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Questions and Answers
Which type of tuberculosis testing facility is listed the most within the document?
Which type of tuberculosis testing facility is listed the most within the document?
How many facilities are listed under TCM MTB Rif at RSUD Bangli?
How many facilities are listed under TCM MTB Rif at RSUD Bangli?
Which of the following facilities is associated with TCM XDR?
Which of the following facilities is associated with TCM XDR?
Which region has the highest number of TCM MTB Rif facilities mentioned?
Which region has the highest number of TCM MTB Rif facilities mentioned?
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What is the total number of TCM MTB Rif facilities listed in the content?
What is the total number of TCM MTB Rif facilities listed in the content?
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Which PKM location has only one TCM MTB Rif facility listed?
Which PKM location has only one TCM MTB Rif facility listed?
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Which RSUD has two TCM MTB Rif facilities associated with it?
Which RSUD has two TCM MTB Rif facilities associated with it?
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Which facility has the notation 'Biakan' associated with it?
Which facility has the notation 'Biakan' associated with it?
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What does TCM stand for in the context of tuberculosis testing facilities?
What does TCM stand for in the context of tuberculosis testing facilities?
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What characteristic describes the morphology of Mycobacterium tuberculosis?
What characteristic describes the morphology of Mycobacterium tuberculosis?
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Which of the following is a transmission factor for tuberculosis?
Which of the following is a transmission factor for tuberculosis?
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Which population has the highest risk of developing active tuberculosis after infection?
Which population has the highest risk of developing active tuberculosis after infection?
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What is the growth rate of Mycobacterium tuberculosis?
What is the growth rate of Mycobacterium tuberculosis?
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Which of the following is NOT a factor that influences tuberculosis transmission?
Which of the following is NOT a factor that influences tuberculosis transmission?
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What is the duration that aerosolized Mycobacterium tuberculosis can survive in the air?
What is the duration that aerosolized Mycobacterium tuberculosis can survive in the air?
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What type of bacteria is Mycobacterium tuberculosis classified as?
What type of bacteria is Mycobacterium tuberculosis classified as?
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Which one of these conditions significantly increases the risk of tuberculosis activation in an infection?
Which one of these conditions significantly increases the risk of tuberculosis activation in an infection?
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Mycobacterium tuberculosis is described as which type of bacteria regarding staining?
Mycobacterium tuberculosis is described as which type of bacteria regarding staining?
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What is the percentage of individuals with normal immunity who may develop active tuberculosis after initial infection?
What is the percentage of individuals with normal immunity who may develop active tuberculosis after initial infection?
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What defines a multidrug-resistant (MDR) strain of M.Tb?
What defines a multidrug-resistant (MDR) strain of M.Tb?
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Which of the following is NOT a classification of drug-resistant tuberculosis?
Which of the following is NOT a classification of drug-resistant tuberculosis?
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What type of regimen is recommended for the treatment of tuberculosis according to the 2007 guidelines?
What type of regimen is recommended for the treatment of tuberculosis according to the 2007 guidelines?
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Which of the following describes a treatment package specifically designed for pediatric patients?
Which of the following describes a treatment package specifically designed for pediatric patients?
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What is the primary purpose of the DOT strategy in TB treatment?
What is the primary purpose of the DOT strategy in TB treatment?
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Which is considered a first-line anti-tuberculosis drug?
Which is considered a first-line anti-tuberculosis drug?
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What is the significance of classifying TB based on HIV status?
What is the significance of classifying TB based on HIV status?
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In the context of TB classification, what does 'RR' signify?
In the context of TB classification, what does 'RR' signify?
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According to the 2016 guidelines, what is the drug combination for Category 1 treatment?
According to the 2016 guidelines, what is the drug combination for Category 1 treatment?
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What is the rationale behind using intermittent dosing for TB medication?
What is the rationale behind using intermittent dosing for TB medication?
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What is the primary purpose of using Isoniazid in tuberculosis treatment?
What is the primary purpose of using Isoniazid in tuberculosis treatment?
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Which treatment regimen is indicated for tuberculosis with minimal or no lesions?
Which treatment regimen is indicated for tuberculosis with minimal or no lesions?
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Which drug combination is included in the 4FDC regimen for tuberculosis treatment?
Which drug combination is included in the 4FDC regimen for tuberculosis treatment?
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What is the duration of the 2FDC(RH) treatment protocol mentioned?
What is the duration of the 2FDC(RH) treatment protocol mentioned?
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Which of the following is NOT a requirement for the effectiveness of first-line tuberculosis treatment?
Which of the following is NOT a requirement for the effectiveness of first-line tuberculosis treatment?
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What is indicated by the use of the term 'Raise and Fall' in relation to tuberculosis treatment?
What is indicated by the use of the term 'Raise and Fall' in relation to tuberculosis treatment?
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What is the recommended regimen for newly diagnosed pulmonary TB patients?
What is the recommended regimen for newly diagnosed pulmonary TB patients?
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In the treatment of TB with rifampicin sensitivity, what is the treatment category for patients with a history of treatment failure or lost follow-up?
In the treatment of TB with rifampicin sensitivity, what is the treatment category for patients with a history of treatment failure or lost follow-up?
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What is the recommended approach for TB patients co-infected with HIV?
What is the recommended approach for TB patients co-infected with HIV?
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How is the administration of TB medication recommended to ensure compliance?
How is the administration of TB medication recommended to ensure compliance?
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What is the optimal dosing recommendation for new pulmonary TB patients?
What is the optimal dosing recommendation for new pulmonary TB patients?
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Which of the following treatments for TB meningitis is recommended?
Which of the following treatments for TB meningitis is recommended?
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What is the recommended regimen for children aged 3 months to 16 years with suspected non-severe MDR/RR-TB?
What is the recommended regimen for children aged 3 months to 16 years with suspected non-severe MDR/RR-TB?
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According to the guidelines, how often should the treatment be observed during the initial phase of TB treatment?
According to the guidelines, how often should the treatment be observed during the initial phase of TB treatment?
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What is indicated regarding the extension of the intensive phase in TB treatment?
What is indicated regarding the extension of the intensive phase in TB treatment?
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Which of the following is not recommended for OAT provision for TB patients?
Which of the following is not recommended for OAT provision for TB patients?
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Study Notes
Tuberculosis Overview
- Tuberculosis (TB) is a disease caused by an infection with Mycobacterium tuberculosis complex (MTBC).
- MTBC species commonly infecting humans are M.tuberculosis, M.africanum (common in Africa), and M.avium (frequently found in HIV patients).
- M. tuberculosis is shaped like a rod with lengths ranging from 2-4 μm and widths from 0.2-0.5 μm.
- M. tuberculosis is an obligate aerobe requiring an oxygen-abundant environment like the apex of the lung.
- It is a facultative intracellular bacterium frequently residing within macrophages, exhibiting a slow growth rate of 15-20 hours.
- M. tuberculosis is an Acid-Fast Bacillus (AFB) meaning it can retain carbol fuchsin or fluorochromes during staining and is not readily decolorized by acid-alcohol solutions.
Transmission of Tuberculosis
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Three factors influence TB transmission:
- The number of bacilli released into the air by coughing, sneezing, or speaking.
- The dose of bacilli required for infection.
- The concentration of bacilli in the air, determined by room volume and ventilation.
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Droplet nuclei (small particles 1-5 μm in diameter) carrying 1-5 bacilli are released when infected individuals cough or sneeze.
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These nuclei can remain suspended in the air for up to 4 hours.
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Coughing releases approximately 3,000 droplet nuclei, while sneezing releases around 1 million.
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An infected individual with a normal immune system has a 10% chance of developing active TB.
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50% of active TB cases develop shortly after infection (within two years).
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Children and elderly individuals experience a higher risk of developing active TB after infection.
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Individuals with HIV infection have a higher risk (50-60%) of developing active TB after exposure.
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Other risk factors include silicosis, diabetes mellitus (DM), long-term steroid use, and long-term immunosuppressants.
Classification of Tuberculosis Cases
Anatomical Location
- TB can be classified based on its location:
- Pulmonary TB: Infection affecting the lungs.
- Extrapulmonary TB: Infection affecting other parts of the body, such as the lymph nodes, bones, or kidneys.
Treatment History
- TB cases can be classified based on prior treatment history:
- New Case: No prior TB treatment.
- Relapse: TB recurrence after successful treatment.
- Failure: Failure to achieve treatment success despite completing a full course of treatment.
- Loss to Follow-up (LTFU): Patient stopped treatment before completion.
Drug Susceptibility
- TB cases can be classified based on drug susceptibility testing results:
- Drug-Susceptible TB: Bacteria are sensitive to standard first-line TB drugs.
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Drug-Resistant TB: Bacteria are resistant to one or more TB drugs.
- Monoresistant TB: Resistance to a single first-line TB medication
- Polyresistant TB: Resistance to more than one first-line TB medication, excluding Rifampicin (R) and Isoniazid (H)
- Multidrug-resistant TB (MDR-TB): Resistance to Rifampicin (R) and Isoniazid (H), with or without further resistance to other first-line medications.
- Pre-extensively Drug-Resistant TB (Pre-XDR TB): Resistance to fluoroquinolones (a class of antibiotics)
- Extensively Drug-Resistant TB (XDR TB): Resistance to fluoroquinolones and at least one drug from the injectable group
- Rifampicin Resistant TB (RR-TB): Resistance to Rifampicin (R) with or without resistance to other medications
HIV Status
- TB cases can be classified based on their HIV status:
- TB-HIV: TB infection in a patient with HIV infection.
- TB-HIV negative: TB infection in a patient without HIV infection.
Diagnosis of Tuberculosis
- The diagnosis is determined by combining information from the following:
- Anatomical location of TB
- Bacteriological or clinical confirmation of TB
- Treatment history
- HIV status
Treatment of Drug-Susceptible Tuberculosis (SO TB)
2007 Treatment Guidelines
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Treatment for SO TB is divided into two stages:
- Intensive phase: 2 months with HRZE (H: Isoniazid, R: Rifampicin, Z: Pyrazinamide, E: Ethambutol) or 4 months with HR (H: Isoniazid, R: Rifampicin).
- Continuation phase: 4 months with HR (H: Isoniazid, R: Rifampicin) or 5 months with HRZE (H: Isoniazid, R: Rifampicin, Z: Pyrazinamide, E: Ethambutol).
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Category 1: 2(HRZE)/4(HR)3 or 2(HRZE)/4(HR)
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Category 2: 2(HRZE)S/(HRZE)/5(HR)3E3
2016 Treatment Guidelines
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Category 1: 2(HRZE)/4(HR)3 regimens or 2(HRZE)/4(HR).
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Category 2: 2(HRZE)S/(HRZE)/5(HR)3E3 or 2(HRZE)S/(HRZE)/5(HR)E.
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Category for children: 2(HRZ)/4(HR) or 2HRZE(S)/4-10HR.
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SO TB regimens are administered daily or intermittently (3 times per week).
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Combination drug therapy (CDT) is provided in the form of "KDT" packets.
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KDT: Isoniazid (H), Rifampicin (R), Pyrazinamide (Z), and Ethambutol (E)
2021 Treatment Guidelines
- OAT (Anti-tuberculosis drugs) Category 1 is used for both the initial and continuation phases with daily dosing.
- OAT Category 2 is no longer recommended for treatment of TB cases within the national program.
- Patients with rifampicin-sensitive TB who have previously been treated for TB (relapse, treatment failure, or loss to follow-up) are treated using OAT Category 1 daily.
2022 WHO Guidelines
- New cases of pulmonary TB: Receive a 6-month regimen of 2HRZE/4HR (2 months HRZE, followed by 4 months HR).
- Daily dosing for new TB cases is recommended.
- SO Pulmonary TB patients: Daily dosing is recommended. Intermittent dosing (three times per week) for the continuation phase is discouraged.
- KDT (Combination Drug Therapy) packets are recommended over individual medication.
- Positive sputum smear at the end of the intensive phase: Extension of the intensive phase is discouraged.
- Patients aged 12 years or older with SO Pulmonary TB: Can receive a 2HPMZ/2HPM regimen (H: Isoniazid, P: Pyrazinamide, M: Moxifloxacin, Z: Ethambutol)
- Children aged 3 months to 16 years with non-severe TB: A 4-month 2HRZ(E)/2HR regimen is recommended.
- TB-HIV patients: Receive the same regimens and durations as those without HIV.
- TB-HIV patients: Antiretroviral therapy (ART) should be initiated within 2 weeks of starting TB medication, regardless of CD4 count.
- TB Meningitis: Requires adjunctive corticosteroid therapy (dexamethasone or prednisolone) gradually tapered over 6-8 weeks.
Key Principles of TB Treatment
- Combination therapy: Multiple drugs are used to prevent the emergence of drug-resistant strains.
- Regular dosing: Medication must be taken regularly and directly observed by a Directly Observed Therapy Short-Course (DOTS) provider.
- Appropriate dosage: Dosage should be tailored to patient weight.
- Adequate duration of treatment: Treatment should continue for a sufficient period (usually 6 months) to ensure eradication of the infection.
- Use of Combination Drug Therapy (CDT): CDT is recommended for improved patient adherence and compliance.
Treatment of Rifampicin-Resistant Tuberculosis (RR-TB)
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4FDC (RHZE): 150/75/400/275 (H: Isoniazid, R: Rifampicin, Z: Pyrazinamide, E: Ethambutol)
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2FDC (RH): 150/150 (H: Isoniazid, R: Rifampicin)
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2FDC (RH): 150/75 (H: Isoniazid, R: Rifampicin)
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Short-course regimens (4 months): 2HPMZ/2HPM (H: Isoniazid, P: Pyrazinamide, M: Moxifloxacin, Z: Ethambutol) or 2HRZ(E)/2HR (H: Isoniazid, R: Rifampicin, Z: Pyrazinamide, E: Ethambutol)
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4-month regimens are recommended for TB with minimal or non-severe lesions.
Requirements for Effective TB Chemotherapy
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Bactericidal Action: TB drugs should kill bacteria.
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Early Sterilization: TB drugs should eliminate rapidly growing and persistent bacteria.
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Prevention of Resistance: TB drugs should prevent the emergence of resistant strains.
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Key drugs used in combination therapy:
- Isoniazid (H): Bactericidal against rapidly growing and persistent bacteria; preventative against resistance.
- Rifampicin (R): Bactericidal against rapidly growing bacteria; preventative against resistance.
- Pyrazinamide (Z): Bactericidal against rapidly growing bacteria; preventative against resistance
- Ethambutol (E): Bactericidal against rapidly growing bacteria.
Key Facts
- Phase 1 (Intensive): Initial phase of TB treatment, focuses on eliminating rapidly growing bacteria.
- Phase 2 (Continuation): Continuation phase aims to eliminate persistent bacteria and prevent resistance.
- Directly Observed Therapy Short-Course (DOTS) provider observes patients take medications to ensure adherence.
- FDC (Fixed-Dose Combination): Tablets containing multiple TB drugs in a fixed dose.
- Treatment goals: Cure, prevent relapse, and minimize drug resistance.
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Description
This quiz covers the key aspects of tuberculosis, including its causative agent, Mycobacterium tuberculosis, and the factors influencing its transmission. Test your knowledge on the characteristics of TB and its global impact. Ideal for students studying infectious diseases or public health.
