TB

Question 1

What is the 2nd leading cause of infectious disease in the U.S.?

Answer 1

Tuberculosis…Duh, look @ the deck name bro!

Question 2

Who is @ highest risk?

Answer 2

HIV infected patients bc they are immunocompromised

Question 3

What are the 2 major reasons for multidrug-resistant strains?

Answer 3

1. Ineffective regimen

2. Non-complience

Question 4

How is TB spread?

Answer 4

Airborne DROPLETS when a person infected:

a. Coughs
b. Speaks
c. Sneezes
d. Sings

Question 5

Am I @ risk if I am close to a TB infected pt for a short time?

Answer 5

@ risk? Sure, but transmission requires CLOSE, FREQUENT, or PROLONGED exposure

Question 6

Where do they hang their hat & how long should I expect replication to be?

Answer 6

1. Once inhaled bacilli travel down bronchial system & implant on BRONCHIOLES or ALVEOLI.
2. Replication is SLOW (Dividing Q25–32 hrs) & spread via the lymphatic system

Question 7

What happens if I inhale TB but my immune system is activated?

Answer 7

1. Tissue GRANULOMA forms
2. TB Contained & preventing replication & spread
3. Caseous Necrosis forms w/i 2-3 wks
4. Further growth is restricted & Latency establishes

Question 8

What happens if I inhale TB & my immune system is compromised?

Answer 8

1. TB is not maintained
2. Granuloma initiated but unsuccessful @ containing TB
3. Liguefaction of tissue drains into bronchus, blood vessels & lymphatics
4. This creates air filled cavities @ original site & Droplets are coughed up

Question 9

Are other organs affected besides the lungs?

Answer 9

Yes, mainly:

1. Blood stream
2. Bone & Joint tissue
3. Kidneys
4. Adrenal Glands
   * 5* Lymph Nodes

Question 10

What exactly is LATENT TB?

Answer 10

That you have TB but it is dormant & you cannot spread it.

1. TB can be dormant for years
2. Few cases even develop/reactivate
3. Reactivation is not well understood @ this time
4. We do know immunosuppressive state can trigger TB to reactivate

Question 11

There are Different Classification Classes of TB

Answer 11

0 = No TB exposure
1 = Exposure, no infection
2 = Latent, no Disease
3 = Clinically Active
4 = Not clinically active
5 = Suspected

Question 12

** What do the TB Classification Classes Mean?**

Answer 12

0--> Negative TB test
1--> + TB test/Negative CxR/Negative Sputum
2 (Latent)-->+ Culture & + CxR
3--> Hx TB/Negative CxR & Sputum
4--> +Skin/Negative Qelse
5-->Dx Pending

Question 13

TB Clinical Manifestations

Answer 13

1. Symptom-free @ Beginning
2. FATIGUE
3. Malaise
4. Anorexia
5. WT LOSS
6. Low-grade fever
7. Night Sweats

Question 14

What are the S/S in the Latent Stage?

Answer 14

1. No S/S
2. Susceptible to reactivation
3. CxR may reveal Fibrotic Granulomas
4. Negative Sputum Culture

Question 15

What is “Early Primary Progressive”?

Answer 15

1.Immune Response Lacks Control
2. Inflammation of tissues
3. Nonspecific S/S:
> Fever, Fatigue, Wt loss
4. Nonproductive cough
5. Early Dx is difficult:
>CxR & Sputum may be Negative

Question 16

How many ppl develop Active TB p immediate exposure?

Answer 16

Approximately 5–10%

Question 17

What S/S would you see in “Late Primary Progressive” TB?

Answer 17

1. Productive, Purulent Cough
2. Progressive wt Loss
3. Anemia
4. Dyspnea
5. Low Grade Fever
6. Chills/Night Sweats
7. CRACKLES IN LUNGS
8. CxR = Normal
9. • Sputum culture(May be blood tinged)
10. Dull on Percussion of Lungs bc of Air Filled Sacs
11. Lack of breath sounds
12. Finger Clubbing

Question 18

What are the Complications of TB?

Answer 18

1. Pleural Effusion & Empyema(Pus in lungs)
   a. Caused by bacteria in pleural space
   b. Inflammatory reaction c plural exudate of protein-rich fluid.

Question 19

What are the Diagnostic Studies Used to Dx TB?

Answer 19

1. Skin Test
2. CxR
3. Bacteriologic Studies
   a. Stain
   b. Sputum Culture
4. Bronchoscopy Washing
5. Fluid from abscess or Effusion
6. CSF
7. QuantiFERON - TB (New Blood test)

Question 20

Skin Test for TB Dx

Answer 20

1. Intradermal administration of tuberculin.
2. Induration (Hardness-Due to mast cell accumulation) @ injection site = Exposure
   a. Sensitivity remains for life & should not use this test again.
3. Reactions >/= 10mm are +
4. False negatives can occur c HIV

Question 21

CxR for TB Dx

Answer 21

1. Cannot Dx on CxR only

>Infiltrates, Cavitary Infiltrates, & Lymph node involvement Suggest TB, but not the diagnostic factor.

Question 22

Bacteriologic Studies for TB Dx

Answer 22

1. Stained Sputum Smears examined for Aacid-Fast-Bacilli
>**Required for Dx**
>Less than 24 hrs
2. **Sputum Culture**
>Needed for **Definitive Dx**
>4--14 days or 3--6 weeks

Question 23

QuantiFERON–TB

Answer 23

1. New Test
2. Rapid Blood Test
   >W/I 12–24hrs
3. Does not replace cultures
4. May detect Active & Latent TB

Question 24

What Drugs are used for Tx of Active TB?

Answer 24

Initial Phase:
1. Isoniazid
2. Rifampin
3. Pyrazinamide
>Contraindicated in Liver Disease & Pregnancy
4. Ethambutol
All 4 are used bc of High Resistance

Question 25

What does "Direct Observed Therapy (DOT)" mean?

Answer 25

1. Bc noncomplience is a major issue in multidrug resistance, Tx fails! 2. DOT means we are required to WATCH pt swallow medications then check 3. This is to ensure adherence to the regimen.

Question 26

What should I educate my pt about concerning Active TB?

Answer 26

1. Educate them on Side Effects 2. When to seek Medical Attention 3. Liver Function should be Monitored.

Question 27

Is there Drug therapy for Latent TB?

Answer 27

Yes, Usually treated c INH for 6--9 months | >HIV pt's should take INH for 9 months

Question 28

Is there a vaccine or something that I can attempt to protect myself?

Answer 28

1. Yes, but not widely used in the U.S. 2. Bacille Calmette-Guerin (BCG) Vaccine to prevent TB is used in other countries 3. The vaccine can lead to a + PPD reaction 4. Ask your pt if they've had it p jumping to conclusions if their PPD comes out +