TB Service

• What are the signs & symptoms of active TB?

  Haemoptysis

  Cough (3 or more weeks)

  Fever

  Night sweats

  Fatigue

  Unintentional weight loss

  Chills

  Loss of appetite

  Chest pain (+/- pleurtic pain)
• What are the risk factors?

  Born in a high-risk country

  Parents or grandparents born in high-risk country

  Homelessness

  Imprisonment

  Time in detention centres

  Refugee camps

  HIV (or any immunosuppressive state)
• There are around 2 million deaths per year.

  1/3 of the world's population is infected with TB (latent)

  TB is one of the top 3 killers (next to HIV & malaria)
• HIV testing in TB cases

  TB pts are routinely screened for HIV
• What is primary TB?

  Infection of an individual who has not previously been infected

  Occurs usually within first 2 years after exposure

  Most common in children
• What is secondary TB?

  Infection of an individual who has been infected in the past, and this is a 'flare up' of TB

  Often occurs due to factors suck as reduced immunity, poor nutritional status, alcoholism, drug use, or advancing age
• What can be used to diagnose TB?

  3x morning sputum specimens -> send for acid fast bacilli

  CXR

  CT scan (if CXR didn't confirm)

  Bronchoscopy/EBUS (if not coughing)

  Surgery/FNA
• What is shown in this CXR?

  TB

  
• What is directly observed therapy (DOT)?

  Strategy used to assure TB patients adhere & complete treatment

  Observation of medication

  Given to all pts with MDR-TB & patients at high-risk of non-compliance
• Why do DOT?

  Most effective strategy to ensure treatment completion

  Reduces the risk of drug resistance, relapse or reactivation

  Associated with better treatment outcomes

  Allows HCP to monitor side effects & response to therapy

  It stops the interruption to treatment that can occur
• What increases the risk of TB?

  Smoking (2x)

  Diabetics (2x)

  Men (2x)

  HIV (20x)
• What does rifampicin do to bodily fluids?

  Turns them orange
• Isoniazid decreases vitamin B6 in body -> peripheral neuropathy

  Always give vitamin B6 with isoniazid
• What is a side effect of ethambutol?

  Colour blindness

  Important do to ophthalmological testing before starting
• What is done when contact tracing?

  Identifying and notifying individuals who may have been exposed to TB.

  In asymptomatic close contacts > 65 years old, consider standard testing for TB (IGRA & CXR, Mantoux for children), followed by consideration of BCG vaccine or treatment for latent TB once active TB have been ruled out for people who are:

  • previously unvaccinated
  • contacts of a person with smear +ve pulmonary or laryngeal TB
  • Mantoux negative/IGRA negative
• What is 'enough contact' to be screened for contact tracing for TB?

  8 hours or more in a 3 months period of close contact
• REMEMBER: BCG vaccine…

  • is not 100%
  • does not last for life
  • should not be boosted
  • scars are not a guarantee
• When are masks indicated for HCPs caring for pts with TB?

  MDR TB is suspected

  Aerosol-generating procedures are being performed

  Pt has very productive cough & HCP is directly exposed to resp secretions
• Pts with suspected pulmonary TB, who are admitted, should be…

  • given single room accommodation
  • separated from immunocompromised pts