regimen 2 | 2HRZE/10HR
49
• New EPTB of CNS, bones, joints, with positive SM/TB LAMP or clinically diagnosed, and: ο Xpert not done* ο Xpert result is MTB not detected
Regimen 2 | 2HRZE/10HR
50
TB treatment in HIV co-infection
Antiretroviral treatment (ART) should be started in all TB patients living with HIV, regardless of CD4 cell count. TB treatment should be initiated first, followed by ART as soon as possible within the first eight weeks of treatment. If with profound immunosuppression (e.g. CD4 counts less than 50 cells/mm3), HIV-positive TB patients should receive ART within the first two weeks of initiating TB treatment. Patients with the TB–HIV co-infection should also receive co-trimoxazole as prophylaxis for other infections. People with HIV infection who, after careful evaluation, do not have active TREATMENT OF TUBERCULOSIS 39 TB should be given TB preventive treatment for presumed latent tuberculosis infection
51
Gastrointestinal intolerance
Rifampicin, isoniazid, pyrazinamide Give drugs at bedtime or with small meals
52
Mild or localized skin reactions
Any of the drugs Give antihistamines
53
Orange-colored urine
Rifampicin Reassure the patient
54
Burning sensation in the feet due | to peripheral neuropathy
Isoniazid Give pyridoxine (Vit B6) 50–100 mg daily for treatment; it can also be given 10 mg daily for prevention
55
Arthralgia due to hyperuricemia
Pyrazinamide Give aspirin or NSAID; if persistent, consider gout and request uric acid determination, manage accordingly or refer
56
Flu-like symptoms | fever, muscle pains, inflammation of the respiratory tract
Rifampicin Give antipyretics
57
Severe skin rash due to hypersensitivity
Any of the drugs Stop anti-TB drugs and refer to specialist
58
Jaundice due to hepatitis
Any of the drugs (especially isoniazid, rifampicin, pyrazinamide) Stop anti-TB drugs and refer to specialist; if symptoms subside, resume treatment and monitor clinically
59
Impairment of visual acuity and | color vision due to optic neuritis
Ethambutol Stop ethambutol and refer to ophthalmologist
60
Oliguria or albuminuria due to renal disorder
Rifampicin Stop anti-TB drugs and refer to specialist
61
Psychosis and convulsion
Isoniazid Stop isoniazid and refer to specialist
62
Thrombocytopenia, anemia, shock
Rifampicin Stop anti-TB drugs and refer to specialist
63
Isoniazid
10 (715) mg/kg, | Not to exceed 300 mg daily
64
Rifampicin (R)
15 (10–20) mg/kg, | Not to exceed 600 mg daily
65
Pyrazinamide (Z)
35 (30–40) mg/kg
66
Ethambuthol (E)
20 (15–25) mg/kg
67
sputum follow-up examinations for New, CDTB
ffup 1: End of Intensive phase (2nd month) ffup 2: ONLY IF positive at end of intensive phase; end of 5th month ffup 3: ONLY IF positive at end of intensive phase; end of treatment (6th month)
68
sputum follow-up examinations for New, BCTB • Retreatment
ffup 1: End of Intensive phase (2nd month) ffup 2: end of 5th month ffup 3: end of treatment (6th month)
69
If interruption is more than one month but less than two months
perform a SM and | decide on continuation of treatment based on results
69
If interruption is more than one month but less than two months
perform a SM and | decide on continuation of treatment based on results
70
For patients who interrupt treatment for less than one month
continue the treatment | and just prolong it to compensate for missed doses
71
If interruption is at least two months,
declare “lost to follow-up”. Exert all efforts to trace | patient, perform Xpert MTB/RIF test and refer to DR-TB treatment center if needed
72
A patient whose treatment was interrupted for at least two consecutive months. A patient diagnosed with active TB but was not started on treatment (i.e., initial LTFU).
Lost to follow-up | LTFU
73
A patient for whom no treatment outcome is assigned. This includes patients transferred to another facility for continuation of treatment but the final outcome was not determined.
Not Evaluated
74
Tuberculin skin test (TST) or interferon-gamma release assays (IGRA) shall not be required prior to initiation of preventive treatment in the following eligible individuals
a. PLHIV; b. children less than 5 years old who are household contacts of bacteriologically confirmed PTB; and c. individuals aged 5 years and older who are household contacts of bacteriologically confirmed PTB and with other TB risk factors
75
Perform TST in the following individuals; if TST is not available, it is not recommended to offer LTBI treatment to these individuals:
a. children less than 5 years old who are household contacts of clinically diagnosed PTB; b. household contacts of bacteriologically confirmed PTB cases who are 5 years and older but with no other risk factors for TB; c. close contacts of bacteriologically confirmed PTB; and d. Other risk factors • patients receiving dialysis • patients preparing for an organ or hematological transplantation • patients initiating anti-TNF treatment • patients with silicosis
76
TB preventive treatment regimen
6H (isoniazid daily): Currently available under the program 3HP (isoniazid, rifapentine weekly) Weekly dosing for three months Contraindicated in pregnant and < 2 years old 3 HR (isoniazid, rifampicin daily) Preferred for children if 3HP not available 4R (rifampicin daily) Preferred for adults if 3HP not available
77
Pregnant women
Isoniazid and rifampicin can be used in pregnant or breastfeeding women. Rifapentine should be avoided due to lack of data on safety in pregnant or breastfeeding women. For pregnant women with HIV who are already on ART, defer preventive treatment until three months post-partum
77
Pregnant women
Isoniazid and rifampicin can be used in pregnant or breastfeeding women. Rifapentine should be avoided due to lack of data on safety in pregnant or breastfeeding women. For pregnant women with HIV who are already on ART, defer preventive treatment until three months post-partum
78
Breastfeeding
Preventive treatment using isoniazid and or rifampicin can be safely given to breastfeeding women. Supplemental pyridoxine (i.e. vitamin B6) should be given to the infant who is taking isoniazid or whose breastfeeding mother is taking isoniazid.
79
Oral contraceptives
Rifampicin and rifapentine interact with oral contraceptive medications with a risk of decreased protective efficacy against pregnancy. Advise a woman receiving oral contraceptives while on rifampicin or rifapentine that she has the following options: 1) take an oral contraceptive pill containing a higher dose of estrogen (50μ), following consultation with a clinician; or 2) use another form of contraception.
80
Liver disease or history of liver disease
Isoniazid and rifampicin/rifapentine are both associated with hepatitis. Treatment should not be initiated in individuals whose baseline liver transaminases is more than three times the upper limit of normal (ULN). Preventive treatment should not be given to individuals with end-stage liver disease
81
Acute hepatitis (e.g. acute viral hepatitis)
Defer preventive treatment until the acute hepatitis has been resolved.
82
Renal failure
Isoniazid and rifampicin/rifapentine are eliminated by biliary excretion. These drugs, therefore, can be given in normal dosages to patients with renal failure. Patients with severe renal failure should receive isoniazid with pyridoxine to prevent peripheral neuropathy.
83
People living with HIV
Rifampicin and rifapentine can be co-administered with efavirenz without dose adjustment. Rifampicin or rifapentine cannot be co-administered with protease inhibitors or nevirapine
84
Baby born to mother with active TB disease
a. Assess the newborn. If the newborn is not well, refer it to a specialist/pediatrician. b. If the newborn is well (absence of any signs or symptoms presumptive of TB), do not give BCG first. Instead give TB preventive treatment. Give Pyridoxine at 5–10 mg/day. Preventive treatment is not necessary if the mother has received more than two months of anti-TB treatment and is not considered infectious. c. At the end of treatment, perform TST. If TST is negative or not available, give BCG. d. If the mother is taking anti-TB drugs, she can safely continue to breastfeed. Mother and baby should stay together and the baby may be breastfed while on TB preventive treatment.

Tuberculosis NTP guidelines (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions