Tuberculosis Epidemiology and Risk Factors Quiz

Being immuno suppressed due to conditions such as HIV, cancer, or steroid use.

Inhaling the organism within aerosol droplets expelled by an individual coughing with active TB.

T cells and macrophages surround the organism to form granulomas.

<p>10% of those infected with TB will develop the active disease known as primary TB.</p> Signup and view all the answers

<p>Common symptoms include dry cough, productive cough with or without hemoptysis, fever, chills, drenching night sweats, anorexia, and weight loss.</p> Signup and view all the answers

<p>Examples include TB meningitis, scrofula (of the neck), TB pleurisy, miliary TB, Pott's disease in the bones and joints, and urogenital TB.</p> Signup and view all the answers

<p>Diagnostic studies include CXR/Chest CT, TB skin test, QuantiFERON GOLD blood test, serial sputum smears and cultures, bronchoscopy, and biopsy.</p> Signup and view all the answers

<p>The definitive diagnosis involves the identification of acid-fast bacilli on sputum gram stain and other specific tests.</p> Signup and view all the answers

<p>Caseating granulomas (necrotizing granulomas)</p> Signup and view all the answers

<p>Purified protein derivative / Mantoux method; Delayed-type hypersensitivity reaction; Positive result indicates exposure history and health status of individual</p> Signup and view all the answers

<p>Requires follow-up, false positive in BCG vaccine recipients, other mycobacterial infections, false negative in anergic or immune suppressed individuals</p> Signup and view all the answers

<p>Measure actual induration, not erythema; ≥ 5 mm for HIV positive, recent immigrants, or contact with person with TB; ≥ 10 mm for organ transplant recipients, immunosuppressed patients, or individuals with fibrotic changes on chest radiographs; ≥ 15 mm for persons with no known risk factors for TB</p> Signup and view all the answers

<p>Hilary paratracheal lymph nodes enlargement, enlargement of lymph nodes of pulmonary hila, cavitation with progressive disease, segmental atelectasis, collapse of one or several segments of a lung lobe</p> Signup and view all the answers

<p>Use of Isoniazid, Rifampin, Ethambutol, and Pyrazinamide for 2 months, followed by continued use of Isoniazid and Rifampin for 4 more months; total duration of 6-9 months</p> Signup and view all the answers

<p>Isoniazid daily for 9 months, Rifampin daily for 4 months, or Isoniazid plus Rifampin for 3 months; Rifampin plus Pyrazinamide daily for 2 months in cases of resistance to Isoniazid</p> Signup and view all the answers

<p>Prevention through reduction of risk factors and BCG vaccination; management includes identification and isolation of active cases, evaluation of risk to household contacts, and appropriate treatment to reduce infectivity</p> Signup and view all the answers

<p>High prevalence in Asians and individuals with HIV</p> Signup and view all the answers

<p>Mycobacterium tuberculosis has high lipid content and is acid-fast on staining. It is inhaled into the lungs and infiltrates areas with increased airflow, leading to symptoms such as cough, fever, and weight loss.</p> Signup and view all the answers

<p>T cells and macrophages surround the organism, forming granulomas.</p> Signup and view all the answers

<p>Dry cough, fever, chills, drenching night sweats, anorexia, weight loss, and signs of chronic illness and malnutrition.</p> Signup and view all the answers

<p>CNS (meningitis), lymphatics (scrofula), pleura (TB pleurisy), disseminated (miliary TB), bones and joints (Pott's disease), and GU (urogenital TB)</p> Signup and view all the answers

<p>CXR/chest CT, TB skin test, QuantiFERON GOLD blood test, serial sputum smears and cultures, bronchoscopy, and biopsy</p> Signup and view all the answers

<p>Primary TB occurs in 5% of exposed people and leads to active TB, while latent TB occurs in 95% of exposed individuals who contain the bacterium without being symptomatic.</p> Signup and view all the answers

<p>Detection of acid-fast bacilli on sputum gram stain and identification of M. tuberculosis</p> Signup and view all the answers

<p>Inhalation of organism within aerosol droplets expelled by individuals coughing with active disease</p> Signup and view all the answers

<p>Risk factors include being immunosuppressed (HIV, cancer, steroids), occupational exposure (health care worker, prison guard), substance abuse (alcohol), diabetes, malnutrition, and poor medical care</p> Signup and view all the answers

<p>Varies based on the site of infection, but may include CNS symptoms, lymphadenopathy, hepatosplenomegaly, hypoxia, and cachexia</p> Signup and view all the answers

<p>Bilateral patchy infiltrates on CXR/chest CT</p> Signup and view all the answers

<p>Primary tuberculosis is characterized by Hilary paratracheal lymph nodes enlargement, enlargement of lymph nodes of pulmonary hila, and cavitation with progressive disease. Reactivation tuberculosis is characterized by right upper lobe cavitation and opacities.</p> Signup and view all the answers

<p>The treatment regimen for multidrug-resistant tuberculosis is based on the specific drug the patient is resistant to. This is because the regimen needs to be tailored to target the specific drug the bacteria is resistant to, in order to effectively treat the infection. It typically involves a combination of second-line drugs such as fluoroquinolones, injectable agents, and other antibiotics based on the individual's drug resistance profile.</p> Signup and view all the answers

<p>The GuantiFERON gold TB test is significant in the diagnosis of tuberculosis, especially in certain populations such as children, adolescents, and immunocompromised individuals, because it helps to avoid false positives that can occur with the Tuberculin Skin Test (TST). This test provides a more accurate and reliable result in these populations.</p> Signup and view all the answers

<p>Individuals who tested negative in the past but are now positive for tuberculosis, with known or unknown exposure, may be considered for prophylactic treatment with isoniazid (INH) for 6-12 months. This is to prevent the progression to active tuberculosis and reduce the risk of developing the disease.</p> Signup and view all the answers

<p>The diagnostic techniques used to detect tuberculosis include sputum cultures, DNA (PCR), RNA amplification techniques, Tuberculin Skin Test (TST), and chest radiographs. Sputum cultures and DNA/RNA amplification techniques provide definitive evidence of infection but may take time to yield results. TST is a simple and cost-effective screening tool but has limitations such as false positives in BCG-vaccinated individuals. Chest radiographs can help visualize the extent of the disease but may not be specific for tuberculosis.</p> Signup and view all the answers

<p>The primary prevention strategies for tuberculosis involve reducing risk factors and BCG vaccination in endemic areas. Secondary prevention includes identifying and isolating active cases, and treating infectivity reduces after 2 weeks of appropriate treatment. These strategies contribute to controlling the spread of the disease by reducing the risk of transmission and providing early intervention for active cases.</p> Signup and view all the answers

<p>The treatment options for latent tuberculosis include isoniazid (INH) daily for 9 months, rifampin daily for 4 months, isoniazid plus rifampin for 3 months, and rifampin plus pyrazinamide daily for 2 months. The rationale behind these options is to effectively eliminate dormant bacteria, prevent the progression to active tuberculosis, and reduce the risk of developing the disease.</p> Signup and view all the answers

<p>The histologic hallmark of tuberculosis is the presence of caseating granulomas (necrotizing granulomas). These granulomas are indicative of the body's immune response to the infection and are a key feature in the histopathological diagnosis of tuberculosis.</p> Signup and view all the answers

<p>The specific considerations for the treatment and management of tuberculosis in immunocompromised individuals include adjusting drug regimens based on immune status, close monitoring for adverse effects, and addressing potential drug interactions. These considerations are important because immunocompromised individuals may have altered immune responses and increased susceptibility to infections, requiring tailored treatment approaches.</p> Signup and view all the answers

<p>The risk factors associated with an increased likelihood of progression to active tuberculosis include HIV infection, recent immigration, exposure to active TB, fibrotic changes on chest radiographs, and high-risk congregate settings. These factors are important in the assessment of individuals at risk because they help identify those who may require targeted screening, prophylactic treatment, or closer monitoring for the development of active disease.</p> Signup and view all the answers

<p>The potential disadvantages of the Tuberculin Skin Test (TST) include the need for follow-up, false positives in BCG-vaccinated individuals, false negatives in anergic or immune-suppressed individuals, and variability in interpretation based on induration size. These limitations impact its use in certain populations such as immunocompromised individuals, where alternative diagnostic tests may be preferred to avoid the potential drawbacks of TST.</p> Signup and view all the answers

<p>The radiographic findings associated with reactivation tuberculosis include right upper lobe cavitation and opacities. These findings are significant in the diagnosis and management of the disease as they help differentiate reactivation tuberculosis from other forms of lung pathology and guide the selection of appropriate treatment regimens.</p> Signup and view all the answers

<p>Risk factors for progression to active tuberculosis include being immunosuppressed (due to HIV, cancer, or steroid use), occupational exposure (such as being a healthcare worker or prison guard), substance abuse (especially alcohol), diabetes, malnutrition, and living in locations with poor medical care. These factors are important in the assessment of individuals at risk because they help identify populations that may require targeted screening and preventive interventions.</p> Signup and view all the answers

<p>Symptoms and signs of tuberculosis include a dry cough that may become productive, hemoptysis (coughing up blood), fever, chills, drenching night sweats, anorexia, weight loss, and physical exam findings such as chronic illness, malnutrition, lymphadenopathy, hepatosplenomegaly, hypoxia, and cachexia.</p> Signup and view all the answers

<p>Mycobacterium tuberculosis has high lipid content and is acid-fast on staining. When inhaled into the lungs, it lands in areas with increased airflow, such as the middle and lower regions. Neutrophils and macrophages infiltrate the area, and the bacteria multiply within macrophages. The bacteria can then move through the lymph system and blood, leading to systemic symptoms and potential dissemination to other organs.</p> Signup and view all the answers

<p>Mycobacterium tuberculosis is transmitted through inhaling organism within aerosol droplets expelled by an individual with active tuberculosis. This can occur through close contact or in crowded, poorly ventilated environments.</p> Signup and view all the answers

<p>Diagnostic studies for tuberculosis include chest X-ray or CT scan, TB skin test, QuantiFERON GOLD blood test, serial sputum smears and cultures, bronchoscopy, and biopsy. The definitive diagnosis is made by identifying acid-fast bacilli on sputum gram stain or through culture.</p> Signup and view all the answers

<p>Extrapulmonary tuberculosis can present with symptoms and signs specific to the involved organ system, such as CNS involvement leading to meningitis, lymphatic involvement leading to scrofula of the neck, pleural involvement leading to TB pleurisy, and disseminated involvement leading to miliary tuberculosis. These presentations can include a variety of symptoms and physical exam findings depending on the affected site.</p> Signup and view all the answers

<p>Primary prevention strategies for tuberculosis include vaccination with the Bacille Calmette-Guérin (BCG) vaccine in countries with high TB prevalence. Secondary prevention strategies include early detection and treatment of active cases, contact tracing, and preventive treatment of latent tuberculosis in high-risk individuals. These strategies contribute to controlling the spread of the disease by reducing the pool of infectious individuals and preventing progression to active disease in those at risk.</p> Signup and view all the answers

<p>The QuantiFERON GOLD TB test is significant in the diagnosis of tuberculosis, especially in certain populations, because it is a blood test that measures the release of interferon-gamma in response to Mycobacterium tuberculosis antigens. It can help differentiate between latent and active tuberculosis and is not affected by prior BCG vaccination, making it useful in populations where BCG vaccination is common.</p> Signup and view all the answers

<p>High-risk populations for tuberculosis in the United States include individuals who are immunosuppressed (e.g., due to HIV infection or immunosuppressive medications), those who have close contact with individuals known to have active tuberculosis, individuals living in congregate settings (e.g., homeless shelters, correctional facilities), and individuals born in or with prolonged residence in areas with high TB prevalence.</p> Signup and view all the answers

<p>Radiographic findings associated with primary tuberculosis include bilateral patchy infiltrates on chest X-ray or CT scan, often involving the middle and lower lung regions. These findings may be accompanied by hilar or mediastinal lymphadenopathy.</p> Signup and view all the answers

<p>The definitive diagnosis for tuberculosis is made by identifying acid-fast bacilli on sputum gram stain or through culture. Additionally, the presence of Mycobacterium tuberculosis DNA or RNA by nucleic acid amplification tests can contribute to the definitive diagnosis.</p> Signup and view all the answers

<p>The radiographic findings associated with primary tuberculosis include Hilary paratracheal lymph nodes enlargement, enlargement of lymph nodes of pulmonary hila, cavitation with progressive disease, larger areas of lung tissue may die, segmental atelectasis, and collapse of one or several segments of a lung lobe. These findings are significant in the diagnosis and management of the disease as they help in identifying the initial stages of tuberculosis and guide the appropriate treatment approach.</p> Signup and view all the answers

<p>The histologic hallmarks of tuberculosis are caseating granulomas (necrotizing granulomas). These are important in the diagnosis of the disease as they provide evidence of mycobacterial infection and aid in confirming the presence of tuberculosis in affected tissues.</p> Signup and view all the answers

<p>The treatment regimen for active tuberculosis involves the use of four drugs initially: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide for 2 months. This is followed by culture and sensitivity testing, and if multi-drug treatment is continued, the use of Isoniazid and Rifampin for an additional 4 months, leading to a total treatment duration of 6-9 months.</p> Signup and view all the answers

<p>For individuals who tested negative in the past but are now positive for tuberculosis, with known or unknown exposure, prophylactic treatment with isoniazid (INH) is recommended for 6-12 months as a preventive measure to reduce the risk of developing active tuberculosis.</p> Signup and view all the answers

<p>High-risk populations for tuberculosis in the United States include recent immigrants, HIV-positive individuals, injection drug users, individuals in high-risk congregate settings (such as hospitals and prisons), individuals with medical conditions that increase the risk of progression to TB (e.g., CKD, malignancies), and children younger than 4 years or those exposed to adults at high risk. These populations are considered at higher risk due to factors such as compromised immunity, close living quarters, and other social determinants of health.</p> Signup and view all the answers

<p>The diagnostic studies used to detect tuberculosis include sputum cultures, DNA (PCR), RNA amplification techniques, Tuberculin Skin Test (TST), and chest radiographs (CXR). Sputum cultures and DNA/RNA amplification techniques offer high specificity but may require follow-up and have limitations in certain populations. The Tuberculin Skin Test has the advantage of detecting delayed-type hypersensitivity reactions but may produce false-positive results in individuals who have received the BCG vaccine or have other mycobacterial infections. Chest radiographs can reveal specific findings associated with tuberculosis, but their interpretation may require additional testing or follow-up.</p> Signup and view all the answers

<p>The prevention strategies for tuberculosis include primary prevention through reducing risk factors and BCG vaccination, and secondary prevention through the identification and isolation of active cases. These strategies contribute to controlling the spread of the disease by addressing both individual and community-level factors that influence the transmission and progression of tuberculosis.</p> Signup and view all the answers

<p>The typical immune response to Mycobacterium tuberculosis infection involves the activation of cell-mediated immunity, characterized by the formation of granulomas and the release of cytokines. This response is significant in the context of tuberculosis diagnosis and management as it influences the interpretation of diagnostic tests, the development of immunological memory, and the efficacy of treatment regimens.</p> Signup and view all the answers

<p>The GuantiFERON gold TB test is significant in the diagnosis of tuberculosis, especially in certain populations, as it offers an alternative to the Tuberculin Skin Test (TST) and can help reduce the likelihood of false-positive results in individuals who have received the BCG vaccine or have other mycobacterial infections. This test is particularly useful in populations where TST may not be reliable or feasible.</p> Signup and view all the answers

<p>The treatment options for latent tuberculosis include Isoniazid daily for 9 months, Rifampin daily for 4 months, Isoniazid plus Rifampin for 3 months, and Rifampin plus Pyrazinamide daily for 2 months (with caution due to the risk of resistance to Isoniazid). The rationale behind each option is to provide effective prophylaxis against the development of active tuberculosis while considering factors such as treatment adherence, drug resistance, and potential adverse effects.</p> Signup and view all the answers

<p>The common extrapulmonary manifestations of tuberculosis include infections in the lymph nodes, bones, genitourinary system, and central nervous system. These manifestations are clinically significant as they may present with atypical symptoms and require specific diagnostic and management approaches to address the diverse impact of tuberculosis on different organ systems.</p> Signup and view all the answers

<p>The size of a positive Tuberculin Skin Test result is determined by the actual induration (not erythema) measured in millimeters. This determination is essential in the assessment of individuals at risk for tuberculosis as it helps differentiate between recent and prior exposure, guides the interpretation of exposure history and health status, and informs the decision-making process for preventive and therapeutic interventions.</p> Signup and view all the answers

<p>Mycobacterium tuberculosis infection is transmitted through inhaling organism within aerosol droplets expelled by individuals coughing with active disease.</p> Signup and view all the answers

<p>Common symptoms and signs associated with tuberculosis include dry cough, productive cough with or without hemoptysis, fever, chills, drenching night sweats, anorexia, weight loss, and various physical examination findings such as chronic illness, malnutrition, lymphadenopathy, hepatosplenomegaly, hypoxia, and cachexia.</p> Signup and view all the answers

<p>Mycobacterium tuberculosis has high lipid content and is acid-fast on staining. When inhaled, the droplet nuclei land in areas of the lung with increased airflow, leading to infiltration of neutrophils and macrophages. The multiplication of acid-fast bacilli occurs in macrophages, and they move through the lymph system and blood. This process is short-lived due to the body's defense mechanisms.</p> Signup and view all the answers

<p>Risk factors for developing tuberculosis include being immunosuppressed (e.g., HIV, cancer, steroid use), occupational exposure (e.g., health care workers, prison guards), substance abuse (e.g., alcohol), diabetes, malnutrition, and living in locations with poor medical care.</p> Signup and view all the answers

<p>Primary tuberculosis occurs when individuals are initially exposed to Mycobacterium tuberculosis and develop active disease. Latent tuberculosis, on the other hand, occurs when individuals contain the bacterium without being symptomatic, and it is not infectious.</p> Signup and view all the answers

<p>Diagnostic studies used to detect tuberculosis include chest X-ray or chest CT to visualize bilateral patchy infiltrates, TB skin test, QuantiFERON GOLD blood test, serial sputum smears and cultures, bronchoscopy, and biopsy. Acid-fast bacilli on sputum gram stain provides a preliminary detection, while identification of M. tuberculosis is the definitive diagnosis.</p> Signup and view all the answers

<p>Common extrapulmonary manifestations of tuberculosis include involvement of the central nervous system (meningitis), lymphatics (scrofula), pleura (TB pleurisy), dissemination (miliary TB), bones and joints of the spine (Pott's disease), and genitourinary system (urogenital TB).</p> Signup and view all the answers

<p>The QuantiFERON GOLD TB test is a blood test used to detect tuberculosis infection. It is significant in the diagnosis, especially in populations where the TB skin test may be less reliable, such as individuals who have received the Bacille Calmette-Guérin (BCG) vaccine or those with a history of previous positive skin tests.</p> Signup and view all the answers

<p>Prophylactic treatment with isoniazid may be considered for individuals who have tested negative in the past but are now positive for tuberculosis, especially if they have known or unknown exposure. The duration and regimen of treatment should be determined based on individual risk factors and the likelihood of progression to active disease.</p> Signup and view all the answers

<p>The typical immune response to Mycobacterium tuberculosis infection involves T cells and macrophages surrounding the organism to form granulomas. In latent tuberculosis, 95% of individuals contain the bacterium without being symptomatic, as they are not infectious and cannot spread the disease.</p> Signup and view all the answers

<p>Prevention and management considerations for multidrug-resistant tuberculosis include using combination drug regimens tailored to the specific drug resistance profile of the patient, closely monitoring treatment response, and ensuring adherence to the full duration of treatment to prevent further drug resistance.</p> Signup and view all the answers

<p>The definitive diagnosis for tuberculosis involves the identification of M. tuberculosis, typically achieved through various diagnostic studies such as acid-fast bacilli on sputum gram stain and other confirmatory tests.</p> Signup and view all the answers

<p>The histologic hallmark of tuberculosis is the presence of caseating granulomas (necrotizing granulomas). These granulomas are significant in the diagnosis of tuberculosis because they indicate a specific immune response to Mycobacterium tuberculosis infection.</p> Signup and view all the answers

<p>Primary tuberculosis is associated with radiographic findings such as hilary paratracheal lymph node enlargement, enlargement of lymph nodes of pulmonary hila, and cavitation with progressive disease resulting in larger areas of lung tissue may die.</p> Signup and view all the answers

<p>Reactivation tuberculosis is associated with radiographic findings such as right upper lobe (RUL) cavitation and opacities. These findings are significant in the diagnosis and management of the disease because they help differentiate reactivation tuberculosis from primary tuberculosis and guide appropriate treatment.</p> Signup and view all the answers

<p>The treatment regimen for active tuberculosis involves a combination of four drugs: Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. These four drugs are used for 2 months, followed by culture and sensitivity testing, and then continued for an additional 4 months. The total duration of treatment is 6-9 months.</p> Signup and view all the answers

<p>The treatment regimen for latent tuberculosis involves various drug combinations and durations. One option is to use Isoniazid daily for 9 months, which helps prevent the reactivation of latent tuberculosis. Another option is to use Rifampin daily for 4 months, which also aims to prevent reactivation of the disease. Additionally, a combination of Isoniazid and Rifampin for 3 months or Rifampin and Pyrazinamide for 2 months can be used to prevent the development of active tuberculosis.</p> Signup and view all the answers

<p>The diagnostic techniques for detecting tuberculosis include sputum cultures, DNA (PCR), RNA amplification techniques, and Tuberculin Skin Test (TST). Sputum cultures and DNA/RNA amplification techniques provide specific identification of Mycobacterium tuberculosis, but they may require specialized equipment and expertise. The Tuberculin Skin Test, while widely available, has limitations such as false positives in individuals who have received the BCG vaccine or have other mycobacterial infections, and false negatives in immune-suppressed individuals.</p> Signup and view all the answers

<p>The prevention strategies for tuberculosis include primary prevention through reducing risk factors and BCG vaccination, and secondary prevention through identifying and isolating active cases. These strategies contribute to controlling the spread of the disease by reducing the likelihood of transmission and preventing the progression of latent tuberculosis to active disease.</p> Signup and view all the answers

<p>Risk factors for an increased likelihood of progression to active tuberculosis include conditions such as HIV infection, organ transplants, immunosuppression, and exposure to high-risk congregate settings. These factors are important in the assessment of individuals at risk because they help identify those who may benefit from targeted screening and preventive treatment.</p> Signup and view all the answers

<p>The QuantiFERON GOLD TB test is significant in the diagnosis of tuberculosis, especially in populations such as children, adolescents, and immunocompromised individuals, because it provides an alternative to the Tuberculin Skin Test and can help avoid false positive results associated with BCG vaccination.</p> Signup and view all the answers

<p>Prophylactic treatment with isoniazid (INH) for 6-12 months is considered for individuals who tested negative in the past but are now positive for tuberculosis, especially those with known or unknown exposure. This treatment aims to prevent the development of active tuberculosis in these individuals.</p> Signup and view all the answers

<p>Mycobacterium tuberculosis infection is primarily transmitted through the inhalation of airborne droplets containing the bacteria, which are released when an infected individual coughs, sneezes, or speaks.</p> Signup and view all the answers

<p>Common symptoms of tuberculosis include persistent cough, weight loss, fever, and night sweats. In advanced cases, hemoptysis (coughing up blood) may also occur.</p> Signup and view all the answers