Tb: Screening & Diagnosis (1) C.L.I.P.S. Background Caused by Mycobacterium tuberculosis Spread through airborne transmission Latent Tb = infected but not acutely sick (Positive PPD or Quant Gold), won’t spread but needs tx Active Tb = infected and symptomatic, sxs include bad chronic cough, hemoptysis, weakness, wt loss, poor appetite, fever/chills/sweats Who to Screen Individuals who have been exposed to someone with Tb, especially children who have been exposed Individuals from high-prevalence Tb countries (Latin America, Caribbean, Africa, Asia, Eastern Europe, Russia) Individuals who work/live in high risk places (jails, long-term care facilities, homeless shelters) Healthcare workers Who is at High Risk for Active Tb Immunocompromised (Elderly, infants & young children, HIV+) IVDU Those with inadequate tx of previous Tb, or those with a recent Tb infection (<2yrs ago) How much of the world population is infected with Tuberculosis? One-third Updated 4/18 Armistead

Tb: Screening & Diagnosis (2) C.L.I.P.S. Testing for Tb (according to CDC) Skin test (PPD): inject tuberculin under skin and recheck in 48-72 hours Blood test (Quantiferon Gold): useful for ppl who received BCG vaccine and may have false-positive PPD Chest X-ray (Post-Ant): can assess for lesions to rule out pulmonary Tb in asymptomatic ppl with +PPD, CXR not diagnostic Sputum smear: looks for acid-fast bacilli but still not diagnostic because may be other benign AFB, need to culture to diagnose Treatment Consult ID! Four 1st line drugs for Tb: isoniazid (INH), rifampin (RIF), ethambutol (EMB), pyrazinamide (PZA) Latent Tb: daily INH for 6-9 months, daily RIF x4 months Active Tb: all 4 drugs daily x2 months, then INH+RIF daily x 4.5 months However… we now have multi-drug resistant Tb (resistant to >1 first-line drug) and extensively drug resistant Tb (resistant to first-line and 1+ of 2nd line drugs What is the PowerPlan for TB diagnosis at UNMH? "Adult Workup for Tuberculosis”