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CASE 1<\/strong><\/p>\n\n

A 16-year-old male had cough with sputum and low-grade fever since the last 2 weeks. His chest X-Ray shows bilateral infiltration with multiple cavities.<\/p>\n\n

\n1. What is the next step?<\/p>\n\n

2. How many sputum samples are to be collected?<\/p>\n\n

3. What is the purpose of each sample?<\/p>\n\n

<\/p>\n","answer":"

1. Collect sputum for NAAT to check for Rif resistance. <\/p>\n\n

2. Two samples<\/p>\n\n

3. 1st sample for NAAT and, 2nd sample is for IRL for LPA (FL-LPA and SLLPA, LC DST). <\/p>\n","tips":{}},{"text":"

The NAAT shows MTB and detected Rif resistance.<\/p>\n\n

What are the preferences to select the right regimen? <\/p>\n\n

<\/p>\n\n

<\/p>\n","answer":"

BPaLM > Shorter > Longer [since the pt is older than 14 years old]<\/p>\n\n

<\/p>\n","tips":{}},{"text":"

Is the patient eligible for BPaLM?<\/p>\n","answer":"

Eligibility Criteria for BPaLM:<\/strong><\/p>\n\n

i. Age: 14 years and above<\/p>\n\n

ii. New microbiologically confirmed RR-TB requiring a new course of treatment<\/p>\n\n

iii. Person with exposure of less than one month intake of Bdq, Lzd and\/or Pa in the past or Person with exposure of more than one month intake of Bdq, Lzd and\/or Pa and documented sensitivity to both the drugs. or People who had not failed treatment with Bdq or Lzd containing shorter or longer regimen, unless and sensitivity to these drugs are documented<\/p>\n\n

iv. People with no significant conduction abnormalities in the heart including structural heart disease, syncope, long QT syndrome, AV blocks , Reentry arrhythmias etc. apart from asymptomatic QTcF>500ms), not on anti-psychoticsiatric medication<\/p>\n\n

v. People with no significant liver dysfunction [LFT (Liver enzymes and\/ or total bilirubin) <3xUpper Limit of Normal (ULN)]<\/p>\n\n

vi. Non-lactating women, non-pregnant or pregnant women with <24 weeks gestation and who is willing for medical termination of pregnancy (MTP)<\/p>\n\n

vii. People with no severe forms of extrapulmonary-MDR-TB like CNS TB, skeletal TB or disseminated TB<\/p>\n","tips":{}},{"text":"

If the patient was 13 years old, what is the preferred regimen in the same scenario?<\/p>\n","answer":"

Oral shorter (9 months) cannot be considered as this is an extensive Bilateral cavity disease. Thus, Consider longer regimen ONLY. <\/strong><\/p>\n","tips":{}},{"text":"

CASE 2<\/strong><\/p>\n\n

A 25 year old female, disseminated tuberculosis with CNS TB, has reported Rifampicin resistance. <\/p>\n\n

What is the preferred regimen and Why? <\/p>\n","answer":"

Since it is disseminated with CNS TB, the BPaLM and 9 month shorter oral Bdq containing regimen is ruled out and hence consider longer oral M\/XDR TB treatment.<\/strong><\/p>\n","tips":{}},{"text":"

1. In the same scenario, if the patient is 13 years of age with pulmonary non-extensive TB disease with Rif Resistance, What would be preferred regimen?<\/p>\n\n

2. What test is to be done before offering the preferred regimen?<\/p>\n","answer":"

1. Shorter oral regimen (9 month) if the FQ resistance is ruled out.<\/p>\n\n

2. Look for NAAT for Inh and FQ. <\/p>\n","tips":{}},{"text":"

CASE 3<\/strong><\/p>\n\n

A 45-year-old lady with known case of diabetes which is poorly controlled, is on oral anti diabetic drug, on irregular treatment for 5 years. She is now complaining of cough with expectoration, lower grade fever, shortness of breath for 1 month, and there is blurring of vision since 1 month. Chest X-Ray shows bilateral mid & lower zone opacity suggestive of TB. Smear microscopy shows AFB+.<\/p>\n\n

What are the Next steps? <\/p>\n\n

<\/p>\n","answer":"

\u2022 NAAT test suggestive of Rif resistance.<\/p>\n\n

\u2022 Ophthalmic evaluation: patient had retinopathy grade 3. <\/p>\n\n

Management:<\/strong> \u2022 Control diabetes with insulin<\/p>\n\n

\u2022 Modified longer oral regimen <\/p>\n","tips":{}}],"behaviour":{"enableRetry":true,"disableBackwardsNavigation":false,"scaleTextNotCard":false,"randomCards":false,"maxProficiency":5,"quickProgression":false},"answer":"Turn","next":"Next","prev":"Previous","retry":"Retry","correctAnswer":"I got it right!","incorrectAnswer":"I got it wrong","round":"Round @round","cardsLeft":"Cards left: @number","nextRound":"Proceed to round @round","startOver":"Start over","showSummary":"Next","summary":"Summary","summaryCardsRight":"Cards you got right:","summaryCardsWrong":"Cards you got wrong:","summaryCardsNotShown":"Cards in pool not shown:","summaryOverallScore":"Overall Score","summaryCardsCompleted":"Cards you have completed learning:","summaryCompletedRounds":"Completed rounds:","summaryAllDone":"Well done! You have mastered all @cards cards by getting them correct @max times!","progressText":"Card @card of @total","cardFrontLabel":"Card front","cardBackLabel":"Card back","tipButtonLabel":"Show tip","audioNotSupported":"Your browser does not support this audio","confirmStartingOver":{"header":"Start over?","body":"All progress will be lost. Are you sure you want to start over?","cancelLabel":"Cancel","confirmLabel":"Start over"},"title":"","description":""}

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Scenarios for deciding for DR-TB Regimen

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Scenarios for deciding for DR-TB Regimen

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