Carla

1. The overall goals for treatment of tuberculosis are 1) to cure the individual patient, and 2) to minimize the transmission of Mycobacterium tuberculosis to other persons. Thus, successful treatment of tuberculosis has benefits both for the individual patient and the community in which the patient resides. For this reason the prescribing physician, be he/she in the public or private sector, iscarrying out a public health function with responsibility not only for prescribing an appropriate regimen but also for successful completion of therapy.

2. People with at least 5 mm of induration or they have a positive result using a TB blood test: HIV-infected persons, Persons with fibrotic changes on chest radiograph, Patients with organ transplants, Persons who are immunosuppressed forother reasons (e.g., taking the equivalent of >15 mg/day of prednisone for 1 month or longer, taking TNF- antagonists)
In addition, people whose TST is at least 10 mm of induration: Recent arrivals (less than 5 years) from high-prevalence countries, Injection drug users, Residents and employees of high-risk congregate settings (e.g., correctional facilities, nursing homes, homeless shelters,hospitals), Persons with clinical conditions disease (e.g., diabetes)
To decide whether an individual who has a positive tuberculin skin test (TST) or interferon gamma release assay (IGRA) result is a candidate for treatment of LTBI
• Determine the benefits of treatment by evaluating individual's risk for developing TB
• Assess the person's level of commitment to completion of treatment
Oncethe decision is made to treat an individual for LTBI, the health care provider must: Emphasize importance of adherence, Identify potential barriers to adherence, Establish a plan to ensure adherence.
Baseline and routine laboratory monitoring during treatment of LTBI are indicated only when there is a history of liver disease, HIV infection, pregnancy, or regular alcohol use.

3. The decision toinitiate combination antituberculosis chemotherapy should be based on epidemiologic information; clinical, pathological, and radiographic findings; and the results of (AFB)--stained sputum (smears) and cultures for mycobacteria. A (PPD)-tuberculin skin test may be done at the time of initial evaluation, but a negative PPD-tuberculin skin test does not exclude the diagnosis of active tuberculosis.If the suspicion of tuberculosis is high or the patient is seriously ill with a disorder, either pulmonary or extrapulmonary, that is thought possibly to be tuberculosis, combination chemotherapy using one of the recommended regimens should be initiated promptly, often before AFB smear results are known and usually before mycobacterial culture results have been obtained.

4. Esputo:
– Enjuagarla boca con agua destilada estéril
– Obtener esputo tras expectoración profunda, matinal.
– Se puede inducir el esputo con nebulizaciones de suero fisiológico (15 ml, 10 min), manitol, solución salina hipertónica al 3%. Broncoscopía.
– Necesario esputo:>25 PMN y 10 células epiteliales/campo de 100x
Una buena muestra es la que proviene del árbol bronquial, obtenida después de un esfuerzode tos. Boca ancha, Pared lisa, tapa, Transparente.

5. Multidrug-resistant TB (MDR TB) is TB that is resistant to at least two of the best anti-TB drugs, isoniazid and rifampicin. XDR TB is defined as TB which is resistant to isoniazid and rifampin, plus resistant to any fluoroquinolone and at least one of three injectable second-line drugs (i.e., amikacin, kanamycin, or capreomycin). BecauseXDR TB is resistant to first-line and secondline drugs, patients are left with treatment options that are much less effective. In the United States, the cost of hospitalization for one XDR TB patient is estimated to average $483,000, approximately twice the cost for MDR TB patients.

6. Antiretroviral therapy (ART) strengthens the immune system and restores protective pathogen-specific immune...