-
what is the leading cause of death in hiv pt?
TB
-
who is at high risk for TB
- homeless
- inner city
- long term
- forien
- institutions
- iv drug user
- poverty
- diabetes
- hiv/aids
- immunosup
-
what organism causes TB
- M tuberculosis
- gram+
- acid fast
- bacillus
- AFB
-
factors that contribute to the reemergence of TB
-
how is TB transmitted
- airborne
- droplets can remain suspended for min-hours but replicate slow
-
is TB highly infectious
NO
-
what can trigger reactivation of latent tb infection
host defenses become impaired
-
tb initial s/s
- cough that becomes productive
- fatigue
- anorexia
- unexplained weight loss
- low grade fever
- night sweats
-
tb late s/s
- dyspnea
- emoptysis
- chest wall pain
-
tb usually heals ____
without complications except for scaring
-
-
military TB
- spreads to other organs via blood stream
- can be fatal if untreated
-
pleural tb effusion and empyma
- bacteria in pleural space
- inflammatory reponse
- fluid or pus in pleural space
-
how long does it take for antibody formation to occur after initial exposure
2-12 weeks for + skin test
-
how is tb skin test performed
- -intradermal injection of 0.1 ml PPD antigen
- -ventral surface of the arm
-
how ong to wait to to read skin test
48-72 hours
-
what do you measure on skin test
-
tb skin test positive reaction readings
- 5mm:if high risk person
- 10mm: if moderate risk person
- 15mm: if low risk person
-
what the tb skin test does not do
does not differenciate between active disease and latent tb infection
-
high risk person
moderate rik person
low risk person
- -immunocomp, recent tb contact, lesion on xray
- -immigrant, iv drug user, workers, clinical disease
- - healthy,no risk factors
-
false positive possible cause
- nonTB mycobacterium
- BCG vaccination
-
false negative possible cause
- recent tb infection
- very young <6mo old
- anergy(cant react to skin test because of weak immune system)
-
anergy
(cant react to skin test because of weak immune system)
-
who will have a positive test
- BCG vaccine
- active tb disease
- latent tb infection
-
when would HCP order further testing
- -positive skin test
- -s/s of tb with negative skin test
-
Chest xray for TB
- -cant diagnos because other diseases can mimic tb
- - cxr could be normal even if someone had tb
-
sputum and smear culture for tB diagnosis
-DEFINITIVE DIAGNOSIS OF TB W/ CULTURE
-
sputum and smear culture
How?
- -take sputum swab on 3 consecutive days
- -initially do stained sputum smear for acid -fast bact(AFB)
- -grow sputum culture for m.TB
-
how long could sputum and smear culture take to grow
8 weeks
-
what are the TB blodd tests
-
if the patient is infected with tb, ____ will secrete____
-
why to use tb blood test
- requires 1 visit
- not affected by BCG vaccination
-
tx for active tb initial phase
-regiem
-how long
-meds
-monitor
- -4 med therapy
- -8 weeks
- -isoniazid, rifampin, pyrazimide, ethambutol
- -liver(hepatitis)
-
which stage of TB should you be more aggressive with tx
active
-
continuation phase of tb
-meds
-length
-outcome
- -d/c ethambol, continue other 3
- -18 weeks
- -feel better
-
when is TB pt considered non infectious
when they have a (-) sputum culture X2 consec months or after 2 weeks
-
what is criteria for latent TB
person has been infected with tb but does not have the disease. exposure
-
latent tb
-regime
-med
-length
- -1 med, no MDR
- -INH
- -6-9 months
-
-
prevention of TB
-BCG vaccine(infants)
-
BCG vaccine facts
- -not typically given in USA
- -cause false positive tb skin test
- -does not effect tb blood test IGRA
-
factors that can reactivate TB
- stress
- smoking
- respiratory disease
-
what are the two types of TB infection
primary and latent
-
what is the difference between primary and latent tb and are they the infection or the disease
infection
primary: no s/s, bacteria is encapsulated, immune system fights, (-) skin test
latent: encapsulates but does not destroy, no s/s, lays dormant, (+) skin test
-
is skin test + or - for
primary tb
latent tb
-
what is the biggest difference between tb infection and tb disease
- tb infection= no s/s
- tb disease= s/s
-
what is tb disease
virus has replicated, + skin test, s/s are present
-
what is the order in which the organism enters the body
- 1) inhaled
- 2)inflammatory
- 3) granuloma
- 4)calcification
- 5) replication inhibited
-
what is the hallmark of primary tb infection
formation of granuloma which is the defense mechanism
-
class rank for TB
- 0-5
- 0-no exposure
- 1-exposure no infection(primary)
- 2-LTBI- infection w/o disease, only +skin text
- 3-tb clinically active- disease, s/s, + tests
- 4- tb but not clinically active- hx of previous disease
- 5- tb suspect- s/s, waiting on results
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