1. 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

2. 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 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”