thera II test I TB

• 1. tubercle bacillis ingested by macrophages but survive inside
• 2. Inflammation response brings more defensive cells to the area. alveolar walls damaged by cytokines
• 3. Tubercle formed with caseous center
• 4. Tubercle ruptures, bacteria spread to other parts of lungs and other organs

• 1. small amount of live, inactive TB bacteria
• 2. Can't spread
• 3. don't feel sick, but may become sick
• 4. TB skin test shows infection
• 5. radiograph is typically normal
• 6. sputum smear & culture are negative
• 7. should consider Tx to prevent TB disease
• 8. doesn't require respiratory isolation

• 1. large amount of active TB bacteria
• 2. may spread TB bacteria
• 3. may feel sick and have symptoms - cough, fever, weight loss
• 4. TB skin test indicating infection
• 5. radiograph is abnormal
• 6. sputum smear & culture may be positive
• 7. needs Tx for TB disease
• 8. may require respiratory isolation

• 1. fever
• 2. chills
• 3. night sweats
• 4. weight loss
• 5. loss of appetite
• 6. fatigue
• 7. malaise

• 1. Spine - back pain
• 2. Kidneys - blood in urine
• 3. lymph nodes - swelling in the neck

• 1. cough lasting 2 or more weeks
• 2. chest pain
• 3. coughing up blood or sputum

• 1. HIV
• 2. recent contact with infectious TB disease
• 3. chest X-ray suggesting previous TB disease
• 4. organ transplant or immunosuppressed

• 1. come to the US in last 5 yrs from TB area
• 2. IV durg users
• 3. residents and employees of high risk settings
• 4. mycobacteriology laboratory personnel
• 5. conditions that increase risk for progression of TB disease
• 6. children less than 4 years of age
• 7. infants, children and adolescents eposed to adults that are high risk

anyone

• 1. specimen collection
•     three sputum speciments
• 2. AFB smear classification
• 3. NAA testing
• 4. culture and identification
• 5. drug-susceptibilty testing

indicates TB disease - doesn't comfirm diagnosis of TB

doesn't exclude TB disease

• confirms diagnosis of TB
• results in 4-14 days
• culture monthly until you get 2 consecutive negatives

• M.tubersulosis not identified
• doesn't exclude diagnosis of TB disease

• determines which drug can kill the tubercle bacilli
• susceptible - no growth
• resistant - growth

resistance to one of the first line drugs

resistance to isoniazid and rifampin

• resistance to fluoroquinolones and at least one of three injectable drugs
•    amikacin
•    kanamycin
•    capreomycin

• 1. isoniazid INH) daily for 9 months
• 2. isoniazid (INH) and rifapentine (RPT) 12, once weekly doses under direct observation therapy (DOT)
• 3. Rifampin (RIF) daily for 4 months or daily for 6 months

• neuropathy - give vitamin B6 (pyridoxine)
• dark urine

• HoTN
• hepatotoxicity
• pseudo jaundice

• children < 2
• HIV/AIDS on antiretroviral TX
• pregnant women, or expecting to be

• 1. > 3 times upper limit of normal in presence of symptoms
• 2. > 5 times upper limit of normal in asymptomatic patient

• hepatitis
• bleeding problems
• orange discoloration of bodily fluids

• polyarthralgia - painful inflammation and stiffness of the joints
• orange discoloration of bodily fluids

• significant interaction
•    HIV medications
•    methadone
•    oral contraceptives

• used once weekly with INH, in the continuation pahse only for HIV-seronegative patients with non-cavitary
• drug susceptible pulmonary TB who have negative sputum smears at 2 months

• flu-like symptoms
• orange discoloration of bodily fluids
• uveitis - swelling and irritation of the uvea (middle layer of the eye)

• hepatitis
• hyperuricemia

optic neuritis - inflammation of the optic nerve

substitute for RIF if tolerance occurs of taking drugs that have unacceptable interactions with RIF

reduce dose in patients with renal insufficiency

adjust dose or dosing interval when creatinine clearance is <30 ml/min

• INDUCTION PHASE
• 1. RIPE - 7 days/wk for 56 doses - 8wks or           5 days/wk for 40 doses - 8wks
• CONTINUATION PHASE
• 2. INH/RIF - 7days/wk for 126 doses-18wks or 
•                  5 days/wk for 90 doses - 18wks
• 2. INH/RIF 2x/wk for 36 doses - 18wks
• 2. INH/RPT 1x/wk for 18 doses (18wks)

• 1. renal insufficiency/end-stage renal disease
• 2. hepatic disease
• 3. extrapulmonary TB

• 1. if > 14 days, restart treatment
• 2. if < 14 days, continue as long as all doses are completed within 3 months
• 3. recieved > 80% of doses
•     sputum smear negative - may be done
•     sputum smear positive - continue therapy
• 4. received < 80% of doses and lapse is
•    <3months, continue therapy
•    >3months, restart therapy from beginning of initial phase