Tuberculosis in Clinical Practice

✍ Scribed by Onn Min Kon (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 378
• Category: Library

✦ Synopsis

This book is targeted at ensuring frontline clinical staff including seniors, trainees and specialist nurses can easily reference the optimum investigation and management of potential TB cases. This will mirror the annual London Advanced TB course which aims to equip all of the team delivering care to have a working knowledge of the entire spectrum of the real life aspects of TB management ranging from investigation of active TB to latent screening in pre biologic therapy. It includes an update of MDR TB management and also the approaches needed to ensure the entire medico-social spectrum of TB care is addressed.

✦ Table of Contents

Contents
The Natural History of TB and Latent Infection
The Natural History of M.tuberculosis Infection
The Pathogen
The Mtb Infection Cycle
Transmission
Primary Mtb Infection and Primary TB
Latent Infection and Post-primary TB
The Epidemiological Cycle of TB
Early Diagnosis of Infectious TB and Outcomes of Active Case Finding
LTBI Screening and TB Prevention
Summary
References
Bacillus Calmette–Guérin (BCG) Vaccine
History of BCG Vaccine
Efficacy of the BCG Vaccine
Policy and Delivery of BCG Immunisation in the UK
Immunology of BCG
BCG Protection Beyond TB
Adverse Events due to BCG
BCG Vaccine: Revaccination Strategies
References
Pulmonary, Pleural and Mediastinal TB: Clinical Aspects and Diagnosis
Pulmonary Tuberculosis
Clinical Presentation of Pulmonary TB
Diagnostic Approach
Imaging: Chest Radiographs and CT Scans
Sputum
Induced Sputum
Bronchoscopy and Bronchoalveolar Lavage (BAL)
Paediatric Specimens
Other Diagnostic Techniques and Biomarkers for Pulmonary TB
Pleural TB
Clinical Presentation of Pleural TB
Diagnostic Approach
Imaging
Sputum in Pleural TB
Pleural Fluid
Pleural Tissue
Closed Pleural Biopsies
Thoracoscopy
Intrathoracic Mediastinal TB
Clinical Presentation of Mediastinal TB
Diagnostic Approach
Imaging
Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS-TBNA)
References
Extra Pulmonary Lymph Node, Abdominal and Pericardial Tuberculosis
Extra Pulmonary Lymph Node Tuberculosis
Epidemiology
Clinical Features
Diagnosis
Treatment
Abdominal Tuberculosis
Introduction
Clinical Features
Peritoneal Tuberculosis
Intestinal Tuberculosis
Diagnosis
Differentiating Intestinal Tuberculosis from Crohn’s Disease
Hepatobiliary Tuberculosis
Pancreatic Tuberculosis
Treatment
Pericardial Tuberculosis
Introduction
Clinical Manifestations and Presentation
Diagnosis
Treatment
References
Spinal and Bone Tuberculosis
Introduction
Incidence
Aetiology
Spinal Tuberculosis
Presentation of Spinal TB
Investigation of Spinal TB
Differential Diagnosis
Presentation of Bone and Joint TB
Investigation of Bone and Joint TB
Differential Diagnosis
Isolation Precautions
Non-tuberculous Mycobacterium (NTM) and Multi Drug Resistant TB (MDR TB)
Poncet’s Disease
Treatment of TB Osteomyelitis
Non-pharmacological Treatment
Surgical Intervention
Outcomes and Long-Term Morbidity
References
Tuberculosis of the Central Nervous System
Epidemiology
Pathogenesis
Clinical Features
Prognosis
Diagnosis
CSF Examination
Diagnostic Imaging
Differential Diagnosis
Drugs for Treatment of CNS Tuberculosis
First Line TB Drugs in the Treatment of TB Meningitis
Duration of Treatment for TB Meningitis
Adjunctive Therapy for CNS Tuberculosis
Additional Supportive Measures
Management of Cerebral Tuberculomas
HIV Treatment in the Setting of TBM and Tuberculomas
Case Vignette
Images
References
Tuberculosis in Renal Disease
Introduction
What Do We Mean by CKD?
Incidence & Prevalence of LTBI & active TB in CKD
Reasons for Susceptibility to Infection and Disease
Screening
Tuberculin Skin Test (TST)
Interferon Gamma Release Assays (IGRA)
When and How to Screen?
Presentation of Active TB
Diagnosis of Active TB
Management of LTBI
Chemoprophylaxis
Management of Active TB
Special Considerations when Treating TB in CKD Patients
Haemodialysis
Peritoneal Dialysis
Post-Transplant
Summary
References
Tuberculosis in Children and Adolescents
Introduction
Diagnosis
Household Contacts
Children Presenting with Symptoms or Abnormal Investigations
Radiology
Chest Radiology
Computed Tomography (CT)
Other Radiology
Microbiology
Specimen Collection
Laboratory Tests
Histology
Immunological Tests
Clinical Diagnosis
Novel Tests
Treatment
Treatment Regimens
Adverse Effects and Monitoring
Drug Interactions
Follow up
Adherence
Future of Treatment
Central Nervous System Disease
HIV Co-infection
Decision-Making around Tuberculosis Infection Treatment
Immune-Based Tests
Management of TB Infection
Other Issues
Infection Control
Impact on School and Education
Child Protection
Conclusions
References
HIV and TB
Introduction
Epidemiology
Risk Factors for Tuberculosis in HIV Infection
Clinical Features and Diagnosis of TB in HIV Co-infection
Diagnosis of Pulmonary TB in HIV
Molecular Testing in Pulmonary TB
Diagnosis of Extrapulmonary TB in HIV
Pleural TB
Central Nervous System TB
Disseminated TB
Treatment of active TB/HIV Co-infection
Timing of ART Initiation
Choice of ART Initiation in HIV/TB Co-infection
Types of ART
Drug-Drug Interactions in HIV/TB Co-infection
Choice of ART Regimen in HIV/TB Co-infection
Patients on Established ART
Choice of TB Treatment in HIV/TB Co-infection
TB IRIS
Clinical Features and Diagnosis of TB IRIS
Outcomes and Treatment of TB IRIS
Diagnosis and Treatment of Latent TB Infection in HIV
Drug Resistant TB in HIV
References
Radiology of Tuberculosis
Introduction
Imaging Tuberculosis: The Modalities
Imaging Considerations in Pulmonary and Abdominal Tuberculosis
Radiology of Pulmonary Parenchymal, Pleural and Nodal Tuberculosis (See Tables 1, 2, and 3)
Intra-thoracic Lymph Nodal Tuberculosis (ITLNTB)
Parenchymal TB
Pleural TB
Miliary TB
Non-tuberculous Mycobacteria
TB in the Immunocompromised Host & TB-IRIS
Latent TB and Radiological Markers of Disease Activity (Table 2)
Cardiac TB
Role of Interventional Radiology in Management of TB
Abdominal and Pelvic TB
Peritoneal TB
Gastrointestinal Tract TB
Hepatic and Splenic TB
Adrenal TB
Genitourinary TB
Bone and Joint TB
Extra-spinal Bone and Joint TB
Imaging of Intracranial Tuberculosis Infection (See Tables 4 and 5)
General Imaging Considerations
Intracranial Pathology
Meningeal Disease
Parenchymal Disease
Complications
Spinal Tuberculosis
General Imaging Considerations
Spinal Pathology
Head & Neck Tuberculosis Infection
CNS Tuberculosis in Immunodeficiency
Role of F18 -fluorodeoxyglucose (F18-FDG) PET-CT in Tuberculosis (Table 6)
References
Laboratory Diagnostic Techniques
Introduction
Specimen Collection
Microscopy
Culture and Susceptibility Methods
Molecular Diagnostics and Whole Genome Sequencing
References
Whole Genome Sequencing: Applications and Cluster Investigations
Introduction
Identification of TB Strains and Predicting Drug Susceptibility
Background
The Advancement with WGS
Identifying Genetically Similar Isolates
Background
Typing Before WGS
Patient Benefits from WGS Relatedness
Public Health Benefits from WGS Relatedness
New Clusters/Incidents
Established Clusters/Outbreaks
Transmission and Evolution of TB
Laboratory Errors
Conclusion
References
The Tuberculin Skin Test and the IFN-γ Release Assays
Introduction
LTBI Definition and Diagnosis
TST
New Version of TST
IGRA
QuantiFERON Test: Interpretation of the QFT Values Within the Uncertainty Zone (IFN-γ Values: 0.2–0.7 IU/ml)
Accuracy
Indeterminate or Borderline Results in IGRAs
Interpretation of Serial QFT Results
Serial IFN-γ Assays
New Experimental Tests
LTBI: Who Does Need to Be Screened?
Recent contacts
Children
Migrants
HIV-Infected Individuals
Subjects Exposed to Biological Therapy
Chronic Kidney Disease, Organ Transplantation, Stem Cell Transplant, Diabetes
Health Care Workers
References
TB Treatment and Complications
Introduction
Drug Regimens: Active Disease
Standard Treatment Regimen
Duration of Continuation Phase
Modification of Drug Regimens, According to Drug Sensitivity
Adjunctive Treatments
Drug Regimens: Latent TB Infection (LTBI)
Drug Doses and Routes
Practical Considerations
Drug Interactions
Monitoring During Treatment
Baseline Assessment
Ongoing Monitoring
Management of Complications
GI Symptoms (Nausea, Vomiting, Poor Appetite, Abdominal Pain)
Rashes
Arthralgias
Peripheral Neuropathy
Neurotoxicity
Drug Induced Liver Injury (DILI)
Special Groups on First Line Regimen
Pregnancy
Renal Failure
Liver Disease
Elderly
Alternative Drug Regimens
Management of Treatment Interruptions
Monitoring of Treatment Response
Further Reading
Multi-drug Resistant Tuberculosis Management
Introduction, Background and Epidemiology
Diagnosing a Case of Drug Resistant Tuberculosis
Management of DR-TB
Conclusion
References
Therapeutic Drug Monitoring in Tuberculosis
Introduction
When Should TDM Be Performed?
Interpretation of TDM Data
The Role of TDM on TB Treatment
Alternative Drug Monitoring Methods
Specific Drug Information
Isoniazid
Rifampicin
Rifabutin
Pyrazinamide
Ethambutol
Fluoroquinolones
Bedaquiline
Linezolid
Clofazimine
Cycloserine/Terizidone
Delamanid
Aminoglycosides
Ethionamide/Prothionamide
p-Aminosalicylic Acid
Conclusion/Summary
References
Anti-tumour Necrosis Alpha Factor Treatment, Immunosuppression and Chemotherapy Prophylaxis
Introduction
Individuals at Increased Risk of Tuberculosis Reactivation
Contacts of Patients with Active Tuberculosis
New Entrant Screening
Patients Receiving Biologic Drug Treatment Including Anti-TNFα Agents
Other Medical Conditions that Increase TB Reactivation Risk
Risk Assessment for Latent Tuberculosis
Immunological Testing; Interferon Gamma Release Assays and Tuberculin Skin Tests
Clinical Risk Assessment for Tuberculosis Exposure
Treatment of Latent Tuberculosis
Adverse Reactions to LTBI Treatment and Hepatotoxicity
Timing of Starting Immunosuppression and Biologics Treatment
Biologic Treatment with Active TB Disease
Adherence and Treatment Support for Patients Taking Latent TB Treatment
Further Reading
Contact Investigation
Introduction
Decision to Initiate Contact Investigation
Assessing the Index Case
Estimate the Degree of Infectivity
Infectious Period
Proximity
Susceptibility of Contacts
Source Case Investigation
Challenges
Undertaking a Contact Investigation Interview
Compile Information
Schedule a Contact Investigation Focused Meeting
Establishing a Rapport
Framework for Identifying Contacts
Prioritising Contacts
Recommendations and Arrangements to Test Contacts
Analyse Attendance and Results
Consider Whether to Expand
Special Circumstances
Multidrug Resistant-TB (MDR-TB) and Extensive Drug Resistant-TB (XDR-TB)
Air Travel
Contact Investigation Following Contact with Bovine TB and Animals/Pets Infected with TB
Congregate Settings
Homelessness
Social Network Analysis and Whole Genome Sequencing
Conclusion
References
Approaches to New Entrant Screening and Occupational Health Screening
Background
Latent TB Screening
What Is LTBI?
Choice of the LTBI Test
Choice of LTBI Management
Choice of Eligible Population
Programmatic Issues and Pathway Support
Screening for Active TB
Population Screened
Setting
Screening Test
Occupational Health
References
Incident Management and Mass Contact Screening
Introduction
Risk Assessment for Contact Investigation
Clinical Features of the Index Case
Susceptibility of Contacts
Duration and Proximity of Contact
Environmental Factors
Duration on Infectiousness
Categorising Contacts
Timing of Contact Tracing
Assessment of Contacts
Screening Tests
Children Under 5 Years
Pregnancy
Chest X-ray
Contact Investigation of MDR TB Cases
Contacts Who Decline Investigations or Treatment
Contact Investigations in Special Settings
Educational Settings
Prisons and Detention Centres
Exposure on an Aircraft
TB Clusters and Outbreaks
Practical Aspects of Contact Investigation
References