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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Compare the risk for active tuberculosis (TB) disease among patients based on their age, immune status, place of birth, and time since exposure to an active case.

  2. Design an appropriate therapeutic plan for an immunocompetent, immunocompromised, pregnant, and pediatric patient with pulmonary TB.

  3. Distinguish between the diagnostic tests used for patients potentially infected with tuberculosis.

  4. Assess the effectiveness of therapy in TB patients.

  5. Describe the common and important adverse drug effects caused by TB drugs.

  6. Select patients for whom therapeutic drug monitoring (TDM) may be valuable and identify the necessary laboratory monitoring parameters for patients on antituberculosis medications.

  7. Design appropriate antimicrobial regimens for the treatment of latent TB infection (LTBI) in all patient populations.

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KEY CONCEPTS

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  • Image not available. Tuberculosis (TB) is the most prevalent communicable infectious disease on earth and remains out of control in many developing nations. These nations require medical and financial assistance from developed nations in order to control the spread of TB globally.

  • Image not available. In the United States, TB disproportionately affects ethnic minorities as compared with whites, reflecting greater ongoing transmission in ethnic minority communities. Additional TB surveillance and preventive treatment are required within these communities.

  • Image not available. Coinfection with HIV and TB accelerates the progression of both diseases, thus requiring rapid diagnosis and treatment of both diseases.

  • Image not available. Mycobacteria are slow-growing organisms; in the laboratory, they require special stains, special growth media, and long periods of incubation to isolate and identify.

  • Image not available. TB can produce atypical signs and symptoms in infants, the elderly, and immunocompromised hosts, and it can progress rapidly in these patients.

  • Image not available. Latent tuberculosis infection (LTBI) can lead to reactivation disease years after the primary infection occurred.

  • Image not available. The patient suspected of having active TB disease must be isolated until the diagnosis is confirmed and he or she is no longer contagious. Often, isolation takes place in specialized "negative pressure" hospital rooms to prevent the spread of TB.

  • Image not available. Isoniazid and rifampin are the two most important drugs to treat TB; organisms resistant to both these drugs (multidrug-resistant tuberculosis [MDR-TB]) are much more difficult to treat.

  • Image not available. Never add only a single antituberculosis drug to a failing regimen for active TB!

  • Image not available. Directly observed therapy (DOT) should be used whenever possible to reduce treatment failures and the selection of drug-resistant isolates.

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INTRODUCTION

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Worldwide, tuberculosis (TB) kills about 1.5 million people each year, more than any other infectious organism. TB is caused by Mycobacterium tuberculosis, and it presents either as latent TB infection (LTBI) or as progressive active disease.1 The latter typically causes progressive destruction of the lungs, leading to death in most patients who do not receive treatment. Currently, one-third of the world's population is infected, and drug resistance is increasing in many areas.1

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EPIDEMIOLOGY

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Image not available. Roughly one of every three people on earth is infected by Mycobacterium tuberculosis...

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