CMN 568-TEST THREE-TB ONLY WITH 100% CORRECT ANSWERS

What are some factors that have contributed to TB morbidity? HIV/AIDS, Immigration, TB in congregate settings, multidrug-resistant TB, and funding cuts. Who is at highest risk for developing TB? Close contacts to a known or suspected TB person, foreign-born where TB is common, travel to TB prevalent countries, and residents and employees of high risk congregate settings, HCWs, medically underserved or low income who abuse drugs/alcohol, children exposed to infected adults. How is TB spread? AIRBORNE! Via droplet nuclei when infected person coughs, sneezes, shouts, or sings. Can be inhaled through nasal or resp tract then the droplets meet the alveoli. Mr. Man sneezes in your face at the WalMart check out, what are factors that play into you acquiring his TB?!? (You can think about the factors after you punch him in the face!) * Your susceptibility *How infected is he? Number of bacilli expelled into the air? *Environmental factors of the air ( Considering Walmart can get pretty stuffy I say your chances are high!) *Proximity, frequency, and duration of exposure (He's less than a foot in front of you, and oh, he just turned around and shouted in your face after you punched him! Now your at a higher risk!) *Can be transmitted through kids, but not as likely. So once these droplet nuclei guys introduce themselves to your alveoli, what is their next mode of action? They start multiplying, yup, that's right, your screwed now! Game over. Now they have multiplied in your lungs, your in for the long haul now...where do they go after that? Some of them hop into your bloodstream and spread to exotic places like your BRAIN, LARYNX, LYMPH, SPINE, BONE, KIDNEY, or maybe they prefer to stay home in the lung. So how do you know if you have LTBI (latent) or TB disease? If your body attacks the bacilli with their special troops called macrophages then all remains under control and you have LTBI. When the sh*t hits the fan, a rapid multiplication of bacilli occurs and now you are blessed with TB disease! (This takes place within 2-8 weeks). When those special troops show up aka macrophages, they actually ingest the tubercle bacilli, forming a barrier called what? Granuloma! Let's say your body keeps things under control (LTBI) and you show up to work where we've started routine TB testing again? Will you be positive? 2-8 weeks after infection, LTBI can be detected via TST or IGRA (Interferon-gamma release assay). However, you are not infectious and you will not spread the organism! Yay, for me! Remember Mr. Man? Well, he has infected you and you just finished a mission trip where TB was prevalent, and you stayed in a tiny home that was overcrowded. Your body is really hacked off at you because you drank the water and now it refuses to build those granulomas around the bacillii. How long before you develop TB disease? Can occur soon after your trip or even years ....yes...years later! You ARE infectious. So after you've come to see my in my office, and I learn that you have been at very high risk of acquiring TB, what test might I order to confirm? M. tb culture from the sputum! Remember we talked about the exotic places that TB can travel in your body? What is the most common? Rare? Common: Lungs Rare: Miliary or all parts of body, can be fatal. If it makes it to the CNS then it will occur as meningitis, but can be in the brain or spine. So I've diagnosed you with TB, but it's extrapulmonary (outside the lungs). Are you just as contagious as if it were in the lungs? Nope not really unless you have concomitant pulmonary disease, extrapulmonary disease in the oral cavity or larynx, or extrapulmonary disease with open site especially with aerosolized fluid. What are the risk of developing TB if untreated in the normal immune system? 5% develop in the first 1-2 years post infection and another 5% later in life. What are the risk of developing TB if WEAK immune system? Untreated HIV infection, highest risk and each year the risk is 7%-10%, and children 5 also increased risk. Does LTBI need isolation and treatment? No, only TB disease. T/F: LTBI and TB disease will usually have a positive skin test or blood test. True! But further testing with a CXR and sputum smears will be positive in TB disease and negative in LTBI. Are the LTBI people symptomatic? No, not typically unless the bacteria becomes active. TB disease may be sick and have symptoms such as cough, fever, and/or weight loss.