Tuberculosis Quiz: Transmission and Treatment

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the most common way that tuberculosis is transmitted?

Direct contact with infected individuals

Sexual transmission

Inhalation of airborne droplets containing live bacilli (correct)

Ingestion of contaminated unpasteurized milk

How long can tuberculosis bacilli remain alive in enclosed spaces?

For months or even years (correct)

A few hours

Several weeks

A few days

What is the primary focus in the development of tuberculosis?

The gastrointestinal tract

The lymph nodes

The bloodstream

The lungs (correct)

Which cells are responsible for initially engulfing tubercle bacilli in the lungs?

Alveolar macrophages (A) Signup and view all the answers

What is the role of T lymphocytes in the progression of tuberculosis?

They activate macrophages to better kill the ingested bacilli (A) Signup and view all the answers

What is the name for the inflammatory tissue formed in the primary tuberculosis focus?

Caseating necrosis (D) Signup and view all the answers

What is the typical incubation period for primary tuberculosis?

3-8 weeks (C) Signup and view all the answers

Which of the following is NOT a rare route of transmission for tuberculosis?

Respiratory droplets (C) Signup and view all the answers

What percentage of patients with smear-positive pulmonary T.B experience cough?

Over 90% (B) Signup and view all the answers

Which of these is the most reliable method for confirming a diagnosis of pulmonary T.B?

Bacteriological examination of sputum (D) Signup and view all the answers

Why is a chest X-ray alone considered unreliable for diagnosing pulmonary T.B?

Other chest diseases can present similarly on X-ray. (D) Signup and view all the answers

Why is the tuberculin test considered less useful in adults compared to children?

Adults have lower sensitivity to the tuberculin test due to prior exposure to the bacteria. (D) Signup and view all the answers

What is the most important factor in treating pulmonary T.B?

Anti-T.B chemotherapy (D) Signup and view all the answers

Why is it important to avoid unnecessary anti-T.B treatment?

It can cause unpleasant side effects and drug toxicity. (A) Signup and view all the answers

Which of these patients would be considered a candidate for inpatient treatment?

A patient with severe haemoptysis and spontaneous pneumothorax. (C) Signup and view all the answers

Why is Streptomycin not recommended for pregnant women diagnosed with T.B?

It can cause developmental problems in the fetus. (A) Signup and view all the answers

Which of the following criteria defines a smear-positive pulmonary tuberculosis (PTB) case?

Two sputum specimens positive for A.F.B by microscopy. (A), One sputum specimen positive for A.F.B and radiographic abnormalities suggestive of active pulmonary TB. (C), One sputum specimen positive for A.F.B and a culture positive for A.F.B. (D) Signup and view all the answers

What is the significance of bacteriological results and their role in determining T.B disease severity?

Bacteriological results offer valuable insights alongside bacillary load, extent of the disease and anatomical site to assess T.B severity. (B) Signup and view all the answers

What is the approximate percentage of smear-positive pulmonary TB (PTB) cases in adults, based on information provided?

At least 65% of all PTB cases in adults. (B) Signup and view all the answers

Which treatment regimen is recommended for a patient who has previously failed a standard first-line treatment regimen for tuberculosis?

2HRZES + 1HRZE + 5HRE (B) Signup and view all the answers

Which of these criteria is NOT a defining characteristic of a smear-negative pulmonary TB (PTB) case?

One sputum specimen positive for A.F.B. by culture, supporting the diagnosis of active pulmonary T.B. (D) Signup and view all the answers

Which of these is NOT an example of a site where extrapulmonary TB can occur?

Brain. (D) Signup and view all the answers

What is the recommended daily dosage of Rifampicin for a patient weighing over 50 kg in the initial intensive phase of tuberculosis treatment?

600 mg (C) Signup and view all the answers

What is the defining characteristic in the diagnosis of extrapulmonary TB?

One culture positive A.F.B specimen or strong clinical evidence suggestive of active extrapulmonary TB. (A) Signup and view all the answers

Which of these is considered a serious extrapulmonary form of tuberculosis?

Tuberculosis meningitis (C) Signup and view all the answers

Which treatment category is specifically designed for patients with chronic or drug-resistant tuberculosis?

Category IV (B) Signup and view all the answers

What is the importance of a decision by a physician to treat with a full curative course of anti-TB chemotherapy in the diagnosis of T.B?

It is a fundamental requirement for identifying all types of T.B, including smear-positive, smear-negative, and extrapulmonary. (B) Signup and view all the answers

Which stage of tuberculosis treatment requires daily supervision by medical staff or family members?

Initial daily intensive phase (B) Signup and view all the answers

Which of these options correctly identifies the primary factors considered in determining the severity of T.B disease?

Bacillary load, extent of the disease, and anatomical site. (B) Signup and view all the answers

Which of the following anti-TB drugs is NOT mentioned as being able to cure 100% of new cases with sensitive bacilli?

Rifabutin (A) Signup and view all the answers

What is the main goal of the D.O.T.S. strategy according to the text?

To ensure all patients with sputum smear-positive pulmonary TB complete the full course of chemotherapy (A) Signup and view all the answers

Which of the following is NOT a benefit of the D.O.T.S. strategy mentioned in the content?

Improved accessibility to treatment (B) Signup and view all the answers

What is the minimum duration of the initial intensive phase in the basic rules for efficient TB treatment?

Two months (C) Signup and view all the answers

What essential property do all five major anti-TB drugs share, as mentioned in the content?

They all have the ability to cure 100% of new cases with sensitive bacilli (D) Signup and view all the answers

Why should Rifampicin or Streptomycin be used with caution in treating diseases other than mycobacterium infections?

These drugs can cause serious side effects which may necessitate discontinuation (A) Signup and view all the answers

What is the main reason why the treatment observer plays a crucial role in the D.O.T.S. strategy?

To ensure that the patient takes the correct medication regularly (A) Signup and view all the answers

Which of the following is NOT one of the five conditions required for a successful D.O.T.S. strategy?

Sufficient funding for TB treatment programs (B) Signup and view all the answers

According to the provided regimen, which phase of treatment should a new patient with sputum negative PTB receive?

Phase I (D) Signup and view all the answers

Which treatment phase is recommended for patients with a relapse of tuberculosis?

Phase II (A) Signup and view all the answers

What is the recommended treatment regimen for a patient with treatment failure?

2HRZES + 5HRE (B) Signup and view all the answers

What is the recommended treatment regimen for a new sputum negative PTB patient, excluding those in Phase I?

2HRZE (C) Signup and view all the answers

In which phase is the treatment for chronic cases of tuberculosis, despite the patient still being sputum positive, NOT APPLICABLE?

Phase IV (B) Signup and view all the answers

Which of the following is NOT a recommended drug for the treatment of DR TB patients?

Levothyroxine (C) Signup and view all the answers

What is the recommended action for individuals who have been in contact with a smear positive pulmonary TB patient?

Three sputum examinations (E) Signup and view all the answers

What is the recommended treatment duration for patients with DR TB?

18-24 months (B) Signup and view all the answers

Study Notes

Tuberculosis Overview

Tuberculosis (TB) is a bacterial, infectious disease caused by Mycobacterium Tuberculosis complex (including human, bovis, and Africana strains).
These organisms are also known as tubercle bacilli or acid-fast bacilli (AFB) due to their resistance to acid decolorization during staining.
TB affects all races, ages, and organs.
Infection primarily occurs via inhalation of tubercle bacilli through the respiratory system.
The lungs are the main organ affected.
An infected individual may not necessarily develop the disease, with the immune system often containing the bacilli.
Approximately 5-10% of infected individuals develop active TB disease during their lifetime.
A smear-positive pulmonary TB (PTB) patient can transmit the infection to 10-15 people annually.

Global Impact of Tuberculosis

Nearly one-third of the global population (about 2 billion people) is infected with Mycobacterium tuberculosis, at risk of developing the disease.
Over eight million people develop active TB annually, with around two million deaths.
More than 90% of global TB cases and deaths occur in developing countries, with 75% of cases affecting the most economically productive age group (15-54 years).
A TB patient loses on average 3-4 months of work time, causing a loss of 20-30% of annual household income.
Contributing factors to the increasing TB burden include poverty, collapsed health infrastructure, weak national TB control programs, and the impact of HIV.
Iraq is a middle-burden country, ranking 108 globally and 7th in the Eastern Mediterranean region concerning TB burden size.
Estimated incidence of TB in Iraq is 45/100,000, with approximately 15,000 new cases annually. Prevalence is 74/100,000 and mortality 3/100,000.

Transmission of Tuberculosis

TB transmission is primarily airborne.
Coughing or sneezing by a patient with active TB produces an aerosol of droplets containing bacilli.
A high number of infectious droplets (3500 during coughing and 1 million during sneezing) are projected into the atmosphere.
Droplets dry and become light particles but retain live bacilli, remaining suspended in the air.
Exposure duration and closeness to an infectious patient significantly increase the risk of infection.
Bacilli can survive for extended periods, especially in enclosed spaces, increasing the risk of exposure.
Ingestion (e.g., through contaminated unpasteurized milk), although less common, can also be a transmission route.
Other rare transmission routes include cutaneous, trans-placental, and trans-sexual transmission.

Incubation and Disease Evolution

The incubation period for primary TB is 3 to 8 weeks.
Post-primary TB can take up to years to manifest.
When virulent bacilli penetrate the lung alveoli, alveolar macrophages phagocytose them, enabling bacilli replication.
The resulting focus (primary focus) of inflammatory cells is a site of tuberculosis-specific caseating necrosis.
Bacilli and their antigens are transported via the lymphatic system to lymph nodes.
T-lymphocytes identify the antigens, which triggers the release of lymphokines, leading to macrophage activation and inhibition of bacilli growth.
The inflammatory tissue in the primary focus is replaced by fibrous scar tissue, isolating and killing the macrophages containing bacilli.
Some bacilli survive, entering a latent stage, detectable via tuberculin skin tests.
Before immunity develops, bacilli from the primary focus are disseminated throughout the body, forming secondary foci.

Primary and Secondary Tuberculosis

Primary TB is primarily pulmonary, though it can also manifest extra-pulmonary (e.g., intestinal).
The immune response often results in spontaneous healing, tissue fibrosis (scarring), and calcification for 80-90% of infected individuals.
For 10-20%, immune response is inadequate, leading to active primary TB or disseminated TB.

Suspected Tuberculosis

The onset of TB is typically insidious. Symptoms develop slowly over several weeks.
Common symptoms include persistent cough with sputum production, chest pain or dyspnea, and (less often) hemoptysis.
Systemic symptoms include evening fever (typically around 38°C), significant night sweats, loss of appetite, loss of weight, and general malaise.
A cough lasting more than 3 weeks that is unresponsive to standard treatment warrants suspicion of TB.

Tuberculosis Case Definition

A confirmed TB case is diagnosed by bacteriological confirmation (e.g., AFB, culture) or clinical assessment by a medical professional.
The site of TB disease is significant. Pulmonary TB affects the lungs in over 80% of cases.
Extra-pulmonary TB involves various organs.
TB disease severity is determined by bacillary load, extent of the disease, and anatomical site of the infection.

Bacteriological Examination of Sputum

A smear test is considered positive if AFB is present in at least two sputum samples.
Positive AFB together with radiographic abnormalities (characteristic of active PTB) requires a full course of anti-TB drugs as determined by a physician.
Smear-negative TB (PTB): is defined by two sets of sputum samples (at least two weeks apart) that are negative for AFB.
In addition, the sample exhibits radiographic abnormalities consistent with active PTB and lack of clinical response to broad-spectrum antibiotics (except quinolones).
Decisions about treatment are made by treating physicians considering these results and full curative course of anti-TB chemotherapy.

Extra-Pulmonary Tuberculosis

Diagnosis: one culture-positive specimen, or strong clinical evidence of active extra-pulmonary TB, followed by treatment decision.
Patients with diagnosed pulmonary and extra-pulmonary TB are typically categorized as pulmonary TB cases.

Case Classification by Previous Treatment

New case: patients with no prior treatment or treatment lasting less than 4 weeks.
Relapse: occurs when patients previously cured of sputum-positive pulmonary TB become bacteriologically positive again (smear or culture-positive).
Treatment failure: patients who remain or become sputum-positive 5 months or more after commencement of treatment, or patients who were initially negative but then became positive after the second month of treatment.
Treatment defaulter: patients who stop treatment or don't adhere to the prescribed schedule for more than 2 months and subsequently present with sputum that is positive for TB.

Management of Tuberculosis

Chronic cases: patients who become sputum-positive after a fully supervised retreatment course.

Diagnosis of Pulmonary TB in Adults

A cough lasting more than three weeks in the absence of other clinical conditions is a critical sign for suspicion of pulmonary TB.
Sputum samples are examined on three consecutive days by looking for AFB using microscopy method.

Radiographic Diagnosis of Pulmonary TB

Radiographic findings may include nodules (round shadows with well-defined borders), patchy shadows (irregular border infiltration), cavities (characteristic of TB), calcified nodules, satellite abnormalities, and fibrosis.

DOTS Strategy

Strategy for Directly Observed Treatment, Short-course (DOTS) tuberculosis treatment.
DOTS requires five conditions for successful implementation: political will of the government, availability of laboratory networks for identifying smear-positive pulmonary TB cases, readily accessible peripheral healthcare centers, reliable drug supply, and an organized surveillance system.

Tuberculosis Treatment

Anti-TB chemotherapy is the most important treatment strategy.
The treatment duration and drugs vary depending on the category of TB and patient characteristics.
The first line standard regimen typically includes 2HRZES + 1HRZE + 5HRE for category I, 2HRZ + 4RH for category III, and second-line regimens for category IV.
Treatment strategies should follow clearly defined protocols to prevent drug resistance.

Compilations and Special Considerations

Pregnant women should start or continue TB treatment according to recommended protocols excluding streptomycin due to possible toxicity to the fetus.
Breastfeeding women can take all anti-TB drugs approved for this purpose.
Patients with liver disease should not take pyrazinamide as part of their therapy.
The use of rifampicin or streptomycin for conditions other than mycobacterium is limited to well-considered indications.
Anti-TB medications can result in mild side effects; severe side-effects require discontinuation and referral to specialists.

Treatment of Contacts

Children and adults who cough and were in contact with a positive index case (smear-positive pulmonary TB patient) should undergo sputum examination.
Children under 5 years old with a positive tuberculin test and symptoms indicative of TB should be treated as cases of active TB.
Those exhibiting no symptoms but with a positive tuberculin reaction need to undergo six-month preventive chemotherapy.
Preventive chemotherapy (INH) should be considered for children under 1 year of age with mothers having positive TB until completion of three-month treatment period of the mothers where the tuberculin test turns out to be negative.

Patient Assessment

Clinical assessment is subjective and not reliable for monitoring TB treatment progress; however, the improvement in patient symptoms may provide clues about TB treatment efficacy.
Bacteriological assessment with sputum smear examination (every month is not necessary) to monitor treatment progress, especially in sputum-positive patients.
Radiography may provide preliminary information, but changes may not be indicative of treatment effectiveness.

National Tuberculosis Program in Iraq

Iraq has an estimated population of 32,249,932 people and is divided into 18 governorates.
The NTP encompasses nationwide TB control program implementation.
NTP has established four-level organization with specialized centers for training, implementation of national plans, activities supervision, and management.
Nineteen governorate clinics contribute to diagnosis, registration, and initial treatment of detected TB cases, with referral to higher-level centers if necessary.
Each health district has a TB Management Unit (TBMU)/District TB Coordinator (DTC) to ensure TB diagnosis and treatment at the local level.
Primary Health Care Centers (PHCCs) are involved in TB control, with specific roles in the management of patients' treatment intake.

Strategic Directions of the National TB Program

Political commitment with increased funding.
Improving the quality and efficiency of primary healthcare facilities for respiratory illnesses.
Quality-assured bacteriology for case detection.
Efficient drug supply and management system.
Strengthening monitoring and evaluation (M&E) systems.
Scaling up the prevention and management of Drug-Resistant TB (DR-TB).
Addressing TB/HIV and the needs of poor and vulnerable populations.
Engaging all care providers, including the public, non-governmental and private sectors.
Empowering patients and communities to increase demand for TB care and ensure adherence to treatment programs.
Promoting research to improve TB program performance.

Importance of DOTS

Curative therapy of patients.
Prevention of new TB infections.
Elimination of Multi-drug resistant (MDR) tuberculosis.
Cost-effective treatment strategy.
Community-based intervention.
Increased life expectancy in patients with HIV.
Improved protection for international travelers.
Economic stimulation through better health outcomes.
Proven effectiveness from numerous studies.

10 Reasons to implement DOTS

Curing the patient
Preventing new infections
Eliminating Multi-drug resistant (MDR) tuberculosis.
Cost-effective treatment strategy.
Community-based intervention.
Increased life expectancy in patients with HIV.
Improved protection for international travelers.
Economic stimulation through better health outcomes.
Proven effectiveness from numerous studies.
Improved control of TB in a population.

Treatment for Special Cases

Pregnant women: majority of anti-TB medication is safe, excluding streptomycin.
Breastfeeding women: most anti-TB treatments are compatible with breastfeeding.
Liver disease: do not include pyrazinamide in the treatment regimen.
Acute viral hepatitis: combination of streptomycin & ethambutol up to 3 months and then 6 months of INH & Rifampcin.
Renal failure: 2 HRZ/6 HR is the safest regimen.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on tuberculosis with this quiz focusing on its transmission, diagnosis, and treatment strategies. Learn about the role of immune cells, incubation periods, and the importance of accurate diagnostic methods. Perfect for students and health enthusiasts alike!