Where does it come from, where does it go?
This bug causes TB (must use correct Latin name).
Mycobacterium tuberculosis
The presence of any one of four symptoms (cough, fever, night sweats, or weight loss) has been shown to have sensitivity in the range of __% for identifying patients in whom further diagnostic evaluation is warranted, even in resource-constrained regions.
80%
This is the favorite time of year of the person on your right.
Please confirm
Your two methods for screening for TB.
tuberculin skin test or Quant Gold
IGRA is preferred over TST in persons ≥5 years old who are likely infected, especially those with BCG vaccination history or unlikely to return for TST reading. Neither test differentiates latent from active disease or predicts progression risk.
There are several options for treatment of latent TB. List at least 2 drugs.
3HP: Isoniazid plus rifapentine once weekly for 12 weeks (82% completion vs 69% for 9-month isoniazid; 0.4% vs 2.7% hepatotoxicity)
4R: Rifampin daily for 4 months (79% completion vs 63% for 9-month isoniazid; 0.3% vs 1.8% hepatotoxicity)
3HR: Isoniazid plus rifampin daily for 3 months
Isoniazid daily for 6 or 9 months (lower completion rates but effective when preferred regimens contraindicated)
____ (continent) has the highest rates of active tuberculosis per capita, driven primarily by the HIV epidemic, but the absolute number of cases is highest in ____ (continent).
Sub-Saharan Africa
Asia (India and China have the greatest burden of disease globally).
Extrapulmonary TB will NOT affect which organ(s)?
Trick question: none, it can affect them all.
NEJM says it has varied and protean clinical manifestations, and therefore requires a high index of clinical suspicion.
This team member has a birthday this weekend and is holding a baby shower to celebrate.
Melanie!
The TB skin test is (more/less/as) sensitive and (more/less/as) specific as the Quant Gold.
The minimum treatment length for latent TB is ____ (duration of time).
3mo (depends on regimen)
3HP: Isoniazid plus rifapentine once weekly for 12 weeks (82% completion vs 69% for 9-month isoniazid; 0.4% vs 2.7% hepatotoxicity)
4R: Rifampin daily for 4 months (79% completion vs 63% for 9-month isoniazid; 0.3% vs 1.8% hepatotoxicity)
3HR: Isoniazid plus rifampin daily for 3 months
Isoniazid daily for 6 or 9 months (lower completion rates but effective when preferred regimens contraindicated)
An estimated _____ persons worldwide have latent infection and are at risk for reactivation.
2 billion or 25%
The NEJM lists 7 classic clinical features of pulmonary TB. List at least 5.
chronic cough, sputum production, appetite loss, weight loss, fever, night sweats, and hemoptysis
True or false: The person across from you had a childhood pet.
Please confirm.
The NEJM estimates that in resource-constrained settings with a high prevalence of TB and HIV infection, an estimated 30% of all patients with tuberculosis and more than __% of those with multidrug-resistant and extensively drug-resistant tuberculosis do not receive a diagnosis.
(must be within 10%)
90%
What is special about the administration of drugs to treat active TB?
Hint: How will we prove therapy completed?
Must be directly observed.
Evidence shows that effective treatment rapidly reduces infectiousness:
After 2 days of standard therapy: infectivity reduced to approximately 10% of pretreatment level
After 14-21 days of treatment: infectivity reduced to <1% of pretreatment level
In more than ___ of persons infected with M. tuberculosis, the pathogen is contained as asymptomatic latent infection. (must be within 10%)
90%
At CD4 counts of less than ___, pulmonary findings may be absent.
75, although atypical presentations are common with CD4 <200
The risk of active tuberculosis increases soon after infection with HIV,19 and the manifestations of pulmonary tuberculosis at this stage are similar to those in HIV-negative persons. At CD4 counts of less than 200 per cubic millimeter, the presentation of tuberculosis may be atypical, with subtle infiltrates, pleural effusions, hilar lymphadenopathy, and other forms of extrapulmonary tuberculosis in as many as 50% of patients. At CD4 counts of less than 75, pulmonary findings may be absent, and disseminated tuberculosis, manifested as a nonspecific, chronic febrile illness with widespread organ involvement and mycobacteremia, is more frequent, with high early mortality. Such cases may be mistakenly diagnosed as other infectious diseases and are often identified only on autopsy.
This is the favorite ice cream flavor of the person on your left.
Please confirm.
Diagnosis of active TB should include this.
sputum microscopy and culture
The standard 6mo regimen for treatment of active TB involves 4 drugs for 2mo then 2 drugs continued for another 4mo. These drugs are... (must name at least 3)
Standard 6-month regimen for drug-susceptible pulmonary TB in adults and children: Isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, then isoniazid and rifampin for 4 months.
Alternative 4-month regimen for persons ≥12 years: Isoniazid, rifapentine, pyrazinamide, and moxifloxacin.
60% of MDR TB comes from 5 countries. List at least 3.
China, India, the Russian Federation, Pakistan, and South Africa
HIV-associated TB commonly presents with
- (symptomatic/asymptomatic) subclinical TB
- (positive/negative) findings on sputum smear
- (positive/negative) findings on CXR
- (positive/negative) culture results
Asymptomatic, subclinical tuberculosis, with negative findings on a sputum smear and chest radiography and positive culture results, is a common feature of HIV-associated tuberculosis and may account for 10% of cases in regions in which tuberculosis is endemic.
This is the middle name of the person on your right.
The USPSTF recommends screening asymptomatic adults at increased risk for LTBI (Grade B recommendation). High-priority populations include 4 groups, name at least 3.
Close contacts of persons with infectious TB
Persons born in or with prolonged travel (>1 month) to high-incidence countries (most of Africa, Asia, Eastern Europe, Latin America, Pacific Islands)
Immunosuppressed individuals (HIV infection, TNF-α antagonists, chronic corticosteroids ≥15 mg/day prednisone for ≥1 month)
Residents of congregate settings (correctional facilities, homeless shelters)
Name at least one drug that could be used to treat either an isoniazid-resistant, rifampin resistant, and/or MDR TB.
Isoniazid-resistant TB: Substitute fluoroquinolone (levofloxacin or moxifloxacin) for isoniazid; continue rifampin, pyrazinamide, and ethambutol for 6 months.
Multidrug-resistant (MDR) and rifampin-resistant TB: The 2019 ATS/CDC/ERS/IDSA guidelines recommend all-oral regimens with at least 5 active drugs, prioritizing fluoroquinolones, bedaquiline, and linezolid.