CLINICAL PHARMACY

TUBERCULOSIS
Ellen Mae P. Florida
MS-Pharm
Epidemiology

Transmission

Clinical Presentation
TUBERCULOSIS
Treatment
TUBERCULOSIS
- A contagious infection that usually attacks
the lungs.

PATHOGEN:
Mycobacterium tuberculosis

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 CHEST X-RAY
PULMONARY TB -VS- NORMAL CHEST
PROBLEM
Appearance on X-ray

o Multiple light areas (opacities) of varying

size that run together (coalesce)
o Inflammation
o Formation of tubercles
o Growths within tissue
o Tissue death

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TRANSMISSION

o Infectious TB coughs, sneezes, shouts or

sings
o Droplet Nuclei (Airborne particle about 1-5
microns) are inhaled and reach the alveoli of
the lungs,
o Via nasal passages, respiratory tract, and
bronchi

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Person w/ LTBI (Infected
o Has a small amount of TB bacteria in the body that
are alive, but inactive.
o Cannot spread TB bacteria to others.
o Does not feel sick, but may become sick if the
bacteria become active.
o Usually has a TB skin test or TB blood reaction
indicating TB infection
o Radiograph is typically normal
o Sputum smears and cultures are negative
o Should consider treatment for LTBI to prevent TB
disease
o Does not require respiratory isolation
o NOT A TB CASE.
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TB Infection vs TB Disease
Person w/ TB Disease (Infectious)
o Has a large amount of active TB bacteria in the body
o May spread TB bacteria to others
o May feel sick and have symptoms (cough, fever, and/or
weight loss)
o Usually has a TB skin test or TB blood test reaction
indicating TB infection
o Radiograph may be abnormal
o Sputum smears and cultures may be positive
o Needs treatment for TB disease
o May require respiratory isolation
o A TB CASE
 SIGNS & SYMPTOMS

Extrapulmonary TB Pulmonary TB

• M. tuberculosis can • Cough >2 weeks

infect any organ of the -Often productive
body (sputum), can be bloody
• Symptoms vary by site • Fever
of disease • Night sweats
• Weight Loss
• Chest pain
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 • Cancer
• Transplant
• Malnutrition
•Diabetes
• Alcoholism
RISK •HIV infection

FACTORS

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DIAGNOSIS
 Signs and symptoms consistent
 Chest X-ray
 Clinical Judgement
 Bacteriology
o AFB Smear microscopy
o Nucleic Acid Amplification Testing
o Culture and Identification
o Drug susceptibility testing (DST)

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 TB TREATMENT REGIMEN

•TB INFECTION – LTBI •TB DISEASE– pulmonary, drug

treatment options susceptible TB, 6 mos. Standard
regimen
 9 months Isoniazid  Intensive phase: 2 months
 4 months Rifampicin RIPE
 3 months Isoniazid +  Continuation phase: 4 months
Rifapentene Isoniazid + Rifampicin

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 (WHO)
DRUG RESISTANT TB
MDR TB: resistant to at least Rifampicin
(RIF) and Isoniazid (INH)

New Cases est. 2017

Detected & reported in 2017

Px. started treatment

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MDR TB
TREATMENT Increasing Resistance

Adverse Effects Frequent changes in

regimens (due to
Second-line drugs toxicity), poor
2 yrs of therapy w/ often cause severe adherence, too few
Second-line drugs adverse effects; effective drugs avilable
very difficult for px. to
Expensive drugs may tolerate.
not be readily
available
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15 ADD A FOOTER MM.DD.20XX
 A 15-year-old male presented to his primay care
physician with frequent cough, weight loss, fatigue, and night
sweats for four months. Two months ago he was treated for
bronchitis that was unresolved. His CXR showed extensive
right upper lobe infiltrates and multiple cavitary lesions. TB
was suspected and a TST was placed and read at 25 mm
CASE STUDY induration. Patient was referred to a pediatric pulmonologist.
The pulmonologist collected sputum specimens that
were positive with numerous AFB. The patient was
accompanied by his mother and 5 month old brother when
the pulmonologist initially saw this patient and suspected
active TB. The infant appeared healthy with no signs and
symptoms of TB. The pulmonologist immediately reported
the 15 year old and infant brother to the local health
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department. MM.DD.20XX
 1) Regarding the infant brother, which is the most
Rationale:
Age <5yrs is one of the most
important factors in prioritizing
contacts because TB dse. Is
more likely to be severe w/
higher mortality rates (e.g. TB
menigitis)
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appropriate response by the local health department?
A. No action necessary at this time, the infant is not
symptomatic and in no immediate danger.
B. The infant may be infected with TB, but it is
premature to react until the older brother is confirmed
to actually have active TB.
C. The infant has had household contact with an
active case of TB. This is an urgent public health
matter and the infant should be evaluated as soon as
possible.
D. The infant probably has been exposed and should
immediately be scheduled to have gastric aspirates
collected.
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Rationale:
Children appear asymptomatic,
however, at the same time they
can have an abnormal CXR and
dse. That can rapidly to more
severe forms of TB.
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2) Which statement is most accurate with regard
to infants and children exposed to TB?
A. Infants and children are highly prone to
developing symptoms of active TB.
B. At least half of infants and children diagnosed
with active TB who are found in contact
investigations are not symptomatic at time of
diagnosis.
C. Infants and children with active TB are
frequently infectious because of increased
upper respiratory secretions.
D. Infants and children are very resilient and do
not typically develop active TB.
MM.DD.20XX
 3) What should the local health department
nurse do next?
A. Cancel the CXR appointment since the
infant is TST negative and CXRs are traumatic
for infants.
B. Keep the CXR appointment since a
negative TST in 5 month old infants does not
Rationale:
rule out infection.
A CXR and physical exam is
needed to rule out active TB in
C. Postpone the CXR appointment until the
this infant even if the TST older brother is confirmed to have TB.
induration is less than 5mm in D. Review signs and symptoms of TB and
diameter. only do a CXR if the infant becomes
symptomatic
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THANK YOU!