TB

Question 1

What is the cornerstone of TB control?

Answer 1

The rapid identification and cure of patients with confirmed pulmonary TB.

This principle is essential for effective management and reduction of TB incidence.

Question 2

What is the primary cause of the increase in TB notifications in Botswana since 1990?

Answer 2

The increasing prevalence of HIV.

HIV significantly impacts TB transmission and progression.

Question 3

What are the three pillars of the WHO ‘End TB Strategy’?

Answer 3

• Integrated patient-centred TB care and prevention
• Bold policies and supportive systems
• Intensified research and innovation

These pillars aim to enhance global TB control efforts.

Question 4

What is the initial diagnostic test for all presumed TB cases?

Answer 4

Xpert MTB/RIF (GeneXpert).

This test provides rapid results for TB diagnosis.

Question 5

What defines a ‘presumed TB case’?

Answer 5

Any person with a cough lasting ≥ 2 weeks.

This definition helps in early identification and management of TB.

Question 6

What samples should be sent for Xpert MTB/RIF?

Answer 6

• Sputum
• CSF
• Pus

These samples are critical for accurate TB diagnosis.

Question 7

What samples should be sent for Culture & DST (C/DST) instead of Xpert?

Answer 7

• Biopsy
• Pleural tissue
• Fine Needle Aspiration (FNA) samples

These samples are used for more detailed analysis of TB.

Question 8

When is the LF-LAM urine test recommended?

Answer 8

For HIV-positive inpatients with signs/symptoms of TB and a CD4 count ≤100, or who are seriously ill regardless of CD4 count.

This test helps in diagnosing TB in immunocompromised patients.

Question 9

What is the standard first-line treatment regimen for Drug-Susceptible TB (DS-TB) in adults?

Answer 9

2HRZE / 4HRE (2 months of Isoniazid, Rifampicin, Pyrazinamide, Ethambutol; 4 months of Isoniazid, Rifampicin, Ethambutol).

This regimen is essential for effective TB treatment.

Question 10

What is the cornerstone of ensuring treatment adherence?

Answer 10

Directly Observed Treatment (DOT).

DOT is crucial for improving treatment outcomes.

Question 11

What is the management for a patient with a positive smear at month 2 of treatment?

Answer 11

Proceed to the continuation phase and repeat smear microscopy at month 3. If still positive, send a sputum sample for C/DST.

This approach helps in monitoring treatment effectiveness.

Question 12

What is the definition of ‘Treatment Failure’?

Answer 12

A patient whose sputum smear or culture is positive at 5 months or later during treatment, or who is found to have DR-TB at any point.

Recognizing treatment failure is critical for timely intervention.

Question 13

Which first-line drug is unsafe in pregnancy?

Answer 13

Streptomycin (S) – can cause hearing loss in the foetus.

This highlights the importance of careful drug selection in pregnant patients.

Question 14

What are the three essential interventions for all TB/HIV co-infected patients?

Answer 14

• Co-trimoxazole Preventive Therapy (CPT)
• Antiretroviral Therapy (ART)
• TB treatment (ATT)

These interventions are vital for managing co-infection effectively.

Question 15

When should ART be started in a TB/HIV patient?

Answer 15

ATT should be started first. ART should be initiated as soon as the patient is tolerating ATT, and within the first 2 weeks.

This timing is crucial for optimizing patient outcomes.

Question 16

What critical drug interaction occurs between Rifampicin and Dolutegravir (DTG)?

Answer 16

Rifampicin decreases DTG levels. The dose of DTG must be doubled to 50mg twice daily while on Rifampicin.

Awareness of drug interactions is essential for effective treatment.

Question 17

What is TB-IRIS?

Answer 17

TB-Immune Reconstitution Inflammatory Syndrome; a paradoxical worsening of symptoms after starting ART due to the recovering immune system’s response to TB antigens.

Understanding TB-IRIS is important for managing ART in TB patients.

Question 18

What is the definition of MDR-TB?

Answer 18

Resistance to at least both Isoniazid (H) and Rifampicin (R).

This definition is critical for identifying and managing drug-resistant TB.

Question 19

What is the definition of XDR-TB?

Answer 19

XDR-TB that is also resistant to a fluoroquinolone (e.g., Levofloxacin) and a second-line injectable agent (e.g., Kanamycin).

XDR-TB poses significant treatment challenges.

Question 20

What is the first action for a patient with ‘MTB Detected’ and ‘Rifampicin Resistance Detected’ on Xpert?

Answer 20

Refer the patient immediately to a DR-TB Treatment Centre to start an MDR-TB regimen.

Prompt referral is essential for effective management of drug-resistant TB.

Question 21

What is the total minimum duration of MDR-TB treatment?

Answer 21

The intensive phase is a minimum of 6 months (with an injectable), followed by a continuation phase of at least 18 months after culture conversion (Total: ~24 months).

This duration is critical for ensuring successful treatment outcomes.

Question 22

What are the three levels of the TB-IPC hierarchy?

Answer 22

• Administrative controls (most important)
• Environmental controls
• Personal respiratory protection

These levels are essential for preventing TB transmission.

Question 23

Who should wear an N95 respirator?

Answer 23

Healthcare workers in high-risk situations (e.g., caring for infectious TB patients, performing sputum induction).

Proper protective equipment is crucial for healthcare worker safety.

Question 24

Who should wear a surgical mask?

Answer 24

Infectious TB patients to reduce the expulsion of large droplets.

This practice helps minimize the risk of TB transmission.

Question 25

Where should **sputum collection** ideally take place?

Answer 25

In a designated, well-ventilated outdoor area (a 'cough spot'). ## Footnote This setting reduces the risk of airborne transmission.

Question 26

Who should receive the **BCG vaccine**?

Answer 26

All clinically well children as soon as possible after birth. Contraindicated in known HIV-positive children or children with clinical signs of HIV. ## Footnote BCG vaccination is important for TB prevention in children.

Question 27

What is **Isoniazid Preventive Therapy (IPT)** and who should get it?

Answer 27

A 6-month course of daily Isoniazid to prevent active TB. Given to all children <5 years and all HIV-positive children <12 years who are contacts of a bacteriologically confirmed TB case and who have no evidence of active TB disease. ## Footnote IPT is a key preventive measure for at-risk populations.

Question 28

Is IPT currently recommended for **adults** in Botswana?

Answer 28

No, the adult IPT programme is currently withheld. ## Footnote This decision reflects current public health strategies.

Question 29

What are common **symptoms of TB in children**?

Answer 29

* Cough ≥2 weeks * Fever ≥2 weeks * Weight loss/failure to thrive * Reduced playfulness * Enlarged lymph nodes ## Footnote Recognizing these symptoms is vital for early diagnosis in children.

Question 30

What is the standard **DS-TB regimen** for a child weighing <30 kg?

Answer 30

2HRZE / 4HR ## Footnote This regimen is tailored for pediatric patients.

Question 31

How is **TB meningitis** in children treated?

Answer 31

2HRZE / 10HR (Total 12 months). ## Footnote This treatment protocol is critical for managing severe TB cases in children.

Question 32

What is the purpose of **pharmacovigilance**?

Answer 32

To detect, assess, understand, and prevent adverse effects or any other drug-related problem. ## Footnote Pharmacovigilance is essential for ensuring drug safety.

Question 33

What must be reported to the **Pharmacovigilance Office**?

Answer 33

All serious, unexpected, or unusual adverse drug reactions (ADRs), especially for new drugs. ## Footnote Reporting is crucial for monitoring drug safety.

Question 34

What is the '**Treatment Success**' rate?

Answer 34

The sum of patients who are 'Cured' and those who 'Completed Treatment'. ## Footnote This metric is important for evaluating treatment effectiveness.

Question 35

What is the definitive source for **TB patient data** at the facility level?

Answer 35

The Facility TB Register (MH 2003). ## Footnote Accurate data collection is vital for TB management.

Question 36

What electronic system is used for **national TB data management**?

Answer 36

The Open Medical Record System (Open MRS). ## Footnote This system facilitates efficient data management and reporting.