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Infectious Disease In The Community And Hospital Setting > Tuberculosis > Flashcards

Tuberculosis Flashcards

(68 cards)

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1
Q

What is the function of the encasing waxy coat of TB?

A

Protects bacteria from antibiotics

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2
Q

Current TB treatment

A

Isoniazid
Pyrazinamide
Ethambutol
Rifampicin

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3
Q

How many people have died of TB so far?

A

100,000,000

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4
Q

Old treatment for TB prior to abx

A

People sent to sanitoriums
Sunshine, rest and good food
Lessons outside
Light therapy on spinal TB

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5
Q

What year was TB declared a global health emergency?

A

1993

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6
Q

How many people are infected with TB worldwide?

A

2 billion

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7
Q

How many new cases of TB are there a year?

A

9 million

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8
Q

How many people die of TB a year?

A

1.7 million

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9
Q

What is the cut off for a county to be consider high risk for TB

A

Incidence of 40/100 000

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10
Q

How is TB transmitted?

A

Airborne organism - smear +ve TB
Regular contact = 8 hours cumulative contact over 3 months
Immunosuppressed or co-morbidities

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11
Q

What are the key factors affecting transmission of TB?

A

Infectiousness of person = 4 + AAFB and productive cough
Environment of exposure = park/small enclose space
Duration of exposure = 8 hours
Virulence of organism
Susceptibility of the contact

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12
Q

Related factors of TB

A 
Poor housing 
Over crowding 
Poor nutritional status
Lowered immunity 
Alcohol/HIV +ve/ drug abusers 
Age young and old 
Ethnic background
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13
Q

What does the process of ‘primary complex’ involve?

A

Droplets inhaled, lodge in alveoli > ghon focus develops > bacteria transported to lymph nodes > 6/10 weeks = calcification/scarring of granulomas (prevents further spread of infection)

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14
Q

What is miliary TB ?

A

Primary infection not controlled
Bacteria spread beyond primary complex via lymphatic system and blood stream
Lodge in any or many organs

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15
Q

What are the two eventualities of miliary spread?

A

Resolves spontaneously

Develop into localised infections in about 10% people - meningitis, osteomyelitis.

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16
Q

How many people infected, actually develop primary TB disease?

A

5%

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17
Q

How many people infected develop post primary disease or reactivation ?

A

10-15%

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18
Q

Pathogenesis of post primary disease/TB reactivation

A

Disease emerges if immunity wanes or later in life;
Viable bacilli multiply and cause immune system to become overwhelmed. (Non-Effective t-cell function) >
Lymphocytes produce cytotoxic substances causing caseation >
Cavity formation

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19
Q

Define infectious TB

A

Pulmonary TB , smear positive

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20
Q

Define non-infectious TB

A

Any site (including pulmonary) diagnosed by culture result (smear negative)

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21
Q

What is environmental TB?

A

Non tuberculosis mycobacterium

Not public health risk as confined to the patient and can’t be transmitted.

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22
Q

Who is affected by environmental TB?

A

Patients with pre-existing lung disease e.g. Cystic fibrosis

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23
Q

How do you treat environmental TB?

A

Longer treatment period

1 yr 18 months as bacteria already resistant to some drugs

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24
Q

What is empirical TB?

A

Patient with all clinical signs of TB but it’d never cultured. Improve on TB treatment

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25
Why and to who would would TB chemoprophylaxis be given to?
People infected with TB but no signs of disease i.e. Latent TB Young children > 35 years HCWs any age showing signs of latent TB
26
Signs and symptoms of TB
``` Persistent cough 3/52 or 2-3/12 Poor appetite Weight loss (cytokine mediated) Chest pain (if pulmonary) Enlarged glands (particularly children and young Asians) Night sweats (cytokine mediated) ```
27
Investigations performed by GP
Sputum x 3 early morning ruined for c&s and AAFB chest x-Ray Refer to TB Team or chest clinic
28
Hospital investigations for TB
``` Tuberculin skin testing Bronchial washings Biopsy Early morning urine Interferon gamma release test (IGRA) CT scan ```
29
What is tuberculin skin or Mantoux testing
Checks for TB immunity | Doesn't differentiate between BCG and TB disease immunity
30
When are bronchial washings used?
If patient not producing sputum
31
What are the requirements for urine testing for TB?
1st urination x 3 | Culture and sensitivity
32
What does the IGRA test do?
Determines immunity by measuring the gamma interferon response to specific antigens Differentiates between TB and BCG immunity as measures the amount of IFN gamma produced by cells met with mtb antigen.
33
What are the treatment aims for TB?
Reduce transmission Cure (minimum interference/shortest time/quality of life) Prevent death - rare in the uk due to late presentation, dx missed Avoid relapse Prevent emergence of drug resistance
34
What is the cure rate for TB
97-98%
35
What is secondary drug resistance
If abx taken intermittently and not for the right amount of time - drug resistance can occur
36
What is primary drug resistance
If DRTB is caught from someone who has had previous treatment
37
What is the treatment regimen for TB?
6 months minimum, site dependant At least 3 abx for 2 months, then 2 abx for 4 months. In practice start on 4 abx whilst waiting for c&s, if orgs res patient still on adequate treatment. Pyrazinamide, isoniazid, rifampicin, ethambutol (2 months) then isoniazid and rif for four. Used in combination to prevent resistance acquiring.
38
Treatment for meningeal TB.
Quadruple therapy for 2 months, isoniazid and rif for remainder of treatment initially 12 months. Add glucorticoid equivalent to prednisiolone 20-40mg if on rif; or 10-20mg adults or 1-2mg/kg max 40mg children. Gradual withdrawal of steroids within 2-3 weeks of starting treatment.
39
What is MDRTB?
Multi drug resistant TB. | Resistant to isoniazid and Rifampicin at outset of treatment.
40
What is XDRTB?
Extensively drug resistant TB Resistant to isoniazid and Rifampicin plus any fluoroquinolone plus at least one of the 3 Injectable 2nd line TB drugs (Capreomycin, kanamycin or Amikacin)
41
What is TDRTB?
Totally drug resistant TB. resistant to all 14 known TB drugs. Reported in media and India.
42
MDRTB drug treatment ?
At least 5 drugs, one injectable
43
XDRTB treatment?
At least 6/7 drugs. First line TB meds injectable. Different abx groups Requires extensive sensitivity and susceptibility testing
44
When should patients with TB/suspected TB b admitted to hospital?
Only if clear clinical or socioeconomic need. | If ill or need clinical support or have issues which make them unable/unreliable to take medications
45
How should a patient be dealt with in hospital with suspected pulmonary TB?
Isolate in appropriately engineered (airflow/neg pressure) and ventilated room. If no appropriate room - isolate in side cubicle. Remain in isolation until 3 early morning sputums = smear negative. (After 2 weeks of treatment pts considered non-Inf) Inform TB nurses of suspected case.
46
How should a patient be dealt with in hospital with smear positive pulmonary TB?
Only admit if clear need Isolate for first two weeks of treatment, unless risk of MDRTB (previously treated) Patient should wear a mask whenever they leave their room for the first two weeks of treatment Inform TB nurses of confirmed case.
47
What actions should be taken for someone with smear negative pulmonary TB/other sites in hospital ?
Isolation not necessary | Inform TB nurses of admission
48
Ways in which TB is prevented?
Contact tracing New entrant screening (born in country >40/100000 cases) - poor Vaccination of high risk groups - parent/parent in HR country, new entrants, contacts, HCWs, vet care, travelling to HR countries Chemoprophylaxis for TB contacts Mop up at key stages of development
49
Who is contact traced for a person who is smear negative?
Household contacts only i.e. Shares lounge, bedroom, bathroom or kitchen - family, students, some cultures were women have 7/days a week contact
50
Who is contact traced for a person who is smear positive?
Anyone who has regular contact I.e. 8 hours cumulative over 3 months with contact. Work environment, household, schools teachers and pupils. If people are immunosuppressed then they should be traced if less than 8 hours contact.
51
How is primary school contact tracing performed if someone is smear positive?
Screen whole school and close contacts of adults and children
52
How is contact tracing performed in secondary school if someone is smear positive?
Look at year only of contact -> if high incidence = screen years above and below.
53
What screening tests are carried out as part of contact tracing?
Mantoux, chest x Ray and IGRA testing
54
Screening/treatment process for children aged 4 weeks - 2 years.
Contact with smear +ve TB: -ve mantoux > chemoprophylaxis for 6 weeks Repeat mantoux: -ve > given BCG +ve > assess for disease and either complete chemoprophylaxis or if disease then complete full 6 months of treatment
55
What screening is required if TB diagnosed after a shortfall flight?
No action unless immunosuppressed patients on flight
56
What screening is required if TB diagnosed after long hall flight?
> 8 hours = screen 2 rows either side of case.
57
Percentage transmission of cattle to human TB?
1%
58
What is done to prevent cattle to humanTB transmission?
Pasteurisation of milk Screening cows Badger culling
59
Hospital contact tracing of patient with TB
Inform patients who have shared same bay or close beds | Inform patients GP and consultant
60
Hospital staff member with TB contacting tracing
Same as household screening plus anyone in hospital who has had >8 hours contact or who is vulnerable MDT with HPA, Hhospital ICN,
61
Steps in hospital contact tracing
Liase with ICN - list of people who need to be informed Assess infectivity of case - length of exposure; susceptibility of other patients; proximity of contact (unless sign exp or suscep) Inform patient Record in cases notes Inform GP
62
What is LTBI?
Latent TB INFECTION | Infected with m, tb but no active disease
63
How is TB usually diagnosed?
Found through screening contact or new arrival screening
64
Who is treated for LTBI and what treatments is given??
Individuals under 35 or HCWs of any age | 12 weeks of Rifampicin and isoniazid
65
What is DOTS?
Directly observed therapy | Package of interventions designed to improve management of TB and adherence with treatment
66
When are DOTS instigated?
If unable to complete treatment due to drug/alcohol or abuse, homeless, chaotic lifestyle Or if not being compliant during treatment / there are concerns about compliance
67
What other actions are taken or services are provided to increase TB treatment compliance?
Rehousing Food vouchers Travel to hospital Social issues to help people help themselves
68
How do TB or HC workers self protect?
BCG Awareness if signs and symptoms Personal screening dependant on contact

Infectious Disease In The Community And Hospital Setting (5 decks)

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