Tuberculosis

Question 1

who is at higher risk for exposure to infection of TB?

Answer 1

• foreign-born persons from areas where TB is common
• persons who visit TB-prevalent countries
• residents and employees of high-risk congregate settings
• close contacts of person known or suspected to have active TB
• health care workers who serve high risk clients
• populations defined locally as high risk for infection of disease, such as medically underserved, low income persons who abuse drugs or alcohol
• children and adolescents exposed to adults at increased risk of infection or disease

Question 2

who is at higher risk of developing TB disease once infected?

Answer 2

• HIV infected
• recently infected within past 2 years
• infants and children
• persons with diabetes or rheumatologic infections
• persons who inject illicit drugs
• history of inadequately treated TB

Question 3

how is TB transmitted?

Answer 3

spread by droplet nuclei, each droplet is 1 bacillus. Need to be less than 10 microns to infect aleoli. can remain suspended in air for several hours. expelled when person with infectious TB coughs, sneezes, speaks or sings. close contacts at highest risk of becoming infected. transmission occurs from person with infectious TB disease (not latent).

Question 4

Name four things to emphasize during patient education.

Answer 4

• Benefits of treatment
• Importance of adherence to treatment regimen
• Possible adverse side effects
• Establishment of optimal follow up plan

Question 5

Why is the TB treatment beneficial?

Answer 5

Avoid disease progression; avoid spreading it to others, including loved ones

Question 6

Why is important to complete the entire treatment regimen? Why is this difficult/why do you need to emphasize it during patient ed?

Answer 6

• To avoid resistance to the drugs (since we just have 4 “big guns”, don’t want to become resistant to one or contribute to increase in overall resistance)
• Emphasize because the tx does take 9 months, which is a long time

Question 7

How will the treatment be delivered? When giving patient ed, can you just have the patient promise to take the meds?

Answer 7

NO. Educate them that tx will be delivered via DOT (Directly Observed Therapy) for 9 months

Question 8

9. Formulate a treatment plan for a patient with a positive Mantoux test and active pulmonary TB.

Answer 8

Include 4 drugs in initial regimen:

• Isoniazid (INH)
• Rifampin (RIF)
• Pyrazinamide (PZA)
• Ethambutol OR streptomycin

Adjust regimen when drug susceptibility results are known

(per book - all drugs are continued for 2 mo, THEN tailored depending on drug susceptibility and continued for 4 mo with at least two active drugs)