TB in Infancy and Childhood Flashcards Preview

Nelson's Pediatrics > TB in Infancy and Childhood > Flashcards

Flashcards in TB in Infancy and Childhood Deck (399):
1

_____ causes tuberculosis in humans.

Mycobacterium tuberculosis

2

 

 

_____ are obligately aerobic, non-motile, slightly curved or straight bacilli.

 

 

 

 

Mycobacteria

 

 

3

MTB retains _____ dye when decolorized with acid-ethanol by the _____ method (acid fastness).

carbofuchsin, Ziehl-Neelsen

4

MTB Survival Strategies

1. prevention of acidification of phagosomes 2. neutralization of the effects of reactive oxygen intermediates by the mycobacterial cell wall 3. inhibition of plasma membrane repair 4. inhibition of phagosome-lysosomal fusion through secretion of SapM (acid phosphatase)

5

Key Risk Factors for TB

smear (+) household contact < 5 y.o. immunodeficiency

6

TB Transmission

inhalation of droplet nuclei (5-200 bacilli)

7

TB Incubation Period

3-12 weeks

8

_____ is the condition in which a child is in close contact with a contagious host but without any signs and symptoms, with (-) TST and (-) CXR and laboratory findings.

TB Exposure

9

_____ is the condition in which a child has no signs or symptoms, (-) CXR and laboratory findings but has (+) TST.

TB Infection Latent TB Infection (LTBI)

10

_____ is presumptive TB with (+) CXR and/or TST.

TB Disease

11

_____ TB has biological specimen which is positive by sear microscopy, culture or rapid diagnostic tests.

Bacteriologically Confirmed

12

_____ TB does not fulfill the criteria for bacteriological confirmation but has been diagnosed with active TB.

Clinically Diagnosed

13

_____ is a case of tuberculosis involving lung parenchyma and tracheobronchial tree ± other sites of the body.

Pulmonary TB (PTB)

14

_____ is a case of TB involving orgens outside the pulmonary system.

Extrapulmonary TB (EPTB)

15

Laryngeal TB is considered as _____.

EPTB

16

_____ is the initial stage in children who inhale MTB.

Primary Disease

17

Primary PTB Disease Components

Ghon focus lymphadenitis lymphangitis

18

95% of primary PTB disease heals by _____.

fibrosis and/or calcification

19

Primary TB in children is asymptomatic up to _____ of patients.

65%

20

Fever in primary Tb is usually _____ and lasts for _____.

low-grade 14-21 days

21

_____ is the condition which develops when initial TB infection fails to heal and continues to progress for months or years.

Progressive Primary TB

22

_____ is the condition which represents reactivation of an old, possibly subclinical TB infection.

Secondary (Reactivation) TB

23

Secondary TB occurs in _____ of the cases of primary infection.

< 10%

24

Secondary TB is more common on _____.

adolescents

25

Clinical Manifestations of Secondary TB

chronic or persistent cough prolonged fever chest pain hemoptysis supraclavicular adenitis

26

_____ is the clinical disease resulting from the hematogenous dissemination of MTB.

Miliary Tuberculosis

27

_____ is the most common clinically significant form of disseminated TB.

Miliary Tuberculosis

28

_____ is now used to denote all forms of progressive widely disseminated hematogenous TB.

Miliary Tuberculosis

29

The most common extrapulmonary sites of Miliary TB include the _____.

lymphatic system bones joints liver

30

_____ are more common in childhood TB than in adults.

peripheral lymphadenopathy hepatomegaly

31

Peritonitis is found in _____ of patients with advanced Miliary TB.

20-40%

32

_____ can be a complication of primary TB which results in enlargement of peribronchial lymph nodes with subsequent compression or nodal extension into the bronchus.

Endobronchial Tuberculosis

33

Compression from Endobronchial TB cam cause _____.

asphyxia obstructive emphysema atelectasis

34

The _____ is more vulnerable to Endobronchial TB due to its anatomy and drainage.

R middle lobe

35

Endobronchial TB can cause _____ which could be mistaken for pertussis or bronchial asthma.

crepitant rales wheezes

36

_____ is the most common form of extrapulmonary TB and probably the most common cause of chronic lymphadenitis in children.

Tuberculous Lymphadenitis (Scrofula)

37

TB Lymphadenitis occurs most frequently in the _____ age group.

10-18 y.o.

38

The most common location for TB Lymphadenitis is the _____, followed by the _____ areas.

anterior cervical space (49.4%) axillary and supraclaavicular areas

39

The most common presentation of TB Lymphadenitis is _____.

unilateral or multiple slow-growing nontender lymphadenopathies

40

The involved lymph node in TB Lymphadenitis is usually described as _____.

firm painless ruberry discrete matted fixed overlying skin induration

41

Fistula formation is seen in _____ of TB Lymphadenitis cases.

10%

42

The use of _____ can improve the diagnosis of TB Lymphadenitis.

FNAB with rapid molecular diagnostic tests

43

_____ is the most severe form of extrapulmonary TB.

Tuberculous Meningitis

44

TB Meningitis occurs most commonly in children _____ but uncommon in infants _____.

< 6 y.o., < 4 mos.

45

TB Meningitis usually appears within _____ after initial infection.

2-6 mos.

46

TB Meningitis usually accompanies Miliary TN in _____ of cases.

50%

47

TB Meningitis Stages: personality changes, irritability, anorexia, listlessness, fever

Stage 1

48

TB Meningitis Stages: increased ICP, cerebral damage, drowsiness, stiff neck, CN palsies, anisocoria, vomiting, tâche cérébrale, absence of abdominal reflexes, seizures

Stage 2

49

TB Meningitis Stages: coma, irregular HR and RR, rising fever

Stage 3

50

TB Meningitis CSF Findings

↑ WBC 50-500 WBC/mm3 PMNS - early Lymphocytes - late ↓ glucose ↑ protein

51

TB Meningitis Neuroimaging Triad

Hydrocephalus (80%) Basal Meningeal Enhancement (75%) Arteritis (cerebral infarcts)

52

_____ are enlarged granulomatous foci within the brain parenchyma.

Tuberculomas

53

Tuberculous brain abscesses lack _____ associated with tuberculomas.

giant cells granulomatous reaction

54

Tuberculomas occur most often in children _____.

< 10 y.o.

55

Tuberculomas are often located at the_____.

infratentorial area cerebellar area

56

The most common areas affected by TB spinal meningitis are _____.

dorsal cord (most common) lumbar region cervical region

57

TB osteomyelitis and arthritis account for _____ of EPTB and only _____ of all cases of TB.

10-15%, 2%

58

TB osteomyelitis and arthritis can be cause by _____ spread from an initial infection.

lymphohematogenous spread

59

Younger children are more vulnerable to TB osteomyelitis and arthritis due to the _____

increased blood flow to growing bones

60

TB osteomyelitis usually starts as an area of endarteritis in the _____ of long bone where blood supply is more abundant.

metaphysis

61

The most common skeletal sites affected by TB are _____.

spine (most common) hip knee

62

The most common sites affected by Pott's Disease are _____.

upper lumbar lower thoracic lumbosacral

63

In Pott's Disease, there is destruction of the intervertebral disk space and adjacent vertebral bodies, collapse of spinal elements and anterior wedging leading to _____.

angulation gibbus kyphosis

64

_____ is the most frequent symptom of Pott's Disease.

back pain

65

Duration of Pott's Disease ranges from _____.

4-11 mos.

66

TB arthritis is _____ in children and is usually _____.

rare, monoarticular

67

_____ is an aseptic reactive polyarthritis caused by TB..

Poncet's Disease

68

_____ is second to PTB in frequency.

GITB

69

The most common forms of abdominal TB are _____.

nodal involvement peritonitis intestinal involvement liver (6.1%) ileum (1.5%) perineum (1..5%) spleen (1.5%)

70

Ingested of sputum infected with MTB is the most important suggested cause of _____.

TB Enteritis

71

TB Enteritis usually affects the _____.

ileocecal area mesenteric LN peritoneum

72

Enlarged caseous and calcified meseneric LNs also known as _____ are often seen as densities on abdominal x-ray.

tabes mesenterica

73

_____ is commonly due to rupture of a caseous abdominal LN and less frequently from a focus in the intestine or fallopian tube.

TB Peritonitis

74

_____ TB Peritonitis is less common and is characterized by tender abdominal masses and a doughy abdomen.

Plastic

75

_____ TB Peritonitis presents with ascitis and classic signs of peritonitis.

Serous

76

TB Peritonitis Peritoneal Fluid Analysis

exudative lymphocytic predominance serum ascitic fluid albumin gradient < 1.1 g/dl ↑ protein content (> 25 g/L)

77

_____ is referred to as primary miliary TB of the liver.

Hepatobiliary TB

78

Hepatobiliary TB Types

diffuse hepatic involvement with PTB or miliary TB diffuse hepatic involvement without PTB focal tuberculoma or abscess

79

The overall incidence of isolated liver TB is _____.

0.3%

80

Hepatic TB lesions that are larger than 2 mm are called _____.

macronodular TB pseudotumoral TB

81

Cutaneous TB Classification: tuberculous chancre

Primary

82

Cutaneous TB Classification: miliary tuberculosis

Primary

83

Cutaneous TB Classification: lupus vulgaris

Secondary

84

Cutaneous TB Classification: scrofuloderma

Secondary

85

Cutaneous TB Classification: tuberculous verrucosa cutis

Secondary

86

Cutaneous TB Classification: tuberculous gumma (metastatic abscess)

Secondary

87

Cutaneous TB Classification: orificial tuberculosis

Secondary

88

Cutaneous TB Classification: micropapular lichen

Tuberculid

89

Cutaneous TB Classification: scrofuloderma

Tuberculid

90

Cutaneous TB Classification: papular-papulonectrotic

Tuberculid

91

Cutaneous TB Classification: nodular (erythema induratum)

Tuberculid

92

Cutaneous TB Classification: Primary

tuberculous chancre miliary TB

93

Cutaneous TB Classification: Secondary

lupus vulgaris scrofuloderma tuberculous verrucosa cutis tuberculous gumma (metastatic abscess) orofocial TB

94

Cutaneous TB Classification: Tuberculids

micropapular lichen scrofuloderma papular-papulonecrotic nodular (erythema induratum)

95

_____ are hypersensitivity reactions to MTB.

Tuberculids

96

_____ is the most common form of childhood cutaneous TB.

Scrofuloderma

97

Cutaneous TB Manifestations

inoculation from an exogenous source or BCG hematogenous dissemination erythema nodosum

98

Ocular TB frequently involves the conjunctivae and the cornea in the form of _____.

phlyctenular keratoconjunctivitis

99

Phlyctenular Keratoconjunctivitis is considered a hypersensitivity reaction to _____.

tuberculin

100

Phlyctenular Keratoconjunctivitis presents as _____.

1-3 mm grey to yellow colored jelly-like nodules

101

Renal TB is an uncommon complication of primary TB which occurs _____ after primary infection.

15-20 years

102

Genitourinary TB is usually seen in children _____.

> 7 y.o.

103

_____ spread could cause tubercles in the glomeruli with caseating sloughing lesions.

Hematogenous

104

Children whose urine reveal presence of MTB are considered highly infectious and should be isolated until _____.

their urine is sterile

105

The most common sites for genital TB in females are _____.

fallopian tubes (90-100%) endometrium (50%) ovaries (20-30%) cervix (2-4%)

106

_____ should be highly suspected in the presence of painless otorrhea unresponsive to conventional treatment ina patient with TB.

TB Mastoiditis

107

Pathophysiology of Perinatal TB

hematogenous spread from umbilical vein → ingestion of infected amniotic fluid or postpartum inhalation

108

Criteria for Congenital TB

1. 1st week of life 2. primary hepatic complex or caseating hepatic granuloma 3. TB infected placenta or endometrium

109

Effects of Maternal TB

infertility poor reproductive performance recurrent abortions stillbirth PROM preterm labor

110

Spectrum of TB: (+) exposure (-) signs and symptoms (-) TST (-) CXR (-) sputum smear (-) other diagnostics

TB Exposure

111

Spectrum of TB: (+) exposure (-) signs and symptoms (+) TST (-) CXR (-) sputum smear (±) other diagnostics

TB Infection

112

Spectrum of TB: (+) exposure (+) signs and symptoms (+) TST (±) CXR (±) sputum smear (±) other diagnostics

TB Disease

113

Classification of TB Disease is based on _____.

bacteriological status anatomical site history of previous treatment HIV status drug susceptibility

114

Those who can expectorate sputum may be classified into PTB, _____.

sputum smear positive or negative

115

TB Classification: a patient who has never had treatment for TB or who has taken anti-TB drugs for < 1 mo. Isoniazid Preventive Therapy (IPT) or other preventive regimens are not considered.

New Case

116

TB Classification: a patient who has been previously treated with anti-TB drugs for ≥ 1 mo.

Retreatment Case

117

TB Classification: a case of TB who has a (-) HIV result at the time of diagnosis

HIV (-) Patient

118

TB Classification: a case of TB who has a (+) HIV result at the time of diagnosis

HIV (+) Patient

119

TB Classification: resistant to 1 first-line anti-TB drug

Monoresistant TB

120

TB Classification: resistant to > 1 first-line anti-TB drug (other than Isoniazid or Rifampicin)

Polydrug-Resistant TB

121

TB Classification: resistance to at least both Isoniazid and Rifampicin

Multidrug-Resistant TB (MDR-TB)

122

TB Classification: resistance to any fluoroquinolone and to at least 1 of 3 second-line injectable drugs (capreomycin, kanamycin, amikacin)

Extensively Drug-Resistant TB (XDR-TB)

123

TB Classification: resistance to Rifampicin, detected using phenotypic or genotypic methods, ± resistance to other anti-TB drugs.

Rifampicin-Resistant TB (RR-TB)

124

A child is presumed to have active TB if ≥ 3 of the following criteria are met:

exposure to host with active TB (Epidemiologic) signs and symptoms (Clinical) (+) TST (Immunologic) (+) CXR findings (Radiologic) (+) laboratory findings (Laboratory)

125

_____ refers to any person with signs and/or symptoms suggestive of TB or those with CXR findings suggestive of TB.

Presumptive TB

126

Children who are ≥ 15 y.o. with cough of ≥ 2 weeks are presumed to have TB if they have any of the ff.:

weight loss fever hemoptysis chest or back pains easy fatigueability malaise night sweats shortness of breath difficulty of breathing

127

Children who are ≥ 15 y.o. with unexplained cough of any duration are presumed to have TB if they have _____.

close contact to host with active TB immunocompromised state

128

A child < 15 y.o. is presumed to have active TB if ≥ 3 of the following criteria are met:

coughing/wheezing x 2 weeks unexplained fever x 2 weeks weight loss failure to thrive loss of appetite failure to respond to 2 weeks of antibiotics failure to regain previous state of health 2 weeks after viral infection fatigue reduced playfulness lethargy

129

A child < 15 y.o. and has had _____ is presumed to have TB if at least 1 of the clinical criteria are met.

close contact to a known case of active TB

130

A child is presumed to have EPTB if the any of the ff. are present:

gibbus non-painful enlarged cervical lymphadenopathy with or without fistula nuchal rigidity pleural effusion pericardial effusion distended abdomen with ascites non-painful enlarged joint tuberculin hypersensitivity

131

Treatment for active TB should be done if the child has ≥ 3 of the ff.:

exposure (+) TST signs &amp;amp;amp; symptoms (+) CXR (+) laboratory tests

132

_____ is the most important diagnostic tool in TB.

TST

133

Reaction to TST starts after _____ and reaches its peak at _____.

5-6 hours, 48-72 hours

134

The current standard for TST is the _____.

Mantoux Test

135

The Mantoux Test is done with _____ of solution containing _____ of purified protein derivative (PPD).

0.1 ml, 0.1 μg

136

PPD for Mantoux Test

5 tuberculin units of PPD-S 2 tuberculin units of PPD-RT 23 with Tween 80

137

Immunologic-based testing for TB is done with _____.

Interferon-Gamma Release Assay (IGRA)

138

The delayed hypersensitivity reaction is manifested as a _____ immune response mediated by _____ and is characterized by an indurated response to the intradermal injection from the cell wall of the MTB.

Type IV, sensiitized T-Lymphocytes

139

Administration of Mantoux Test

2 in. below elbow in the volar aspect of the forearm g.25-27 short bevel needle (1/4-1/2 in.) 0.1 ml of PPD intradermal - wheal of 6-10 mm

140

TST should be read within _____.

48-72 hours

141

(+) TST reactions can be read accurately for up to _____.

7 days

142

(-) TST reactions can be read accurately for up to _____.

72 hours

143

False (+) TST

infection with non-tuberculous mycobacteria previous BCG vaccination (≤ 5 years) incorrect TST administration incorrect measurement or interpretation incorrect strength of antigen

144

False (-) TST: Host Factors

infections live attenuated virus vaccinations (measles, mumps, polio, varicella) metabolic derangements nutritional factors lymphoid organ diseases coricosteroids immunosuppressive agents age (newborns, elderly) advanced TB infection stress complete anergy

145

False (-) TST: Tuberculin Factors

improper storage (light, heat) improper dilution chemical denaturation contamination adsorption into syringe (controlled with Tween 80)

146

False (-) TST: Administration Factors

too little antigen delayed administration after drawing into syringe too deep

147

False (-) TST: Reading and Recording Factors

inexperienced reader conscious or unconscious bias error in recording

148

The tuberculin solution must be stored at _____.

2-8°C

149

(+) TST: populations with no risk factors

≥ 15 mm

150

(+) TST: high risk populations

≥ 10 mm

151

(+) TST: ≥ 5 mm

HIV (+) close contact CXR with untreated TB organ transplant immunosuppression

152

_____ is the inability to react to a TST because of a weakened immune system.

Anergy

153

_____ is the change from a (-) to a (+) TST result.

Skin Test Conversion

154

_____ can distinguish latent TB from previous BCG vaccination.

IGRA

155

_____ is preferred for childern < 5 y.o.

TST

156

IGRA is preferred for children who _____.

have receivedd BCG are unlikely to return for reading

157

IGRA results are available within _____.

24 hours

158

IGRA blood samples should be processed within _____.

8-30 hours

159

_____ of blood is needed to perform IGRA.

1-2 ml

160

The only finding that may be highly suggestive of TB infants and children is the _____ found in miliary TB.

uniform stippling of both lungs

161

Gastric AFB is only (+) in _____ of cases.

30-40%

162

Primary Complex CXR Findings

parenchymal involvement (primary focus) lymphangitis localized pleural effusion regional lymphadenitis

163

_____ is the most common CXR finding in children with TB.

Lymphadenopathy

164

Proper Exposure for CXR

300-500 mA

165

PTB CT Scan Findings

< 1 cm LN calcified nodes ring enhancement granuloma peribronchial, axillary, hilar, paricardiac nodes

166

PTB CXR Findings

Ghon Complex (64%) parenchymal infiltrates (78%) air-space opacities (63%) atelectasis (22%) cavitary lesions (21%) bronchial and tracheal compression (12%) miliary pattern (10%)

167

The parenchymal reaction to TB is typically _____.

acinar consolidation (homogenous with ill-defined borders)

168

PTB predominantly affects the _____ with preferential location between _____.

upper lobes anterior-posterior segments right-left segments

169

Atelectasis in TB usually affects the _____

R upper and middle lobes *bronchial compression by enlarged LN

170

Progression from Ghon focus and lymohadenopathy occur in children _____.

< 5 y.o. > 10 y.o.

171

Radiographic clearing of TB usually occurs within _____ after therapy.

6 mos. - 2 years

172

Chronic PTB tends to localize in the _____.

apical and posterior segments of the upper lobes R > L

173

Chronic PTB CXR Findings

Local Exudative TB Local Fibroproductive TB Cavitation Tuberculoma

174

_____ is the radiolodic hallmark of reactivation TB.

Cavitation

175

Tuberculomas are usually found in the _____.

upper lobe R > L

176

In advanced Miliary TB, stippling in the lungs coalesce and produce a richly stippled patter called the _____.

snowstorm effect

177

Radiographic Improvement of Miliary TB starts at _____ and complete clearing is seen in _____.

5 weeks 7-22 mos. (mean 16 weeks)

178

Bronchiectasis from TB is 2x more frequent in patients with _____.

hemoptysis

179

Pott's Disease begins with deposition of MTD through end arterioles into the _____.

anterior part of the vertebral body adjacent to the end plate.

180

_____ bone loss from TB is needed before changes are manifested on x-ray.

> 50%

181

X-ray Triad of TB Arthritis

Phemister Triad juxtaarticular osteoporosis peripherally located osseous erosions narrowing of the interosseous space

182

the Phemister Triad is characteristic of _____.

TB Arthritis

183

The most specific CT Scan finding in TB Meningitis is _____.

basal cistern enhancement

184

The majority of infarcts caused by TB Meningitis are located at the _____.

basal ganglia internal capsule

185

The _____ are the most commonly affected regions of Tuberculoma.

frontal and parietal lobes

186

If the caseous core of a tuberculoma liquefies, it results in a _____.

TB Abscess

187

Tuberculomas are usually _____ while TB Abscesses are usually _____.

multiple (tuberculoma) solitary (abscess)

188

Spinal TB MRI Findings

CSF loculation obliteration of he spinal subarachnoid space loss of outline of the spinal cord (cervicothoracic) matting of nerve roots (lumbar)

189

Routes of Abdominal TB

ingestion of infected sputum hematogenous spread local spread

190

_____ is the most common radiographic manifestation of abdominal TB.

Lymphadenopathy (55-66%) *mesenteric, omental, peripancreatic

191

_____ is the most common clinical manifestation of abdominal TB.

Peritonitis (1/3)

192

_____ involvement is seen in 80-90% of abdominal TB cases.

Ileocecal

193

The wide gaping of the ileocecal valve with narrowing of he terminal ileum is called the _____.

Fleischner Sign

194

The earliest radiographic abnormality seen in Renal TB is _____ due to erosion.

moth-eaten calyx

195

Genital TB in males is usually confined to _____.

seminal vesicles prostate gland

196

The primary sign of TB Pericarditis is pericardial thickening _____ on CT scan.

> 3 mm

197

Most patients with TB Pericarditis have distention of the inferior vena cava to a diameter _____.

> 3 cm

198

_____ microscopy is the easiest, least expensive and most rapid (1 hour) procedure in diagnosing TB.

AFB Smear

199

Fluorescence Microscopy uses _____ which causes the acid-fast bacilli to fluoresce against a dark background.

auramine-based

200

Traditional TB culture methods used solid culture media like _____.

egg-potato-based agar-based

201

Solid TB culture requires _____ to isolate organisms and another _____ for sensitivity testing.

4-6 weeks, 2-4 weeks

202

Mycobacterial culture with the use of _____ are more rapid and sensitive.

broth-based culture media

203

Liquid TB culture provides results in ____.

7-14 days

204

Specimen Collection: _____ is recommended for infants and children who are unable to produce sputum even with aerosol inhalation.

Gastric AFB

205

Specimen Collection: _____ of gastric content should be aspirated for gastric AFB.

5-10 ml (max 15 ml)

206

Specimen Collection: For gastric lavage, _____ of sterile distilled water is injected through a stomach tube.

25-50 ml

207

Specimen Collection: Gastric AFB should be done once daily for _____.

3 consecutive days

208

Specimen Collection: If transfer of gastric AFB is delayed for more than 1 hour, it must be neutralized with _____ and stored at _____>

sodium carbonate, room temperature

209

Specimen Collection: For older children who can expectorate, a series of _____ should be collected in _____ before start of therapy.

2 sputum specimens 2 different days

210

Specimen Collection: Sputum AFB

1. clean and thorough rinse of mouth with water 2. breathe deeply 3 times 3. after 3rd breath, cough hard and bring sputum from deep in the lungs. 4. expectorate the sputum into a sterile container.

211

Specimen Collection: _____ of sputum should be collected for AFB.

3 ml (1 tsp.)

212

Specimen Collection: If a sputum AFB sample is delayed for more than 1 hour, it should be _____.

refrigerated

213

Specimen Collection: The minimum amount for a respiratory aspirate AFB sample is _____.

3 ml

214

Specimen Collection: If respiratory aspirate AFB sample is delayed for more than 1 hour, it should be _____.

refrigerated

215

Specimen Collection: The minimum amount for a CSF AFB sample is _____.

1-2 ml

216

Specimen Collection: If a CSF AFB sample is delayed for more than 1 hour, it should be _____.

kept at room temperature

217

Specimen Collection: CSF AFB samples should be _____ if for PCR testing.

refrigerated or frozen

218

Specimen Collection: Tissue AFB samples should have _____ added for transport.

2-3 ml sterile saline

219

Specimen Collection: If a tissue AFB sample is delayed for more than 1 hour, it should be _____.

refrigerated

220

Specimen Collection: If an exudate or abscess AFB sample is delayed for more than 1 hour, it should be _____.

refrigerated

221

Specimen Collection: Exudate AFB swabs should have _____ added for transport.

2-3 ml sterile saline *ideally 7H9 broth

222

Specimen Collection: _____ of blood should be taken for TB culture.

1-10 ml

223

Specimen Collection: Blood for TB culture must be placed in a _____.

yellow top vial (sodium polyanetholsulfonate, SPS) green top vial (heparin)

224

Specimen Collection: Blood for TB culture must be transported at _____.

room temperature

225

Specimen Collection: BMA AFB specimen should be placed in a _____.

yellow top vial (sodium polyanetholsulfonate, SPS)

226

Specimen Collection: _____ of first morning urine should be collected for _____ for urine AFB testing.

40 ml (min. 10-15 ml) 3 consecutive days q8-24 hours

227

Specimen Collection: Stool AFB is not recommended except in patients with _____.

HIV

228

When MTB antigen load is small and the degree of tissue sensitivity is high, granuloma formation results from _____.

organization of lymphocytes, macrophages, Langerhans giant cells and fibroblasts

229

_____ utilize techniques to amplify nucleic acid regions specific to the MTB complex.

Nucleic Acid Amplification Tests (NAATs)

230

The most common target of NAATs is the _____ followed by the _____.

IS6110, 65-kDa

231

Line probe assays are recommended for _____ specimen only.

smear(+)

232

The _____ is the first fully automated, cartridge-based NAAT for TB which simplifies molecular testing by integrating and automating sample preparation, amplification and detection.

Gene Xpert MTB/RIF Assay

233

The _____ is a time-PCR-based molecular test that can simultaneously detect TB and Rifampicin resistance.

Gene Xpert MTB/RIF Assay

234

The Gene Xpert MTB/RIF Assay will show results within _____.

2 hours

235

The _____ is recommended by the WHO as a replacement for conventional microscopy, culture and drug susceptibility testing as the initial diagnostic test for TB.

Gene Xpert MTB/RIF Assay

236

T-Lymphocytes from an infected host release _____ as a marker of infection or active TB.

Interferon Gamma (IFN-g)

237

Drug Efficacy TB Groups

1. actively growing MTB in open cavities (bactericidal drugs) 2. slowly multiplying MTB in caseous lesions (sterilizing drugs) 3. intracellular MTB in acidic compartments of macrophagesor acidic lung lesions (sterilizing drugs 4. TB persisters in hypoxic environments which are unresponsive to most anti-TB medication

238

Children have fewer mycobacterial organisms and are thus less likely to develop _____.

secondary drug resistance

239

EPTB is more common in _____.

children

240

_____ involves direct observation of anti-TB medication intake.

Direct Observed Treatment Short Course (DOTS)

241

3 Properties of Anti-TB Drugs

bactericidal activity sterilizing activity ability to prevent resistance

242

Properties of Anti-TB Drugs: killing of bacteria in a log-phase growth

bactericidal activity

243

Properties of Anti-TB Drugs: kill slowly growing or intermittently replicating bacilli

sterilizing activity

244

_____ is the most potent sterilizing anti-TB drug.

Rifampicin

245

_____ is only active in the acidic intracellular environment of macrophages and in areas of acute inflammation.

Pyrazinamide

246

_____ is bactericidal against rapidly multiplying MTB in an environment with high oxygen tension and neutral pH.

Streptomycin

247

_____ is used together with other drugs to prevent emergence of resistant bacilli.

Ethambutol

248

First-Line Anti-TB Drugs

Isoniazid Rifampicin Pyrazinamide Ethambutol

249

Second-Line Anti-TB Drugs: Injectables

Aminoglycosides (Streptomycin, Kanamycin, Amikacin) Polypeptides (Capreomycin)

250

Second-Line Anti-TB Drugs: Fluoroquinlones

Levofloxacin Moxifloxacin Ofloxacin

251

Second-Line Anti-TB Drugs: Rifampicin Analogs

Rifabutin Rifapentine

252

Second-Line Anti-TB Drugs: Oral Bacteriostatic Agents

Para-Aminosalicylic Acid Cycloserine Terizidone Ethionamide Prothionamide

253

_____, formerly a first-line anti-TB drug, is now classified as a second-line drug due to the increasing resistance and its IM route.

Streptomycin

254

In cases of _____, Streptomycin may still be used as part of the initial treatment

meningitis liver disease

255

_____ and _____ have recently been approved as anti-TB drugs as they have been proven to be effective in culture conversion.

Bedaquiline (hastens conversion) Delamanid (increasing conversion rates after 8 weeks of treatment)

256

Children should be given the adult dose of anti-TB drugs once they reach _____.

25 kg

257

Isoniazid: Dose

children - 10 (10-15 mkday) adults - 5 (4-6 mkday) *max. 300 mg/day

258

Isoniazid: Mechanism of Action

bactericidal against actively growing MTB inhibits mycolic acid synthesis inhibits catalase-peroxidase enzyme

259

Isoniazid: Adverse Reactions

hepatitis, peripheral neuropathy, allergic sken reactiong, possible hemolysis in G6PD, inhibits drug-metabolizing enzymes (DME) leading to increased risk of phenytoin, ethosuximide and carbamazepine toxicity

260

First-Line Anti-TB Drugs: bactericidal against actively growing MTB inhibits mycolic acid synthesis inhibits catalase-peroxidase enzyme

Isoniazid

261

First-Line Anti-TB Drugs: hepatitis, peripheral neuropathy, allergic sken reactiong, possible hemolysis in G6PD, inhibits drug-metabolizing enzymes (DME) leading to increased risk of phenytoin, ethosuximide and carbamazepine toxicity

Isoniazid

262

Plasma half-life of Isoniazid varies from _____ to _____.

< 1 hour (fast acetylators) > 3 hours (slow acetylators)

263

Discontinue Isoniazid, Rifampicin and Pyrazinamide if AST and/or ALT are _____.

> 3-5x normal values

264

For Isoniazid and Rifampicin, there is _____ for renal dysfunction.

no dose adjustment

265

Isoniazid and Rifampicin are best absorbed on an _____.

empty stomach

266

When co-administering Isoniazid and Rifampicin, Isoniazid must not exceed _____.

10 mkday

267

Rifampicin: Dose

children - 15 (10-20 mkday) adults - 10 (8-12 mkday) *max. 600 mg/day

268

Rifampicin: Mechanism of Action

inhibits DNA-dependent RNA polymerase

269

Rifampicin: Adverse Reactions

hepatitis, hypersensitivity reactions, flu-like symptoms, thrombocytopenia, orange discoloration of body fluids, induces drug-metabolizing enzymes (DME) resulting in decreased plasma levels of AEDs, antibiotics, hormonal therapy agents and corticosteroids

270

First-Line Anti-TB Drugs: inhibits DNA-dependent RNA polymerase

Rifampicin

271

First-Line Anti-TB Drugs: hepatitis, hypersensitivity reactions, flu-like symptoms, thrombocytopenia, orange discoloration of body fluids, induces drug-metabolizing enzymes (DME) resulting in decreased plasma levels of AEDs, antibiotics, hormonal therapy agents and corticosteroids

Rifampicin

272

Pyrazinamide: Dose

children - 30 (20-40 mkday) adults - (20-30 mkday) *max. 2 g/day

273

Pyrazinamide: Mechanism of Action

disruption of membrane energy metabolism

274

Pyrazinamide: Adverse Reactions

nausea, vomiting, most common cause of hepatotoxicity, hypersensitivity reactions, polyarthralgia

275

First-Line Anti-TB Drugs: disruption of membrane energy metabolism

Pyrazinamide

276

First-Line Anti-TB Drugs: nausea, vomiting, most common cause of hepatotoxicity, hypersensitivity reactions, polyarthralgia

Pyrazinamide

277

Pyrazinamide requires dose modification in _____.

renal failure

278

Ethambutol: Dose

children - 20 (15-25 mkday) adults - 15 (15-20 mkday) *max. 1.2 g/day

279

Ethambutol: Mechanism of Action

inhibits transferase enzymes involved in cell wall synthesis

280

Ethambutol: Adverse Reactions

peripheral neuropathy, retrobulbar optic neuritis (impairment of visual acuity and red-green color vision)

281

First-Line Anti-TB Drugs: inhibits transferase enzymes involved in cell wall synthesis

Ethambutol

282

First-Line Anti-TB Drugs: peripheral neuropathy, retrobulbar optic neuritis (impairment of visual acuity and red-green color vision)

Ethambutol

283

_____ was previously omitted from anti-TB regimens in children < 6 y.o. due to difficulty monitoring optic neuritis.

Ethambutol

284

No anti-TB drug is effective against _____.

non-replicating or dormant MTB

285

_____ has the best bactericidal activity against rapidly multiplying MTB.

Isoniazid

286

Rifabutin's advantages are _____.

reduced induction of hepatic metabolism used in patients also receiving antiretroviral therapt for HIV

287

______ was developed for once-weekly anti-TB therapy because it was more potent and longer-acting.

Rifapentine

288

Amikacin: Dose

children - 15-30 mkday IM/IV adults - 15 mkday IM/IV *max. 1 g/day

289

Kanamycin: Dose

children - 15-30 mkday IM/IV adults - 15 mkday IM/IV *max. 1 g/day

290

Streptomycin: Dose

children - 20-40 mkday IM adults - 15 mkday IM *max. 1 g/day

291

Aminoglycosides: Mechanism of Action

bactericidal inhibits protein synthesis

292

Aminoglycosides: Adverse Reactions

nephrotoxicity, electrolyte disorders, CN VIII damage (ototoxicity), neuromuscular blockade

293

Second-Line Anti-TB Drugs: bactericidal inhibits protein synthesis

Aminoglycosides Polypeptides

294

Second-Line Anti-TB Drugs: nephrotoxicity, electrolyte disorders, CN VIII damage (ototoxicity), neuromuscular blockade

Aminoglycosides

295

Aminoglycosides are contraindicated in _____.

pregnancy

296

Aminoglycosides need dose adjustment in _____.

renal insufficiency

297

Capreomycin: Dose

children - 15-30 mkday IM adults - 15 mkday IM *max. 1g

298

Capreomycin: Mechanism of Action

bactericidal inhibits protein synthesis

299

Capreomycin: Adverse Reactions

personality changes, psychosis, depression, seizures

300

Second-Line Anti-TB Drugs: personality changes, psychosis, depression, seizures

Capreomycin

301

Ofloxacin: Dose

≤ 5 y.o. - 15-20 mkday PO BID > 5 y.o. - 10-15 mkday PO OD adults - 10-15 mkday PO OD

302

Levofloxacin: Dose

children - 7.5-10 mkday PO adults - 10-15 mkday PO *max. 740 mg/day

303

Moxifloxacin: Dose

children - 7.5-10 mkday PO adults - 10-15 mkday PO *max. 400 mg/day

304

Fluoroquinolones: Mechanism of Action

bactericidal inhibits DNA gyrase

305

Fluoroquinolones: Adverse Reactions

nausea, bloating, headache, dizziness, insomnia, tremulousness, tendon rupture, arthralgia, QTc prolongation, hypoglycemia

306

Second-Line Anti-TB Drugs: bactericidal inhibits DNA gyrase

Fluoroquinolones

307

Second-Line Anti-TB Drugs: nausea, bloating, headache, dizziness, insomnia, tremulousness, tendon rupture, arthralgia, QTc prolongation, hypoglycemia

Fluoroquinolones

308

Fluoroquinolones are avoided during _____ due to concerns for arthropathy.

pregnancy < 18 y.o.

309

Fluoroquinolones need dose adjustment in _____.

renal insufficiency

310

Later-generation quinolones such as _____ are recommended instead of Ofloxacin since they are more potent.

Levofloxacin Moxifloxacin

311

Children _____ metabolize Levofloxacin faster.

< 5 y.o.

312

Prothionamide: Dose

children - 15-20 mkday BID or TID adults 15-20 mkday OD or BID (500 or 750 mg/day) *max. 1 g/day

313

Prothionamide: Mechanism of Action

weakly bactericidal blocks mycolic acid synthesis

314

Prothionamide: Adverse Reactions

GI upset, anorexia, metallic taste, hepatotoxicity, endocrine disorders, gynecomastia, hair loss, acne, impotence, menstrual irregularity, reversible hypothyroidism

315

Second-Line Anti-TB Drugs: weakly bactericidal blocks mycolic acid synthesis

Prothionamide

316

Second-Line Anti-TB Drugs: GI upset, anorexia, metallic taste, hepatotoxicity, endocrine disorders, gynecomastia, hair loss, acne, impotence, menstrual irregularity, reversible hypothyroidism

Prothionamide

317

GI symptoms caused by Prothionamide can be minimized by _____.

food bedtime intake

318

_____ is recommended while on Prothionamide.

Vit. B6

319

Ethionamide: Dose

15-20 mkday PO *max. 750 mg/day

320

Ethionamide: Mechanism of Action

bactericidal inhibits cell wall (mycolic acid) synthesis

321

Ethionamide: Adverse Reactions

GI upset, hepatotoxicity, hypothyroidism

322

Second-Line Anti-TB Drugs: bactericidal inhibits cell wall (mycolic acid) synthesis

Ethionamide

323

Second-Line Anti-TB Drugs: GI upset, hepatotoxicity, hypothyroidism

Ethionamide

324

Ethionamide should be given at a _____ initially and if there is no adverse GI events then it can be given OD.

split dose

325

Ethionamide is contraindicated in pregnancy due to its _____.

teratogenicity

326

Cycloserine: Dose

children - 10-20 mkday q12 adults - 10-15 mkday OD or BID (500 or 750 mg/day) *max. 1 g/day

327

Cycloserine: Mechanism of Action

bacteriostatic inhibits cell wall synthesis

328

Cycloserine: Adverse Reactions

CNS toxicity, inability to concentrate, lethargy, personality changes, peripheral neuropathy, skin problems, lichenoid eruptions, SJS

329

Second-Line Anti-TB Drugs: bacteriostatic inhibits cell wall synthesis

Cycloserine

330

Second-Line Anti-TB Drugs: CNS toxicity, inability to concentrate, lethargy, personality changes, peripheral neuropathy, skin problems, lichenoid eruptions, SJS

Cycloserine

331

Cycloserine should be used with caution in patients with pre-existing _____.

mental health issues

332

Cycloserine may be associated with severe _____ adverse reactions.

neuropsychiatric

333

Cycloserine should be avoided in patients with a history of _____.

seizure disorder.

334

_____ is recommended while on Cycloserine.

Vit. B6

335

Para-Aminosalicylic Acid (PAS): Dose

150 mkday PO OD *max. 12 g/day

336

Para-Aminosalicylic Acid (PAS): Mechanism of Action

bacteriostatic inhibits folic acid synthesis inhibits iron metabolism

337

Para-Aminosalicylic Acid (PAS): Adverse Reactions

GI upset, hypothyroidism, hypersensitivity, crystallization in urine

338

Second-Line Anti-TB Drugs: bacteriostatic inhibits folic acid synthesis inhibits iron metabolism

Para-Aminosalicylic Acid (PAS)

339

Second-Line Anti-TB Drugs: GI upset, hypothyroidism, hypersensitivity, crystallization in urine

Para-Aminosalicylic Acid (PAS)

340

Advantages of Fixed-Dose Combination (FDC) Tablets

prescription errors are less likely less tablets to ingest the patient cannot be selective about which drugs to take

341

Fixed-Dose Combination (FDC) Tablets Preparations

H 50 mg + R 75 mg + Z 150 mg H 50 mg + R 75 mg

342

Fixed-Dose Combination (FDC) Tablets: 4-7 kg, Intensive Phase (HRZ)

1

343

Fixed-Dose Combination (FDC) Tablets: 8-11 kg, Intensive Phase (HRZ)

2

344

Fixed-Dose Combination (FDC) Tablets: 12-15 kg, Intensive Phase (HRZ)

3

345

Fixed-Dose Combination (FDC) Tablets: 16-24 kg, Intensive Phase (HRZ)

4

346

Fixed-Dose Combination (FDC) Tablets: 25+ kg, Intensive Phase (HRZ)

adult dose

347

Fixed-Dose Combination (FDC) Tablets: 4-7 kg, Continuation Phase (HR)

1

348

Fixed-Dose Combination (FDC) Tablets: 8-11 kg, Continuation Phase (HR)

2

349

Fixed-Dose Combination (FDC) Tablets: 12-15 kg, Continuation Phase (HR)

3

350

Fixed-Dose Combination (FDC) Tablets: 16-24 kg, Continuation Phase (HR)

4

351

Fixed-Dose Combination (FDC) Tablets: 25+ kg, Continuation Phase (HR)

adult dose

352

_____ should be added in the intensive phase for children with extensive disease or living in settings where the prevalence of HIV or of Isoniazaid resistance is high.

Ethambutol

353

TB Registration Groups: a patient who has never had treatment for TB or who has taken anti-TB drugs for <1 mo.

New

354

TB Registration Groups: a patient previously treated for TB who has been declared cured or completed treatment in their most recent treatment episode, and is presently diagnosed with bacterioloically-confirmed or clinically diagnosed TB

Relapse (Retreatment)

355

TB Registration Groups: a patient who has been previously treated for TB and whose treatment failed at the end of their most recent course

Treatment After Failure (Retreatment)

356

TB Registration Groups: a patient whose sputum smear or culture is (+) at 5 mos. or later during treatment

Treatment After Failure (Retreatment)

357

TB Registration Groups: a clinically diagnosed patient for whom sputum examination cannot be done and who does not show clinical improvement anytime during treatment

Treatment After Failure (Retreatment)

358

TB Registration Groups: a patient who was previously treated for TB but was lost to follow-up for ≥ 2 mos. in their most recent course of treatment, and is currently diagnosed with either bacteriologically-confirmed or clinically-diagnosed TB

Treatment After Lost to Follow-up (TALF) (Retreatment)

359

TB Registration Groups: a patient who has been previously treated for TB but whose outcome after their most recent course of treatment is unknown or undocumented

Previous Treatment Outcome Unknown (PTOU)

360

TB Registration Groups: a patient who does not fit into any of the other groups

Others

361

TB Categories: new PTB or EPTB (except CNS/bones/joints)

Category I

362

TB Categories: new EPTB (CNS/bones/joints)

Category Ia

363

TB Categories: previously treated drug-susceptible PTB or EPTB (except CNS/bones/joints)

Category II

364

TB Categories: previously treated drug-susceptible EPTB (CNS/bones/joints)

Category IIa

365

TB Treatment: Category I

2 HRZE / 4 HR

366

TB Treatment: Category Ia

2 HRZE / 10 HR

367

TB Treatment: Category II

2 HRZES / 1 HRZE / 5 HRE

368

TB Treatment: Category IIa

2 HRZES / 1 HRZE / 9 HRE

369

TB prophylaxis is recommended for _____.

children < 5 y.o. HIV (+) immunosuppressed individuals

370

Isoniazid Preventive Therapy (IPT) Dose

10 mkday

371

_____ is a case of TB, usually PTB, excreting bacilli which are resistant to one or more anti-TB drugs.

Drug-Resistant TB

372

_____ is the bacterial resistance present in patients who have not received prior treatment with anti-TB drugs.

Primary Resistance

373

_____ is the bacterial resistance in patients with some record of previous treatment.

Secondary Resistance

374

_____ is defined as clinical evidence of TB together with the detection of MTB from a specimen collected from the subject with genotypic or phenotypic resistance to at least Rifampicin.

Confirmed MDR-TB

375

_____ is defined as clinical evidence of TB and with positive clinical response to MDR-TB treatment or with immunological evidence of TB and documented exposure to a source case of MDR-TB.

Probable MDR-TB

376

TB is said to be cured when _____.

treatment is completed as recommended by the national policy without evidence of failure and ≥ 3 consecutive cultures taken at least 30 days apart are (-) after the intensive phase

377

The outcome when TB treatment is completed as recommended by the national policy without evidence of failure but no record that ≥ 3 consecutive cultures taken at least 30 days apart are (-) after the intensive phase is _____.

Treatment Completed

378

Risk Factors for Drug Resistance

failure to adhere to the appropriate regimen previous inappropriate treatment contact with DRTB host immigration from an area withhigh incidence of DRTB HIV (+)

379

Treatment Strategies for DRTB

Standardized Empirical Individualized

380

Treatment Strategies for DRTB: drug resistance and susceptibility (DRS) data from representative patient populations are used to base regimen design in the absence of individual drug susceptibility testing, and all patients in a defined group or category receive the same regimen

Standardized

381

Treatment Strategies for DRTB: each regimen is individually designed based in the patient's previous history of anti-TB treatment and with consideration of drug resistance and susceptibility (DRS) data from the representative patient population

Empirical

382

Treatment Strategies for DRTB: each regimen is individually designed based in the patient's previous history of anti-TB treatment and individual drug susceptibility testing results

Individualized

383

TB Treatment: focuses on sputum culture conversion

Intensive Phase

384

TB Treatment: focuses on ensuring sterilization

Continuation Phase

385

Anti-TB Drug Groups: Group 1

First-Line Oral Agents (HRZE)

386

Anti-TB Drug Groups: Group 2

Injectable Agents (Kanamycin, Amikacin, Capreomycin, Streptomycin)

387

Anti-TB Drug Groups: Group 3

Fluoroquinolones (Moxifloxacin, Levofloxacin, Ofloxacin)

388

Anti-TB Drug Groups: Group 4

Oral Bacteriostatic Second-Line Agents (Ethionamide, Prothionamide, Cycloserine, Terizidone, PAS)

389

Anti-TB Drug Groups: Group 5

Agents with Unclear Efficacy (Clofazimine, Linezolid, Amoxicillin-Clavulanic Acid, Thioacetazone, Imipenem, Cilastatin, Clarithromycin, High Dose Isoniazid - 16-20 mkday)

390

XDR-TB Treatment

use any Group 1 agents use an injectable agent to which the strain is susceptible and consider an extended duration of use if resistant to all injectable agents, use one which has not yet been given use later-generation fluoroquinolones use all Group 4 agents that have not been used extensively in a previous regimen use ≥ 2 agents from Group 5 consider low dose H treatment if with low-level resistance adjuvant surgery for local disease strong infection control measures treat HIV comprehensive monitoring and full adherence support

391

BCG Vaccine Storage

lyophilized powder (heat and light sensitive) refrigerated (2-8°C)

392

Once reconstituted, BCG must be refrigerated and used within _____.

2-3 hours

393

Contraindications for BCG

HIV (+) Immunosuppression

394

_____ are intended to be used on newborns and young infants to replace or amplify BCG early in life and on older children who have not yet been exposed or infected.

Pre-Exposure TB Vaccines

395

_____ are given post-infancy and to older age groups to reduce progression of latent TB.

Post-Exposure TB Vaccines

396

_____ are given to those with active TB in conjunction with anti-TB treatment to shorten the duration of drug therapy or reduce relapses after completion of treatment

Therapeutic Vaccines

397

 

Algorithm for Preventive Therapy of Childhood Tuberculosis

 

A image thumb
398

Diagnostic Algorithm for TB

A image thumb
399

Screening of Pediatric Drug-Susceptible Household Contacts of TB

A image thumb