Tuberculosis / Myobacterium Avium Comlex Disease

Tuberculosis

Usually affects the lungs

-Can involve lymph nodes, pleurae bones, joints, kidneys, and GI tract

-Caused by mycobacterium

Multidrug-resistant tuberculosis

Type of TB resistant to at least one of the first-line medications, including isoniazid and rifampin

TB considerations

-Transmission: Inhalation of airborne droplets

-Primary infection: initial infection is 2-10 weeks after exposure, can be mild / pneumonia-like. Within 6 months, macrophages encapsulate, but cannot eliminated bacteria. Calcified tubercles, usually upper lobes of lungs, visible on X-rays

-Latent infection: immune system suppresses the infection, can become active

-Active TB: Latent can turn active if new exposure or immunosuppression, disseminated TB can infect other systems

Isoniazid (INH)

Anti-TB med

-Use: Bactericidal for mycobacteria by blocking the synthesis of mycolic acid

-AE’s: Peripheral neuropathy, rash, elevated liver enzymes, GI issues

-Contras: Liver disease / alcoholics

-Interventions: Give with vitamin B6 to prevent nerve pain, monitor LFTs, empty stomach for best absorption

-Ed: Must keep taking for at least 6 months - 2 years EVEN IF THEY FEEL BETTER, avoid high histamine foods/akcohol, s/sx of liver damage/nerve damage

-BBW: Severe or fatal hepatitis

Rifampin (rif)

Anti-TB

-Use: kills tuberculosis-causing bacteria by binding to RNA, prophylaxis for exposure to TB

-AE’s: ORANGE DISCOLORATION OF BODY FLUIDS, hepatotoxicity, GI upset, rash, flu-like symptoms

-BBW: Significant risk of hepatotoxicity

Mantoux skin test

A diagnostic test for tuberculosis that involves intradermal injection of purified protein derivative (PPD) to assess immune response. A positive reaction indicates exposure to the TB bacterium and requires further evaluation

-read 48-72 hours after injection

-positive result leads to X-ray follow up

QuantiFERON-TB Gold

Blood test that measures concentration in blood

Evaluation of treatment

Adequate drug therapy: symptoms improve in 2-3 weeks, decreased fever / cough, weight gain, improved well-being