Monday, 25 March 2019

Rule of 2 - Tuberculosis

Rule of two

1.      2 out of 10 word cases of TB are in India
2.      Tuberculosis has 2 words T and B = TB
3.      TB can be pulmonary or extra pulmonary.
4.      Resistant TB can be MDR or XDR Tb.
5.      MDR TB is seen in 2% of new TB cases.
6.      2 patients of every 10 patients are extra pulmonary RB cases
7.      One can treat both sputum positive of sputum negative cases
8.      Sputum negative cases confirm by GeneXpert or LPA test

9.      Don’t ignore fever and cough.

10.  Don’t ignore fever of more than 2 weeks duration.

11.  Don’t ignore cough of more than 2 weeks duration.

12.  Get 2 sputum examination to rule out TB (stat and nearly morning).

13.  Collect 2 ML of sputum for examination.

14.  Sputum can be tested by Z N Stain or fluorescent microscopy.

15.  2 tests for TB to remember: Sputum AFB and Molecular tests.

16.  Molecular tests can be GeneXpert TB test or LPA (line probe assay) test.

17.  GeneXpert TB tests is for rifampicin resistance (2R)

18.  GeneXpert TB test in private sector costs 2 thousand rupees.

19.  LPA for 2 drug resistances: INH and Rifampicin

20.  GeneXpert TB test results are available in 2 hours

21.  LPA test takes more than 2 days for the results

22.  In retreatment cases do both sputum AFB and molecular test

23.  In retreatment cases before labelling as a resistant case do the GeneXpert test 2 times.

24.  2 advanced investigations to remember: HRCT Chest and Bronchoscopy

25.  MDR TB means resistance to Rifampicin and INH. (2 drugs)

26.  XDR Tb means resistance to 2+2 drugs (Rifampicin and INH + quinolone and one injectable) or to 2 group of drugs

27.  Take 2 weeks precautions if AFB is positive.

28.  Rule out HIV and Diabetes Mellitus in case of TB.

29.  Use 2 type of masks, N 95 (for doctor) and surgical mask (for patients).

30.  Notify TB and screen the contacts.

31.  Not notifying TB is a crime under 2 clauses of MCI (5.2 and 7.14).

32.  Municipal Corporation and West Bengal CEA can take action if one fails to notify TB or fails to screen the contacts.

33.  Spreading infection is punishable under IPC Sections IPC 269/270.

34.  Patients of TB can be new cases or retreatment cases.

35.  There are 2 spells of treatment Intensive phase and continuation phase.

36.  For treatment TB can be sputum conformed TB or clinical TB.

37.  Give four drugs for 2 months.

38.  When we give 5 drugs we add SM injection for 2 months.

39.  At 2 months get 2 sputum tests done to confirm if AFB is negative or not.

40.  At 2 months if sputum AFB is positive think of GeneXpert TB tests or LPA test.

41.   In health care setting masks should be available at the reception and laboratory.

42.  Avoid split ACs at 2 places - in cars and at home.

43.  Use burial method or phenol to destroy the sputum.

44.  Skin and GI are the major organs affected by ATT.

45.  Vit B 6 and Vit D should be added to ATT.

46.  Brain and bone TB involvement require long treatment.

47.  MDR TB requires 2 years treatment.

48.  In MDR TB 2 out of 10 cases will die.

49.  In MDR cases 2 out of 10 will default.

50.  Patient rights: To get free diagnostics and free drugs from the government.

51.  Acid-fast bacteria visualized on a slide may represent M. tuberculosis or nontuberculous mycobacteria (NTM).

52.  Notify both confirmed and suspected case.

53.  Collect sputum: Spontaneously (by coughing) or induced by inhalation of aerosolized hypertonic saline generated by a nebulizer.

54.  Two most common presentation of Extra pulmonary TB are TB Lymph Nodes or pleural effusion.

55.  Common test for pleural effusion are proteins and presence of lymphocytes.

56.  Tow thigs to remember in pleural effusion: GeneXpert is negative and ADA test is positive.

57.  Paradoxical reaction in TB lymph nodes occurs at 2 months.

58.   MDR TB can be both pulmonary and extra pulmonary TB.

59.  Think before you order two tests: ELIESA and Gold Interferon.

60.  All biopsy samples should be taken in saline (for IRL) and formalin.

(with inputs from Dr Ashwani Khanna)