Presentation on theme: "Wyoming Department of Health Communicable Diseases"— Presentation transcript:
1 Wyoming Department of Health Communicable Diseases 307-777-8939 TuberculosisWyoming Department of HealthCommunicable Diseases
2 What is Tuberculosis?An infection caused by Mycobacterium tuberculosisSpread person to person through droplets released from an infected person by sneezing, coughing, singing or laughingCan be classified as:Active TB DiseaseLatent TB Infection (LTBI)
3 Transmission Occurs when an individual inhales infected droplets Depends onInfectiousness of TB infected individualEnvironment in which the exposure took placeClosed, tight environments pose a greater risk of transmissionLength of exposureThe longer the exposure, the greater the riskVirulence of TB bacteria
4 Who is at risk? HIV Infected Individuals Individuals born in TB endemic countriesIndividuals who have been in contact with someone with TBAlcohol and illicit drug usersIndividuals with conditions that may compromise the immune systemIndividuals who were previously treated incorrectly for TB infection
5 TB Worldwide 1/3 of the World’s population is infected with TB Approximately 9 million people became infected with TB in 20101.4 million people die from TB each yearTB is the leading cause of death among individuals with AIDS
6 TB in the United StatesThe rate of TB in the US in 2010 was 3.6 cases per 100,000 populationThe rate has been steadily decreasing since 1992A total of 11,182 cases were reported in 2010Hawaii reported the highest case rate of 8.8 cases per 100,000 populationMaine reported the lowest case rate of 0.6 cases per 100,000 populationCenter for Disease Control and Prevention (2011, October 7). Reported Tuberculosis in the United States, 2010.
7 TB in Wyoming Wyoming is a low incidence state Reported case rate of 1.3 per 100,000 population in 2010This number increased by 0.9 cases per 100,000 population from 2009Wyoming had the 42nd highest case rate in 2010Active TB Disease is a REPORTABLE disease in Wyoming
8 Active TB Disease Infectious stage of TB Manifests six or more weeks after exposureOccurs when the body cannot control the TB bacteria in the bodySymptoms may include:Prolonged CoughUnexplained Weight LossFeverNight SweatsChest PainBlood in SputumPatients diagnosed with active TB disease should:Be isolated and provided with a mask to wear for doctor appointments, etcImmediately start a treatment regimenIf HIV status is unknown, an HIV test should be done in order to correctly prescribe the best treatment regimen
9 Diagnosis of Active TB Physical Exam/Symptom evaluation Chest X-ray Cannot confirm TB DiseaseUsed to detect lung abnormalities or rule out diseaseBacteriologic Cultures (AFB smears)Used to confirm/rule out TB diseaseSputum sample, bronchoscopy, gastric washingSputum SampleMost cost-effectivePatient coughs sputum into a sterile container at least 3 different times in 8-24 hour intervals, at least one being an early morning specimen
10 Active TB TreatmentTreatment must last 6 months or more (depends on patient’s response to the treatment regimen)2 phases of treatmentInitial PhaseFirst 8 weeks of treatment4 drugs usedIsoniazid (INH)Rifampin (RIF)Pyrazinamide (PZA)Ethambutol (EMB)Kills most bacteriaContinuation PhaseStarts after the first 8 weeks of treatment until treatment is completeAt least 2 drugs usedKills remaining bacteria
11 Active TB TreatmentAdherence to proper treatment is essential in treating active TB and avoiding drug resistanceDrugs should be taken as prescribedThis time should be convenient for the patientCan be monitored by Direct Observed Therapy (DOT)A medical provider watches the patient take the medication in person, by webcam or other meansDrug resistance can occur ifAn improper treatment regimen is prescribedThe patient does not take all of their medication as prescribed
12 Active TB Treatment Evaluation The patient should be evaluated regularly to ensure the patient is properly responding to treatment bySymptom evaluationChest x-raySputum smears or other bacteriologic specimensPatients should be reevaluated and treatment regimen should be assessed if:Symptoms do not improve after 2 months of therapySymptoms worsenPositive cultures remain after 2 months of treatmentCulture results become positive after having a negative culture
13 Active TB Treatment Evaluation Liver function testsINH can impact the liver causing hepatitis, liver function tests should be routinely performed on individuals that:Are HIV positiveHave conditions that may cause hepatitisAre taking other medications which may cause hepatitisAre pregnantUse alcohol regularlyHave symptoms of hepatitis
14 Extrapulmonary TBMore common in young children and HIV infected individualsSymptoms often coincide with the location of infectionInfection can spread to:BrainKidneysBones/JointsPleuraLymph nodesLarynxMiliary (Disseminated) TB (very rare)All parts of the body can be infectedTravels through blood streamTuberculous lymphadenitis
15 Extrapulmonary TBTests for Extrapulmonary TB are bacteriologic tests of samples taken from affected areas such as:Urine sample for kidneySpinal fluids for TB meningitisEtc.Extrapulmonary TB can be treated with 9 months of INH or RIFDuration of treatment can be shortened to 6 months if a combination of four drugs are used daily for the first two monthsFor more information visit
16 Latent TB Infection (LTBI) Occurs when an individual inhales infected droplets but the bodies immune system keeps the bacteria under control in the bodyCan progress to active TB disease if the immune system cannot continue to control the infectionAsymptomaticShould be treated to prevent progression to active diseaseIs not infectious at this stage
17 Targeted Screening for TB The CDC recommends that the following should be screened for TB:Close contacts to individuals with active TB diseaseHIV Infected individualsInjection drugs users and users of other high risk substancesIndividuals with medical conditions that are at greater risk for TBIndividuals/Employees in high risk congregate settingsHealthcare workers who serve high-risk clientsIndividuals born in countries with high prevalence/incidenceInfants and children exposed to high risk adultsWDH recommends that all healthcare facilities conduct the CDC evaluation to determine the frequency for employee screening.
18 Diagnosis TARGETED Screening/Risk Assessment A risk assessment should be completed to determine if someone is at risk for TBThis assessment and other resources can be found atTST/IGRAIf risks are present, a TST test should be placedBCG status should be ignored after 1 year of vaccinationIGRA is another option but there is limited availability and should be approved by WDH TB Program staff before testingChest x-rayA chest x-ray should be done to rule out active infection if the TST or IGRA is positive
19 Tuberculin Skin Test (TST) Administration0.1 mL of PPD tuberculin solutionInject intradermally on the forearmProduce a 6 to 10 mm whealReadingRead the test hours laterMeasure the induration, NOT the erythemaMeasure transversely across forearmRecord induration in mm, no induration = 0mmPositivity depends on risk factors!
20 LTBI TreatmentTreatment of LTBI is essential in preventing progression into active diseaseTreatment regimen is recommended for 9 months but can be done in 6 under specific circumstances6 month regimen is not recommended for those living with HIV, previous TB disease, or childrenINH is the recommended medicationRIF can be given to people who cannot take INHRIF should not be used in conjunction with certain anti-retroviral medicationsFor more information visit
21 Progression of Disease Progression of LTBI to Active TB Disease is 7%-10% over the lifetime unless other conditions existIndividuals with LTBI are more likely to progress to active infection within 2 years of becoming infectedProgression of LTBI to Active TB is more likely if:LTBI is untreatedLTBI is treated improperlyThe immune system is compromised (HIV, certain cancers, immune suppressants, etc.)HIV infected individuals with LTBI have a 7%-10% chance of progression to active infection EVERY YEAR.
22 Prevention The spread of TB can be prevented by: Quickly identifying individuals with TB by targeted testing of those at riskIsolating individuals with active diseaseCorrectly utilizing PPE when dealing with an Active TB patientPromptly starting appropriate treatment for those diagnosed with TBVerifying that patients are compliant with and complete treatment (DOT)
23 ReferencesCenter for Disease Control and Prevention. (2011, May 25). Tuberculosis- Testing and Diagnosis. Retrieved fromCenter for Disease Control and Prevention. (2011, October 11). Tuberculosis- Data and Statistics. Retrieved fromCenter for Disease Control and Prevention. (2011, November 2). Tuberculosis- Treatment. Retrieved fromCenter for Disease Control and Prevention. (2010, July 1). Tuberculosis- Basic TB Facts. Retrieved fromCenter for Disease Control and Prevention. (2010, July 1). Tuberculosis- Infection control and prevention. Retrievedfrom