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GORGAS > TB > Flashcards

TB Flashcards

1
Q

What is a TB chancre?

A

Caused by Multibacillary inoculation
Primary cutaneous TB (exogenous source)

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2
Q

What is a scrofuloderma

A

Classically on the neck
Fistula forming draining from underlying stuctrue such as LN, bone or epidydimis
Secondary TB

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3
Q

What are Gummas

A

Cold abscesses which ulcerate
Caused by haemaogenous spread

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4
Q

What is TB periorificalis? Or perianal

A

Multibacillary TB
Lesions in mouth or round anus

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5
Q

What is lupus vulgaris?

A

Paucibacillary
Through haemaogenous spread to face
Can be on face/soles/hand
Hand is typically people who work with cattle

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6
Q

What is TB verrucosa cutis

A

Whole plaque is warty

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7
Q

What is papular necrotic Tuberculids?

A

Looks like molluscum

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8
Q

How do you treat cutaneous TB?

A

It is usually paucibacillary
Tx same pulmonary TB
Resistant strains uncommon

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9
Q

Who should get tested for latent TB?

A

Active TB contacts
Current or planned immunosuppression
Individuals from TB endemic countries
Prisoners/homeless

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10
Q

Who is a 5mm PPD test considered positive in?

A

HIV patients
Recent contacts
Immunosuppressed
Fibrotic changes on lung consistent with old TB

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11
Q

10mm PPD test considered positive in who?

A

IVDU
Recent arrival from endemic country
Lab tec
Health workers

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12
Q

What are Tuberculids?

A

A cutaneous allergic reaction to TB, no AFB are actually in the skin.
-erythema nodosum
-papulonecrotic TB
-lichen scrofuloderma

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13
Q

Most common site of spinal TB

A

Thoracolumbar

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14
Q

What typically accompanies Potts disease?

A

Gibbus deformity of spine
Cold paravertebral abscesses

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15
Q

What is the most common form of TB CNS disease? Who is it most dangerous in?

A

TB meningitis followed by tuberculoma
Most dangerous in children <2yrs

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16
Q

How do you diagnose TB meningitis?

A

Xpert CSF (after centrifuging)

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17
Q

Monoresistant TB
Polyresistant TB

A

Resistance to one drug
Resistance to multiple but not RR-TB or MDR

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18
Q

MDR definition

A

At least rifampicin and isoniazid resistance

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19
Q

R-R TB definition?

A

Rifampicin Resistant TB, considered same as MDR TB (90% rif is also resistant to INH)

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20
Q

Pre XDR?

A

Fulfills definition of MDR TB plus resistant to fluoroquinolone

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21
Q

XDR definition

A

Extensive Drug Reisistance: resistant to isoniazid and rifampicin plus any fluroquionolone plus at least one additional group A drug

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22
Q

Examples of Group A drugs?

A

Bedaquiline
Linezolid

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23
Q

What is early bactericidal activity and why is it necessary?

A

Fall in log 10 colony forming units of mycobacterium TB per ml sputum per day during first 2 days. PREVENTS RESISTANCE

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24
Q

Most bactericidal TB drug?

A

Isoniasid>rifampicin>ethambutol

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25
Q

What is sterilising activity? What drugs are most sterilising?

A

Kills dormant bacteria. PREVENTS RELAPSE. most sterilising is pyrizinamide>rifampicin>isoniazid

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26
Q

Complications of TB meningitis?

A

Vasculitis mainly- give aspirin
Hyponatrameia
Tuberculomas

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27
Q

Treatment of drug susceptible Pulmonary TB?

A

RIPE 6 month treatment
Rifapentin/moxifloxacin/isoniasid/pyrazinamide for 4 months

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28
Q

Tx of TB meningitis?

A

Isonasid and rifampicin for 7-9 months
Ethambutol and pyrazinamide 2 months
Needs steroids and consider aspirin for vasculitis cx

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29
Q

When do you give ARVs in HIV postive patients with TB meningitis?

A

Not start ARV until intensive phase (8 weeks) of TB tx complete
WHO states within 2 weeks if CD4<50

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30
Q

Tx of cavity disease TB

A

CDC suggests extending therapy to 9 months
If culture positive at 2 months, extend intensive phase to 3 months long

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31
Q

Tx duration of bone disease in TB?

A

9-12months duration
RI for 7-9 months in continuation phase following 2 months of RIPE

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32
Q

Which smear microscopy is better?

A

Auramine>ZN staining
More sensitive, quicker reading time

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33
Q

What type of culture is superior?

A

Liquid medium, faster turnaround for positive and negative result

34
Q

Which DST culture are best?

A

Liquid medium MGIT; 5-7 days
Detects multiple drug resistances
Agar place and LJ also goof but take 4-6 weeks

35
Q

What are disadvantages to using MODS liquid medium?

A

Contamination rate very high
Only test for rifampicin and isoniazid resistance

36
Q

Benefits of using TRUENAT

A

Battery operated, good in low income settings
But Low sensitivity in smear negative

37
Q

Benefits of using LaMP

A

Results in 1hr
Can do large volume of tests
Uses sputum only, no drug susceptibility testing!

38
Q

Benefits of XPERT?

A

Looks for rif resistance only
Results fast, expensive

39
Q

When do you use urine LAM TB Test?

A

Only in HIV positive inpatients who have low CD4 counts/are very unwell

40
Q

How do you dx pleural TB?

A

Pleural fluid superior to pleural tissue

41
Q

How do you treat Hr TB?

A

6 months of rifampicin, ethambutol, pyrazinamide and levofloxacin

42
Q

How do you treat MDR or RR TB?

A

BPaL (9 months) or BPaLM (6 months)

Bedaquiline, pretomanid and linezolid

Now all oral regimen of 7 drugs:
4-6 months bedaquiline
4-6months levo/moxi, clofazamine, ethionamide, pyraziamide and isoniaside
Followed by 5 months of levo/moxi, pyrazinamide, ethambutol and clofazamine

43
Q

MDR TB individualised tx regimen

A

Choose at least four drugs from Group A, B and C
Need tx for 18 months

44
Q

XDR tb Treatment

A

5 drugs from group a through to C
Treatment is in hospital!

45
Q

When can you not use BPaL/ BPaLM

A

CNS or Bone disease or milairy disease only Pulmonary and LN disease

46
Q

Important SE of linezolid?

A

Myelosuppression, peripheral amd optic neuropathy

47
Q

SE of ethionamide?

A

Hypothyroid

48
Q

SE of pretonamide?

A

Hepatotoxic

49
Q

SE ethambutol?

A

Colour blindness (optic neuritis)

50
Q

SE pyrazinamide?

A

Hyperuricemia (gout)
Arthralgia
Hepatitis

51
Q

Isoniasid SE?

A

Sideroblastic anaemia
Peripheral neuritis (give B6)
Hepatitis

52
Q

What age most at risk in children of severe TB?

A

Infancy <2yrs
At risk of disseminated disease

53
Q

When do most cases occur in children?

A

<5yrs
Majority cases occur within 1yr of exposure

54
Q

What kind of TB do children get?

A

Mostly pulmonary
Mostly smear negative, smear positive seen in older children

55
Q

How do you prevent TB in HIV positive children?

A

6 or 9 months isoniazid
3 months of Weekly isoniasid and rifapentine or daily

56
Q

How do you dx TB in children?

A

Plot on growth chart, kids get failure to thrive
CXR
Sputum in order children

57
Q

What are atypical presentations of TB in children?

A

Acute severe pneumonia not getting better with abx, especially in HIV positive children.

Suspect if asymmetrical, persistent wheeze

58
Q

Most common CXR finding in PTB in children?

A

Asymmetrical lymphadenopathy
Can look like widened mediastinum

59
Q

What are common extrapulmonary TB findings in children?

A

TB adenitis: asymmetrical painless usually cervical LN. Visibly enlarged
TST usually strongly positive

TB pleural effusion: school- aged children, need pleural tap for dx

Miliary and CNS TB more common <2

Bone TB often monoarticular painless effusion

60
Q

When do you admit a child with TB ro hospital?

A

Severe TB
Severe malnutrition
Severe resp distress and other comprbidities

61
Q

What is most accurate sample for Xpert in children?

A

Sputum sample
Gastric aspirate slightly lower

62
Q

How do you tx TB in children?

A

Same as adults
Doses are weight based- not age
From 24kg change to adult dosing

63
Q

Tb drug toxicities in children?

A

Rare
Watch out for hepatotoxicity

64
Q

Tx of TB HIV confection in children

A

First line drugs
Commence ART within 2-4 weeks
Cotrimoxazole preventative therapy
Pyridoxine supplement

65
Q

What is a good indication of response to tx in children with TB?

A

Weight!!

66
Q

Dx of congential TB

A

Proven TB in the infant PLUS;
- lesions occurring in first week of life
- a primary hepatic complex
-maternal gentian tract or placental TB
-exclusion of postnatal transmission by investigating contacts

67
Q

When is BCG CI in children?

A

<34 weeks
<2kg

68
Q

Tx of congential TB?

A

RIPE for 6-9 months for mother and baby

69
Q

Tx of latent TB in HIV patient?

A

If positive TST need to give isoniasid
If TST not possible give IPT to;
-PLHIV in areas >30%
-health workers, prisoners, contacts, miners

70
Q

How to screen for TB in PLHIV

A

1)Four symptoms screen- cough, fever, weightless, night sweats
2) CRP >5
3) CXR
4) RDTs
5) any inpt with HIV on wards where TB prevalence >10%

71
Q

Xpert sensitivity in Pulmonary vs EP?

A

Much more sensitive for pulmonary specimens

72
Q

When do you use TB LAM?

A

HIV patients with CD4 <50
RDT

73
Q

When do you start ART in HIV patients with TB?

A

Within 2 weeks if CD4 <50
No later than 8 weeks irrespective of CD4 count
Immediate ART does increase mortality

74
Q

What ARVs good with rifampicin?

A

Efavirenz
Dolutegravir
Raltegravir

Double dose of dolutegravir and raltegravir, efavirenz same dose

75
Q

When do you start ARVs with TB meningitis?

A

Within 8 weeks

76
Q

Tx of latent TB?

A

ISH for 6 months or rifampicin for 3-4 months or isoniasid and rifampicin for 3 months

Can give weekly rifapentine and isoniasid for 3 months

77
Q

What is the general epidimology of TB-who has symptoms/ who tests positive?

A

Most people don’t have symptoms
Lower concentrations of mycobacterium in sputum so test is false negative in about 1/3 of people

78
Q

How can you reduce transmission of TB in clinics?

A

Open windows
Wear masks

79
Q

Who are superspreaders of TB?

A

People with MDR TB who are not yet identified and on incorrect treatment

80
Q

How much more likely are people with HIV and malnourishment to get TB?

A

Malnourishment and air pollution more important risk factors than TB in LMIC as malnourishment and air pollution affect a much larger proportion of population

GORGAS (33 decks)

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