Tuberculosis Presentation PDF

Tuberculosis AUGSBURG UNIVERSITY PA PROGRAM CLINICAL MEDICINE I RACHEL ELBING PA-C, MPH SLIDE CREDIT: VANESSA BESTER, EdD, PA-C Objectives 1. Summarize the etiology, pathophysiology, clinical features, and how diagnosis is established for the conditions listed below: ► Tuberculosis infectio...

Tuberculosis AUGSBURG UNIVERSITY PA PROGRAM CLINICAL MEDICINE I RACHEL ELBING PA-C, MPH SLIDE CREDIT: VANESSA BESTER, EdD, PA-C Objectives 1. Summarize the etiology, pathophysiology, clinical features, and how diagnosis is established for the conditions listed below: ► Tuberculosis infection (Latent tuberculosis) ► Tuberculosis disease (Active pulmonary tuberculosis) ► Extrapulmonary tuberculosis 2. Compare and contrast the laboratory tests that screen for tuberculosis. 3. Differentiate the evaluation of a patient with a known history of TB or previously positive skin test. 4. Diagnose tuberculosis based on interpretation of tuberculin skin tests and chest radiography. 5. Determine the first line therapy and patient education for tuberculosis diagnoses. 6. Summarize the monitoring of a patient undergoing tuberculosis treatment. 7. Assess the public health issues surrounding TB including directly observed therapy, disease reporting, surveillance and contact investigations.  TB Etiology ► Mycobacteria Tuberculosis: ACID-FAST BACILLI (AFB) ► Cough, sneeze, talking of infected person aerosol spread ► Aerosolized mycobacteria can last in air for several hours -  TB Epidemiology ► M tuberculosis infects ¼ of the world’s population (2 billion people!) ► 10.6 million new cases of TB worldwide in 2021 ► 1.6 million people dying of disease & 15% case fatality rate ► Increased in mortality for first time since 2005 ► ~13 million people infected in United States ► 7860 reported active cases in 2021  TB Risk Factors ► Persons who have been recently Infected with TB bacteria ► Close contacts of a person with infectious TB disease ► Persons who have immigrated from areas of the world with high rates of TB ► Children less than 5 years of age who have a positive TB test ► Disproportionate rates in disadvantaged populations: persons experiencing homelessness, malnourished, substandard housing, injection drug users ► Significant increased risk in persons with what other diagnosis ____________? ► Persons who work at high risk facilities: hospitals, homeless shelters, correctional facilities, nursing homes/HIV homes  TB Risk Factors ► Persons with medical conditions that weaken the immune system ► Babies and young children ► HIV infection ► Diabetes mellitus ► Severe kidney disease ► Chronic Systemic Corticosteroids ► Substance use disorder ► Silicosis ► Low body weight ► Organ transplants ► Head and neck cancer ► Immunosuppressive treatment for rheumatoid arthritis or Crohns disease  TB Pathophysiology ► Infection most commonly manifests in the lungs ► Mycobacteria-filled droplet is inhaled into lung: upper lobes most cm. ► Healthy immune system usually can keep TB from replicating (alveolar macrophages), but usually cannot destroy them Primary completely Tuberculosis ► Once infection established, lymphatic and hematogenous (clinically and dissemination before an effective immune response radiographically silent) ► T-cells and macrophages form granulomas to encase the TB ⮚ Infection is ► Caseating granulomas typically form in lung apices contained but NOT eradicated  Different Types of TB: All get some form of treatment ► Primary TB ► TB Disease(active) ► Usually asymptomatic & ► Symptomatic, cavitary nothing on Xray lesion on Xray ► Fever ► If symptoms (often in children): ► Night sweats ► Cough ► Weight loss ► Chest pain ► Poor appetite ► Night sweats ► Weakness ► Poor appetite ► Chest pain ► Problems gaining weight ► Sputum production (hemoptysis) ► TB Infection (Latent TB) ► Extrapulmonary TB (active) ► Asymptomatic, not contagious ► Bones, kidneys, lymph nodes ► Normal CXR and central nervous system ► Positive PPD or QuantiFERON ► Miliary or Disseminated ► 5-15% chance of re-activating  Screening Tests ► Developed to primarily test for TB infection (latent TB) ► Positive test does NOT distinguish between infection vs disease Screening utilization: ► People who have spent time with someone who has TB disease ► People from a country where TB disease is common (most countries in Latin America, the Caribbean, Africa, Asia, Eastern Europe, and Russia) ► People who live or work in high-risk settings (for example: correctional facilities, long-term care facilities or nursing homes, and homeless shelters) ► Health-care workers who care for patients at increased risk for TB disease ► Infants, children and adolescents exposed to adults who are at increased risk for latent tuberculosis infection or TB disease  Screening Tests: Options ► Mantoux tuberculin skin test (TST) (PPD test – Purified protein derivative) ► Sensitivity : 77%; Specificity 97% ► Only 59% specific with prior BCG vaccination ► Preferred in children < 5yr ► False negatives in immunosuppressed individuals ► IGRAs (interferon-gamma release assays) {QuantiFERON gold} ► Sensitivity: 60-90%; Specificity: 95% ► Preferred for those who have received the TB vaccine Bacillus Calmette–Guérin (BCG- Mycobacterim bovis). ► Not typically given in US ► Lasts ~20 years ► ~50% effective ► Preferred for those unlikely to return for 48-72hr read  Screening Test: 2 step testing ► If the Mantoux tuberculin skin test (TST) is used to test health care personnel upon hire (preplacement), two-step testing should be used ► Some people with latent TB infection have a negative reaction when tested years after being infected ► The first TST may stimulate or boost a reaction.  Reading the TST: INDURATION not erythema ► Mantoux tuberculin skin test (TST) ► 5 mm or more is positive in ► HIV-positive ► Recent contacts with a TB patient ► CXR with nodular or fibrotic changes c/w old/healed TB ► Organ transplants and other immunosuppressed patients ► 10 mm or more is positive in ► Recent arrivals (less than five years) from high-prevalence countries ► Injection drug users ► Residents and employees of high-risk facilities ► Mycobacteriology lab personnel ► High risk populations ► Kids