TUBERCULOSIS

Epidemiology: From 1953-84, cases decreased by 5.6%/yr. From 1985-93, cases increased by 14%.

Classification

1. No TB exposure, no infection (PPD negative)

1. TB exposure, no infection (PPD negative)

2. TB infection, no disease (PPD positive, sputum/CXR negative)

3. Disease (sputum pos or BOTH PPD and CXR)

4. TB hx, no disease

5. TB suspect

TUBERCULOSIS cont’d

PPD skin test:

1. A reaction of 5 mm or greater INDURATION is positive IF:

a. close, recent contact w/ known TB

b. CXR c/w TB

c. immunosuppressed

d. HIV +

e. high risk for HIV

1. A reaction of 10 mm or more is pos in all others. Chemoprophylaxis should be considered IF:

a. CXR c/w past disease

b. recent conversion documented

c. consequences to others is significant

d. comorbid disease

e. high risk for HIV

PROPHYLAXIS for TB 1-2, 4 (INH)

Highly recommended for the following groups:

1. Close contacts of pulmonary TB pts. After 3 mos, if PPD still negative, may D/C

2. PPD convertors (change w/in past 2 yrs)

PPD positive w/ positive CXR

PPD convertors w/ or at high risk for HIV

PPD positive, immigrants < 2yrs, < 35 yrs old fr Cent and S America, Asia, Phillipines, Africa.

PPD positive < 21 yrs old

Lower priority:

1. Post-partum < 35 yrs old, PPD positive

2. PPD positive on steroids, immunosuppressive rx, leukemia, lymphoma, IDDM, silicosis, post gastrectomy, renal failure w/ uremia

PPD positive, health care workers

Contraindications to INH:

1. Unstable liver disease, AST > 3 X normal

2. Known INH adverse reaction

1

Length of Rx:

Immunocompromised including HIV( 1 yr

Children ( 9 mos

All others ( 6 mos

Vitamin B6: should be given to persons at high risk for peripheral neuropathy- DM, uremia, alcoholics, malnutrition, HIV, pregnant, elderly.

TREATMENT for TB 3

1. 6 mos: INH, RIF, PZA, EMB

2. 9 mos: INH, RIF, EMB