Presentation on theme: "TB Disease and Latent TB Infection"— Presentation transcript:
1 TB Disease and Latent TB Infection Karen Galanowsky RN, MPHNurse Consultant, TB ProgramNew Jersey Department of Health & Senior Services
2 Transmission of M. tuberculosis Spread by droplet nucleiExpelled when person with infectious TB coughs,sneezes, speaks, or singsClose contacts at highest risk of becominginfectedTransmission occurs from person with infectiousTB disease (not latent TB infection)
4 Latent TB Infection (LTBI) LTBI is the presence of M. tuberculosisorganisms (tubercle bacilli) withoutsymptoms or radiographic evidence of TBdiseaseWith LTBI, the person is healthy and cannot spread TB to anyone
5 Testing for M. tuberculosis Infection Mantoux tuberculin skin test (TST)Skin test that produces delayed-type hypersensitivity reaction in persons with M. tuberculosis infectionUse a cut point of 5mm or 10 mm depending upon the reason for testingQuantiFERON® -TB Gold TestBlood test that measures and compares amount of interferon-gamma (IFN-) released by blood cells in response to TB antigens
6 Persons at Risk for Developing TB Disease Persons at high risk for developing TB disease fall into 2 categoriesThose who have been recently infectedThose with clinical conditions that increase their risk of progressing from LTBI to TB diseaseHIVUncontrolled diabetesCancer of the head or neckTNF-alpha blockers
7 Targeted Tuberculin Testing Detects persons with LTBI who would benefit from treatmentDe-emphasizes testing of groups that are not at high risk for TBCan help reduce the waste of resources and prevent inappropriate treatment:
8 When TB Disease Develops Symptoms Prolonged coughNight sweatsLoss of appetiteWeight lossFatigueFeverChillsCoughing up bloodChest pain
9 Evaluation for TB Medical history Physical examination Mantoux tuberculin skin test or Quantiferon-TB GoldChest radiographBacteriology testing for smear and culture identification
10 Common Sites of TB Disease LungsPleuraCentral nervous systemLymphatic systemGenitourinary systemsBones and jointsDisseminated (miliary TB)
11 Principles of Treatment for TB Disease Treatment for TB disease is usually 6 – 9 monthsThe four first-line drugs should be used initially until drug susceptibility studies are determined.Dosages should be calculated based on weight (mg/kg)All TB medications should be ingested together the approximately at the same time dailyTB medications may be given intermittently (twice or thrice weekly by directly observed therapy after the initial phase of treatment.
12 MDR and XDR-TBMDR-TB - Mycobacterium TB that is resistant to at least Isoniazid and RifampinXDR TB is defined as resistance to the four first-line drugs, an injectable, and one of the quinolonesIndividuals with XDR TB are more likely to die during treatment or have treatment failureXDR TB has emerged worldwide as a threat to public health and TB control raising concerns for a future epidemic of virtually untreatable TBSecond-line anti-TB medications are used in the treatment of MDR and XDR-TB. These are costly, difficult to administer, and cause serious side effects
13 Factors that Affect TB Transmission Infectiousness of person with TBEnvironment in which exposure occurredDuration of exposureProximity to the infectious person
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