what are the DDX for tuberculosis?
- Nontuberculosis mycobacterial infection (fatigue, dyspnea, occasional hemoptysis)
- Fungal infection (PNA, modules, cavitation)
- Lung cancer (fever, cough, chest pain, hemoptysis, dyspnea)
- Lymphoma (fevers, night sweats, wt loss)
what patient population are at risk of TB
- close contact
- immigrants from endemic areas
- residents/employees of high risk areas
- medically underserved
- IV drug user
- HIV/AIDS
PPD reading of > or equal to 5mm induration interpretation / pt population
- HIV
- Close contact
- CXR w/fibrotic changes
- Immunosuppression (TNF-a inhibitors)
PPD reading of > or equal to 10 mm induration interpretation / pt population
- person with clinical conditions that INCREASE risk of reactivation: silicosis, DM, chornic renal failure with dialysis, malignancies
- kids <4
- from country of high prevalence
- Residents/employees in high risk settings
PPD reading of > or equal to 15mm induration interpretation / pt population
Healthy individuals >4 with low likelihood of true TB infection
signs and symptoms of active TB
- fever, night sweats, cough >2wks (productive or hemoptysis), weight loss, lymphadenopathy
what is the gold standard for diagnosis of TB?
sputum culture ( take 3 separate morning sputum and culture–Takes 6-8weeks to grow)
what is the initial stain used for TB? confirmatory stain?
Initial stain: Rhodamine-aureamine
Confirmatory: Ziehl-Neelson and/or Kinyun stain
When diagnosing TB, how is interferon gamma release assay useful?
utilized for diagnostic of Latent TB. Indicates there has been a cellular response to TB
what are the four drugs used for TB and list major AE for each
- INH- AE: hepatitis, N/V, peripheral neuropathy (give Vit B6), rash
- Rif (red/organge body fluids, N/V, hepatitis, Steven-Johnson syndrome)
- PZA (Urticaria, hypercuricema/gout, hepatitis, joint aches
- EMB (optic neuritis, color blindness)
