Tuberculosis Overview Quiz

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Questions and Answers

What is the primary route of transmission for tuberculosis?

Ingestion of contaminated food

Contact with infected surfaces

Airway by inhalation of aerosols (correct)

Blood transfusion from an infected donor

Which of the following best describes primary tuberculosis?

It leads to severe necrosis in the lungs.

It occurs in previously infected individuals.

Symptoms are generally nonspecific. (correct)

It is usually asymptomatic in all cases.

Koch's bacillus is the name given to which bacterium responsible for tuberculosis?

Mycobacterium bovis

Mycobacterium tuberculosis (correct)

Mycobacterium africanum

Mycobacterium leprae

Which of the following is NOT a phase of tuberculosis?

Chronic tuberculosis Signup and view all the answers

What is a significant challenge in treating tuberculosis effectively?

Resistance to anti-tuberculosis drugs Signup and view all the answers

During which phase of tuberculosis might a person experience hemoptoic sputum?

Secondary tuberculosis Signup and view all the answers

Which population is most affected by tuberculosis, according to epidemiological data?

Asia, Africa, and Eastern Europe Signup and view all the answers

What is one of the main objectives of antituberculous chemotherapy?

Prevent relapse Signup and view all the answers

What is the primary cause of resistance to first-line anti-tuberculosis drugs?

Patient non-compliance and/or inadequate treatment Signup and view all the answers

Which of the following best describes the action of isoniazid in tuberculosis treatment?

It alters the walls of mycobacteria by inhibiting the synthesis of mycolic acids Signup and view all the answers

What is the recommended duration for maintaining treatment once sputum analysis shows negative results?

3 to 6 months Signup and view all the answers

Which of the following drugs is NOT categorized as a first-line anti-tuberculosis drug?

Kanamycin Signup and view all the answers

In patients with AIDS, which drug resistance is particularly common?

Multidrug resistance to first-line drugs Signup and view all the answers

What is a significant challenge associated with tuberculosis treatment mentioned in the content?

Non-compliance and long treatment durations leading to relapses Signup and view all the answers

What is one of the key features of the pharmacokinetics of isoniazid?

It easily diffuses through various tissues, including the blood-brain barrier Signup and view all the answers

Which of the following represents an example of a third-line anti-tuberculosis drug?

Bedaquiline Signup and view all the answers

What is the primary mechanism of action of rifampin?

Inhibits bacterial RNA synthesis Signup and view all the answers

Which of the following factors increases the incidence of isoniazid side effects?

Alcoholism and previous liver disease Signup and view all the answers

What condition is pyrazinamide primarily associated with in terms of its mechanism of action?

Generates an acidic environment affecting fatty acid synthesis Signup and view all the answers

Which of the following adverse drug reactions is NOT commonly associated with rifampin?

Seizures Signup and view all the answers

Which of the following is a contraindication for the use of rifampin?

Patients with a history of hypersensitivity Signup and view all the answers

What is a common gastrointestinal adverse effect of pyrazinamide?

Nausea and vomiting Signup and view all the answers

Which of the following statements about rifampin is true?

It causes body fluids to turn orange. Signup and view all the answers

Which of the following drugs is commonly referred to as the drug of choice for tuberculosis?

Isoniazid Signup and view all the answers

What is the main mechanism of action of ethambutol?

Altering the synthesis of the mycobacterial cell wall Signup and view all the answers

Which of the following is NOT noted as an adverse drug reaction of ethambutol?

Hepatotoxicity Signup and view all the answers

What is the typical duration of treatment for tuberculosis in healthy individuals?

6 months Signup and view all the answers

Under which condition are second-line anti-tuberculosis drugs generally used?

Presence of drug-resistant organisms Signup and view all the answers

What treatment regimen is typically followed for patients resistant to isoniazid and rifampicin?

Combination of isoniazid, rifampicin, and ethambutol for at least 12 months Signup and view all the answers

What is one of the most significant adverse effects associated with ethionamide?

Hepatotoxicity Signup and view all the answers

Why has the use of streptomycin in tuberculosis treatment decreased?

It has severe adverse reactions. Signup and view all the answers

What does the initial phase of the 2+4 treatment regimen for tuberculosis include?

Rifampin, isoniazid, pyrazinamide Signup and view all the answers

What is the primary infectious agent responsible for leprosy?

Mycobacterium leprae Signup and view all the answers

Which leprosy type is characterized by severe peripheral neuropathy and multiple skin lesions?

Lepromatous leprosy Signup and view all the answers

Which of the following accurately describes the symptoms of tuberculoid leprosy?

Hypopigmented maculae with no sensation Signup and view all the answers

What is a common risk associated with the use of leprosy drugs?

Liver and cardiac toxicity Signup and view all the answers

What is the role of dapsone in leprosy treatment?

Analogue of sulfonamides inhibiting folate synthesis Signup and view all the answers

What distinguishes amikacin from kanamycin in tuberculosis treatment?

Amikacin is preferred due to its lesser toxicity. Signup and view all the answers

Which combination is recommended for the initial treatment of lepromatous leprosy?

Dapsone, rifampin, and clofazimine Signup and view all the answers

Which of the following statements about leprosy is false?

Most leprosy cases in the U.S. occur in locals born there. Signup and view all the answers

What is the primary mechanism of action of aminosalicylic acid (PAS)?

It antagonizes folate synthesis. Signup and view all the answers

Which country reported around 80% of global leprosy cases in 2015?

Brazil Signup and view all the answers

Which second-line antifungal drug is known for causing peripheral neuropathy during the initial treatment phase?

Cycloserine Signup and view all the answers

What dosage of levofloxacin is recommended for multidrug-resistant tuberculosis treatment?

500 mg once daily Signup and view all the answers

What is a major side effect associated with the use of capreomycin?

Nephrotoxicity Signup and view all the answers

What type of bacteria do fluoroquinolones primarily target in tuberculosis treatment?

Multi-drug resistant strains Signup and view all the answers

What is the therapeutic action of bedaquiline in tuberculosis management?

It acts as a bactericide, inhibiting bacterial ATP-synthetase. Signup and view all the answers

During what phase of treatment does 15-20 mg/mL concentration of cycloserine inhibit M. tuberculosis?

During the entire treatment duration Signup and view all the answers

Study Notes

Antimycobacterial Drugs

Antimycobacterial drugs are used to treat mycobacterial infections, including tuberculosis.
Tuberculosis is a chronic lung disease caused by mycobacteria of the Mycobacterium tuberculosis complex ( M. Bovis, M. tuberculosis, M. Africanum, M. microti).
Tuberculosis is one of the most serious public health problems worldwide in the 21st century.
It is considered a re-emerging infectious disease.
In 2020, approximately 10.4 million people developed tuberculosis, and 1.7 million died from the disease.
85% of cases occur in Asia, Africa, and Eastern Europe.
In Spain, the estimated number of infected individuals ranges between 10 and 15 million.
Resistance to anti-tuberculosis drugs due to non-compliance and inadequate treatment is a serious health problem.

Tuberculosis- Etiopathogenesis

Tuberculosis is chronic lung disease caused by Mycobacterium tuberculosis complex.
Mycobacteria mainly affect the lungs, but can cause lesions in any organ and tissue.

Tuberculosis- Route of Transmission

Transmission occurs through the airway by inhalation of aerosols (sneezing, coughing).

Tuberculosis- Phases of the Disease

Primary tuberculosis: Individuals without prior exposure to the bacillus develop nonspecific symptoms such as general malaise and weight loss.
Secondary tuberculosis: Occurs in previously exposed individuals and exhibits larger areas of necrosis than primary tuberculosis. Hemoptysis (coughing up blood) is a key symptom.
Extrapulmonary tuberculosis: characterized by the hematogenous spread of bacilli.

Anti-Tuberculosis Chemotherapy

Objectives of anti-tuberculosis chemotherapy include the rapid removal of bacilli, preventing relapse and preventing infections in close contacts (isolation).
Treatment should consist of two or more drugs (no monotherapy), and should be maintained for three to six months after the sputum analysis is negative.
Preventive chemotherapy aims to prevent infection in close contacts.

Tuberculosis- Problems

Increase in AIDS patients is a favorable condition for mycobacteria.
Long treatments lead to non-compliance and result in relapses.
Development of multidrug-resistant strains.

Tuberculosis- Resistance

Resistance to first-line drugs is due to patient non-compliance.
Isoniazid and rifampin are the main drug targets against which resistance develops.
In cases of resistance, second-line drugs are used.
Resistance to first-line drugs is more common in patients with AIDS.

Tuberculosis- Drug Targets (Mycobacterium Cell Wall Structure)

Mycolic acids
Arabinogalactan
Lipoarabinomannan
Peptidoglycan (cell wall component)

Anti-Tuberculosis Drugs- Categories

First-line treatment: Isoniazid, Rifampin, Ethambutol, Streptomycin, Pyrazinamide
Second-line treatment: Aminoglycosides (Kanamycin, Amikacin), Quinolones (Ciprofloxacin, Ofloxacin), Para-aminosalicylic acid(PAS), Etionamide, Cycloserine, Capreomycin, Rifabutin, Rifapentin
Third-line treatment: Bedaquiline (approved in 2014)

Isoniazid- First-line Drug

Mechanism of action: Inhibits mycolic acid synthesis in mycobacteria.
Pharmacokinetics: Readily absorbed orally, penetrates tissues well, metabolized in the liver, and excreted in urine.
Adverse reactions: Hepatitis, neurological disturbances, seizures, hypersensitivity reactions.

Rifampicin- First-line Drug

Mechanism of action: Inhibits bacterial RNA synthesis. It is bactericidal for M. tuberculosis.
Pharmacokinetics: Well-absorbed orally and intravenously; crosses the blood-brain barrier, placenta, and breast milk. Primarily metabolized in the liver, with excretion in feces and urine.
Adverse reactions: Hepatotoxicity, flu-like syndrome, and gastrointestinal discomfort. May stain body fluids orange.

Pyrazinamide- First-line Drug

Mechanism of Action: Converted to pyrazinoic acid by mycobacterium pyrazinamidase, this acid alters metabolic and cell membrane transport functions of mycobacteria causing decreased pH, thus inhibiting enzyme FAS1
Pharmacokinetics: Well absorbed in the gastrointestinal tract; crosses the blood-brain barrier. Excreted in urine.
Adverse reactions: Nausea, vomiting, hepatotoxicity, fever, urticaria, diarrhea, peptic ulcer.

Ethambutol- First-line Drug

Mechanism of action: Interferes with cell wall synthesis. Has bacteriostatic properties.
Pharmacokinetics: Absorbed orally; excreted by the kidneys
Adverse reactions: Dose-dependent visual disturbances, neuritis, altered color perception, gastrointestinal disorders, hypersensitivity, and hyperuricemia.

Streptomycin- First-line Drug

Mechanism of action: Aminoglycoside antibiotic that inhibits protein synthesis.
Usage: Decreased due to adverse reactions
Combined treatment is necessary to reduce appearance of resistance.

Tuberculosis Treatment Regimens

2+4 Treatment: Two-month initial phase of combinations, extended to 9 months (2+7) for HIV-positive patients.
Severe cases: Treatment for at least 12 months may be necessary.
Drug-resistant cases: Longer treatment with at least 12 months of first-line drugs, or second-line drugs are needed.

Second-line Anti-tuberculosis drugs

Used in cases of resistance to first-line drugs or when there is no response to conventional therapy.
Or when serious adverse drug effects from first-line drugs occur

Leprosy

Infectious disease caused by Mycobacterium leprae or Hansen's bacillus.
Primarily affects the skin and peripheral nerves.
Nerve involvement causes numbness and weakness in affected areas.
Globally, leprosy cases are declining.
A significant proportion of leprosy cases occurs in India, Brazil, and Indonesia.
The United States sees cases primarily in individuals migrating from regions where leprosy is endemic.

Leprosy Symptoms

Tuberculoid leprosy: Consists of one or few hypoesthetic (numb) hypopigmented (less colored) macules. Areas affected due to damage to peripheral nerves.
Lepromatous leprosy: Involves most of the skin and other parts of the body (kidneys, nose, and testicles). Shows macules, papules, nodules, or skin plaques, frequently symmetrical distribution. Peripheral neuropathy, and more severe nerve damage.
Borderline leprosy: displays characteristics of both tuberculoid and lepromatous leprosy.

Drugs for Leprosy

Dapsone: Analogy with sulfonamides, inhibitor of folate synthesis. Combination therapy (Dapsone+Rifampin+Clofazimine) for lepromatous leprosy, and (Dapsone+Rifampin) for those with lower microbial load. Also used in AIDS prophylaxis, well tolerated but allergic reactions and hemolysis are possible side effects.
Rifampin: Used in leprosy combination therapies.
Clofazimine: Phenazine staining, unknown mechanism, Variable intestinal absorption, elimination via feces; Deposits in tissue and skin as crystals (half-life is 2 months). Used in combination. Adverse effects: skin and eye discolouration, gastrointestinal issues.

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Test your knowledge on tuberculosis, its transmission routes, phases, and treatment challenges. Explore key topics such as the bacterium responsible, drug resistance, and the affected populations. This quiz will help solidify your understanding of tuberculosis and its management.