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Infectious Disease > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

Subtypes of tuberculosis

A

Multi-drug resistant TB (MDR-TB) & extensively drug resistant TB (XDR-TB).

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2
Q

Predisposing factors of TB

A
  • Extended periods in TB-endemic areas
  • Close proximity to personnel with active Mycobacterium Tuberculosis (Mtb)
  • Recirculated air
  • Immunocompromise
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3
Q

Transmission of TB

A

Transmission occurs when a contagious patient
coughs, spreading bacilli through the air.

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4
Q

Incubation period of TB

A

3-12 weeks (TST/PPD); Transition from latent to
active can be 10-60 years.

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5
Q

Leading infectious cause of death worldwide.

A

Tuberculosis

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6
Q
  • High-endemic areas, primary infection occurs usually in childhood, but in less-endemic areas can occur in adults.
  • Characterized by local granulomatous inflammation in periphery of the lung (GHON focus) may be accompanied by ipsilateral lymph node involvement (GHON complex).
  • Infection is usually asymptomatic but can present as an acute lower respiratory tract infection.
A

Tuberculosis

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7
Q

Routinely given to children in countries with a high
prevalence of TB to prevent childhood TB, however, not used in the U.S. because of low risk of TB infection.

A

Bacille Calmette-Guerin (BCG)

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8
Q

How does BCG affect TST

A

may cause a false positive reaction to a TB skin
test.

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9
Q

What is the preferred method of testing for people who have received BCG

A

*QuantiFERON® – TB Gold In-Tube test (QFT–GIT); *
SPOT® TB test (T–Spot).

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10
Q

TB Navy Instruction

A

BUMEDINST 6224.8C

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11
Q

LTBI is defined as a positive result on the following labs:

A

(a) Tuberculin skin test (TST)
(b) Purified protein derivative (PPD)
(c) Positive QuantiFERON Gold blood test
(d) Positive IGRA-TB blood test

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12
Q

Labs & Rads Status for LTBI:

A

(1) Positive TST/PPD or blood test
(2) Normal CXR
(3) Negative acid-fast sputum test
(4) Has Mtb bacteria in their body (typically the lungs) that are alive, but inactive.

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13
Q

Initial TB Exposure Risk assessment form

A

NAVMED 6224/7

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14
Q

Evaluation of Positive TB tests

A
  • Chest Radiograph
  • Sputum Examination
  • LFTs
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15
Q

What must the provider r/o prior to dx of LTBI

A

Active TB

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16
Q

Treatment of LTBI

A

(a) Isoniazid & rifapentine (3HP) PO once a week x 12 weeks.
(b) Rifampin (4R) 1 PO QD x 16 weeks (4 months)
(c) Isoniazid & Rifampin (3HR) 1 PO daily x 12wks (3 months).

17
Q

Why are shorter duration regiments for LTBI treatment preferred?

A

Poor compliance with longer treatment regiments

18
Q

How often is the follow up for LTBI treatment?

A
  • Monthly
19
Q

What form is used for LTBI monthly evaluations

A

NAVMED 6224/9

20
Q

Patient education for LTBI

A

(a) Implications of positive IGRA or TST results, benefits/risks of LTBI treatment, and potential signs of an adverse drug effect.
(b) Necessity for strict adherence to treatment in the absence of side effects.

21
Q

Where should successful completion of LTBI treatment be documented

A

Medical record

22
Q

What percentage of TB infections occur in the lungs

A

70-80%

23
Q

What three terms are denoted for Active TB

A
  • Post primary TB
  • Reactivation TB
  • Active TB
24
Q
  • Most common in adults (60%–80%). Can occur years to decades after primary infection after immunological impairment.
  • Frequent symptoms of active disease are fever, anorexia or reduced appetite, weight loss, night sweats, anemia, and persistent cough (>14 days) with purulent and/or bloodstained sputum.
  • Hemoptysis is usually the result of cavitating lung disease causing erosion of pulmonary blood vessels.
  • Patients may complain of localized thoracic pain secondary to accompanying pleural inflammation
A

Post-primary Re-Activation TB

25
Q

Lab/Imaging Findings for Active TB

A
  • IGRA-TB – Measures immune response to TB antigens.
  • Tuberculin Skin Test (TST)
  • Sputum Test - Acid-Fast Bacillus (AFB) with NAAT
  • Gold standard for confirmatory diagnosis; can
    differentiate between LTBI & ATB.
  • CXR
26
Q

Procedures for suspected or confirmed Active TB

A
  • Patients with suspected/known active TB immediately get surgical masks to minimize aerosolization of respiratory secretions and spread.
  • Medical department personnel must wear particulate respirators (N95 minimum) when working in spaces containing a person with known or
    suspected active TB.
  • Immediate isolation from non-infected personnel & other crewmembers, and transfer to an MTF as soon as practicable.
27
Q

When must a MER be submitted for known or suspected cases of active TB

A

24 hours

28
Q

Who should be notified of suspected or active TB

A

cognizant NEPMU

29
Q

Who will conduct/facilitate TB contact investigation with SMDER

A

Cognizant NAVENPVNTMEDU assisted by ISIC/TYCOM

30
Q

TB prevention

A
  • Follow routine testing & screening guidelines in BUMEDINST 6224.8C
  • Exercise extreme caution when dealing with suspected cases or confirmed cases.
  • Crew education in endemic areas and thorough port-briefs.
  • Ensure pre-deployment and post-deployment TST/PPD is conducted.

Infectious Disease (20 decks)

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