03 - Respiratory System Infections Flashcards
1
Q
Primary infection originated in the respiratory system:
A
● Meningitis
● sepsis
2
Q
t/f: Lungs are very well vascularized
A
● Lung infections have likeliness to gain access to bloodstream
● Thus causing an invasive disease
3
Q
In order to develop a respiratory tract infection:
A
a. Has to have shift in host factors
b. Or there is a shift in quality of normal flora
c. Or exposure of microorganism is so significant that it overwhelms host defences
4
Q
Upper RT
A
● Collects & filters air
● Non-sterile spaces
● There is a rich microbiome → largely commensal organisms
5
Q
t/f: Tonsils important for defence against infection
A
true
6
Q
t/f: Not uncommon for the normal flora to contain microbes that are considered pathogenic; ○ As long as they remain in upper RT there is no issuesv
A
true
7
Q
Upper RT: Defensins
A
antimicrobial peptides make it difficult for microorganisms to cause infection
8
Q
Upper RT: Lactoferrin
A
bind to iron to keep its load low
9
Q
Upper RT: Lactoferrin
A
bind to iron to keep its load low
10
Q
Upper RT: Lysozyme
A
destroys and digests peptidoglycans
11
Q
Lower RT
A
● Respiratory tree ● Main purpose: exchange of gas ○ Oxygen & CO2 ● Typically sterile ○ There are often no commensal organisms that are normal flora ○ There is NO microbial antagonism to contribute to resilien ● Ciliary escalator ○ Helps to move organisms out ● Secretory antibodies ○ IgA ● Phagocytes
12
Q
Upper Respiratory Tract Infections; Bacterial URTIs
A
● Pharyngitis
○ Mostly viral
○ Streptococcal pharyngitis is the most common cause for this bacterial URTI
○ Group A streptococcus (Streptococcus pyogenes)
● Otitis media and Rhinosinusitis
○ Streptococcus pneumoniae (35%)
○ Haemophilus influenzae (20 – 30%)
13
Q
Upper Respiratory Tract Infections; Viral URTIs
A
● Pharyngitis
● Otitis media → middle ear infection
● Rhinosinusitis
● Common cold
14
Q
Upper Respiratory Tract Infections; Viral URTIs treatment
A
*can only provide symptomatic measures and supportive therapy
15
Q
Upper respiratory infections are normally viral or bacterial?
A
viral
16
Q
URT: Streptococcal Pharyngitis → Strep Throat
A
Caused by streptococcus pyogenes (Group A strep) ● Pharynx appears red ○ Presence of purulent abscesses ○ Swollen lymph nodes ○ Mostly viral can be bacterial
17
Q
URT: Streptococcal Pharyngitis → Strep Throat
A
Caused by streptococcus pyogenes (Group A strep) ● Pharynx appears red ○ Presence of purulent abscesses ○ Swollen lymph nodes ○ Mostly viral can be bacterial
18
Q
URT: Streptococcal Pharyngitis → Strep Throat Symptoms
A
● Pain during swallowing ● Bad breath ● Fever ● Headache ● Malaise
19
Q
URT: Streptococcal Pharyngitis → Strep Throat can cause
A
● Laryngitis
○ If it moves to larynx
● Bronchitis
○ If it moves to bronchi = more complicated
20
Q
Subtypes of streptococcus pyogenes: Scarlet fever
A
● Some subtypes can erythrogenic toxins
○ Cause rash over the body
○ Strawberry like tongue
21
Q
Subtypes of streptococcus pyogenes: Glomerulonephritis
A
○ Inflammation of kidney
○ Loses ability to appropriately filter the blood
○ Can cause acute renal failure
22
Q
○ Inflammation of kidney
○ Loses ability to appropriately filter the blood
○ Can cause acute renal failure
A
23
Q
Subtypes of streptococcus pyogenes: Rheumatic fever
A
○ Unusual, immunological reaction to group A strep
○ Develop rheumatic fever
24
Q
Suspect bacterial pharyngitis → Group A strep:
A
● Perform rapid strep test ○ Rapid molecular technique ○ Take swab of pharynx ○ Identify strep organism ○ Takes 15 mins to perform ○ Good level of sensitivity ● Prescribe antibiotic ○ Due to its capacity to cause scarlet or rheumatic fever ○ Do not want to leave Group A strep untreated ● Well and easy to cure with antibiotics
25
Strep Throat Prevention
● People are contagious 2 days after antibiotics
| ● Manage exposure to respiratory secretions
26
URT: Otitis Media
Severe ear pain due to inflammation & pressure on ear drum
27
URT: Otitis Media can cause
```
● Rupture
● Hearing impairment
● If they are viral → cannot resolve them
○ Put tubes in ears to relieve pressure
● If they are bacterial → antibiotics
```
28
URT: Otitis Media is most common in which population and why
Pediatric cases most common
● 85%
● Anatomy & immunity
○ Eustachian tubes are narrow and have angle
○ Making it difficult for them to drain right
29
URT infections bacterial
- strep throat
- otitis media
- rhinosinusitis
30
URT: Rhinosinusitis Symptoms
```
● Sinus pain & pressure
○ Nociceptors are actively innervated
○ Cause pain and pressure
● Headache
● Malaise
● Viral → symptom management
● Bacterial → antibiotics
```
31
Rhinosinusitis more common in adults or children?
adults
32
Upper Respiratory Tract Infections → Viral
● Most rhinosinusitis and otitis media are caused by viral infections
○ ~10% by bacteria
33
t/f: Most rhinosinusitis and otitis media are caused by viral infections
○ ~10% by bacteria
true
34
Likely to be bacterial if acute rhinosinusitis lasts...
more than 10 days
● Accompanied by:
○ High fever
○ Pus-filled nasal discharge
35
Upper Respiratory Tract Infections → Viral; Streptococcus pneumoniae
leading cause of bacterial middle ear and sinus infections
● Primary bacterial pathogen
● Infections move from pharynx → sinuses (via throat) or → middle ear (via auditory tubes)
● Risk of invasive pneumococcal disease
○ Pneumonia
○ Meningitis
○ Bacteremia
36
Upper Respiratory Tract Infections → Viral; Common Cold
```
● Most common human infections
● Numerous viruses responsible
○ Rhinovirus
○ Coronavirus
○ Adenovirus
● Remains infective for hours outside the body
● Highly contagious
○ Exits host cell though lysis
○ This causes symptoms
```
37
How does the common cold exit host cell?
through lysis
38
Upper Respiratory Tract Infections → Viral; Common Cold Transmission
```
● Respiratory droplets
○ Coughing on someone or object
● Fomites
● Direct contact
● Single virus is sufficient to cause infection
***Hand-washing & routine practices
```
39
Upper Respiratory Tract Infections → Viral; Common Cold Symptoms
```
● Prodrome of chills and rigors
○ This occurs first
● Sneezing
● Rhinorrhea
● Nasal congestion
● Dry, scratchy sore throat
● Malaise
● Cough ~1 week
● No fever (unless concomitant bacterial infection)
○ Cold does not like our body temperature
○ We are too warm
```
40
LRT infections: Pneumonia
Infection of the LRT:
● Lower lobes are Inflamed
● Fluid-filled alveoli & bronchioles
○ Feel SOB
41
LRT infections: Pneumonia serious cases
Empyema: Presence of pus within the pleural space
| ● MUST be hospitalized
42
Pneumonia is the what ranked cause of death
6th leading cause of death + most common cause of death due to infection
43
Affects of age within pneumonia
● More common in the fall and winter
○ Similar pattern to the flu
○ Flu sets good stage for pneumonia to occur
○ Flu damages lungs → opportunity for pneumonia to occur
● Length of stay increases in clients ≥70 years of age
44
When is pneumonia more common?
More common in the fall and winter
45
What sets the stage for pneumonia?
○ Similar pattern to the flu
○ Flu sets good stage for pneumonia to occur
○ Flu damages lungs → opportunity for pneumonia to occur
46
Age categories that all cause pneumonia related hospitalizations
Younger than 4 + those older than 65
47
Pathophysiology of Pneumonia
Pneumococcal pneumonia → bacterial
● 85% of community acquired cases
○ Caused by streptococcus pneumoniae
● Pathogens in pharynx aspirate into lower lobes of the lungs
○ Once it enters lower lobes = disease
● 75% of humans are colonized with S. pneumoniae
○ Belongs in upper respiratory tract
○ Cough it up = get rid of it
○ All of us microaspiration in our sleep and we cough
○ Pneumonia develops if not effectively cleared by the immune system
48
Pneumococcal pneumonia → bacterial Risk Factors
```
● Previous viral respiratory disease
● Drug abuse
● Alcoholism
○ Dramatically suppresses cough reflex
○ They microaspirate at night = cough is inhibited
○ Microorganism stays in the lower lobes
○ Causes pneumonia
● HF
● DM
● AIDS & other immune conditions
```
49
Pneumococcal pneumonia → bacterial: Three important variables
● Pathogenicity of the organism
○ What is its capacity to cause infection in lung
○ More virulent → more likely to acquire pneumonia
○ S. Pneumoniae is very virulent and pathogenic
● Degree of aspiration
○ We cough and swallow it → gut destroys microbe
○ Must effectively cough it up
● Health of the host
○ Immune and respiratory systems
50
Community acquired pneumonia (CAP)
Primary atypical pneumonia
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- 85% of cases are caused by streptococcus pneumoniae
51
Nursing home acquired pneumonia (NHAP)
● Acquire in long-term care
52
Hospital acquired pneumonia (HAP) → not many cases
● Hospitals are filthy with gram negative organisms
● VAP (ventilator associated pneumonia)
● HCAP (health care associated pneumonia)
○ Pneumonia in non-hospitalized patients with lots of interaction with healthcare system
○ Organism was acquired in hospital
53
T/F: all strep are gram positive
true
54
Streptococcus Pneumoniae → leading cause of community acquired pneumonia
● Coccoid shaped bacteria
| ● Grow in pairs and chains
55
Streptococcus Pneumoniae :Pathogenic factors
Produce adherence factors
○ Facilitate binding to pharyngeal epithelial cells
Induce endocytosis
○ It goes into non-phagocytic epithelial cells of the lung
Produce a cytotoxin (pneumolysin)
○ Induces cell lysis
○ Destroys cell membranes
○ Cause bleeding → Community acquired have rust coloured sputum
56
Community Acquired Pneumonia: Pneumococcal pneumonia caused by
caused by streptococcus pneumoniae
57
Community Acquired Pneumonia: Pneumococcal pneumonia
● Transmission via respiratory droplets
● S. pneumoniae damages alveolar lining b/c cytotoxin
○ RBCs, WBCs & plasma enter lungs
○ Fluid filled alveoli where air should be + Inflammation
○ Impairs gas exchange
○ Causing pneumonia
58
What kind of onset does Pneumococcal pneumonia have
sudden
59
Pneumococcal pneumonia symptoms
```
● Fever
● Chills
● Congestion
● Productive cough
● Chest pain due to fluid buildup
● SOB due to impaired gas exchange
● Fatigue
● Loss of appetite
```
60
Sputum in Pneumococcal pneumonia characteristics and can cause
Sputum → rust coloured (blood) & increased neutrophils
● Invasive diseases
● Bacteremia
● Meningitis
61
T/F: Pneumococcal pneumonia affects extreme of age
true
62
Invasive Pneumococcal Disease
● Infection does not stay in lung → moves elsewhere
● Extremes of age are affected
● Need to worry about sepsis or meningitis
63
Community Acquired Pneumonia
Mycoplasma pneumoniae → walking pneumonia
● Bacterial
● Primary atypical pneumonia
○ The other 15% of CAP
64
Community Acquired Pneumonia: Transmission
● Respiratory droplets
● Fomites
● Direct contact
65
Community Acquired Pneumonia is it seasonality?
occurs throughout the year
| ● Most frequently reported in young adults
66
Community Acquired Pneumonia: Pathogenic Factors
```
● Damage ciliary escalator
○ Inhibit removal of mucus
○ Slow growing
○ Accumulation of mucus and fluid
○ Impairs gas exchange
○ Possess adhesins specific to the cilia of respiratory epithelial cells and a capsule
```
67
Community Acquired Pneumonia: Symptoms
```
● Fever (lower than CAP)
● Malaise
● Headache
● Sore throat
● Excessive sweating
● Non-productive cough
● Symptoms not typical of other types of pneumonia
● Mucoid (thick, sticky) sputum
```
68
Viral Pneumonia must be distinguished from what?
→ must distinguish it from influenza
69
Influenza virus
- viral pneumonia is caused by the influenza virus
- Seasonal (spring and fall)
- Pandemic (H5N1)
70
-viral pneumonia is caused by
influenza virus
71
Respiratory syncytial virus (RSV) is mainly involved in what population?
mainly in pediatric population
72
Respiratory syncytial virus (RSV) transmission
● Respiratory droplets
● They are not colonizing the respiratory tract → NOT normal flora
● They are acquired through droplets
73
Viruses can lead to pneumonia in 2 ways:
1. Primary viral pneumonia
- Uncomplicated
2. Respiratory viral infection followed by bacterial super-infection
a. They will have influenza virus
b. This will cause influenza
c. Influenza will weaken the host defenses → diminish neutrophils and damage resp epithelial cells
d. This sets stage for bacterial pathogens → streptococcus pneumoniae
e. This means they have super infection
74
Viral Pneumonia Symptoms:
```
● Non-productive cough
● Low grade fever
● Myalgias
● Fatigue
● Sore throat
● Headache
```
75
Viral Pneumonia treatment
*can only provide symptomatic management
76
INFLUENZA disease Symptoms:
```
● Sudden & high fever
● Pharyngitis
● Congestion
● Dry cough
● Malaise
● Myalgias → profound aches and pains
● Headache
```
77
Corona Virus Disease
* Novel Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2)
* Transmission through respiratory droplets and aerosols
* Clinical features of COVID-19 and symptom severity are variable and influenced by host factors such as age, comorbidities and vaccination status
78
Corona Virus Disease transmission
• Asymptomatic infection and transmission
79
Corona Virus Disease symptoms
* Fever, chills, headache, dry cough, sore throat, runny or congested nose, muscle aches, joint pain, fatigue, shortness of breath, decrease/loss of smell and taste, nausea, diarrhea
* Pneumonia, acute respiratory distress syndrome, sepsis and death
80
Corona Virus Disease Vaccination
¡ 4 SARS-CoV-2 vaccines approved for use in Canada
§ Viral vector vaccines (AstraZeneca Vaxzevria and J&J)
§ mRNA vaccines (Moderna SpikeVax, Pfizer-BioNTech Comirnaty)
¡ mRNA vaccines
§ Induce spike protein production by host cells; Host immune system recognizes the spike protein as foreign, initiates an immune response; develops antibodies against the spike protein
§ 2 doses of a mRNA vaccine prevents severe illness, hospitalization and death from COVID-19
§ Some clients will still develop COVID-19, but experience only mild symptoms aka ”breakthrough cases”
81
Corona Virus Disease: Things to remember:
¡ High quality masks, physical distancing, and good ventilation are important additional layers of protection against COVID-19
§ No vaccine is 100% effective
§ Not everyone is vaccinated
§ Not everyone is able to be vaccinated
82
Symptoms of Long COVID-19
- Fatigue, memory problems, sleep disturbance, shortness of breath, general pain and discomfort, difficulty thinking or concentrating (brain fog)
- Anxiety, depression and PTSD
83
Treatments for covid-19
- Anti-inflammatory Drugs
- Monoclonal antibodies
- Antivirals
84
Does a normal lung exam rule out pneumonia?
● NO
● Just b/c the lungs sound clear does not mean they are normal
● Order chest x-ray
85
CAP → Diagnosis
How helpful is a client’s history and physical examination in making the diagnosis of CAP?
● Fever, cough, sputum, dyspnea, respiratory rate, heart rate
● None of these alone are enough to gauge our diagnosis on
● They are clues!
86
Chest X-Ray → for Pneumonia: Infiltrate or Consolidation
fluid or pus that has moved into the lungs
87
Pneumococcal pneumonia
→ microbe produces invasins
| ○ Mechanically causing damage to lung
88
t/f: a chest x ray is necessary for diagnosis of pneumonia
● A chest x-ray is necessary
| ● Symptoms and signs are required to establish a diagnosis of pneumonia
89
Diagnosis of Pneumonia Signs and Symptoms
● Fever
● Productive cough
● Increased respiratory and heart rate
● Lower O2 sat level
90
Diagnosis of Pneumonia: Infiltrates on chest x-ray
● NO filtrate → NO pneumonia; in most cases
● Immunocompromised → may not produce as much filtrate due to depressed immune system
● Pathologically dehydrated → may not produce as much filtrate
91
Other Diagnostic Tests for pneumonia include
```
Need to determine:
1. Severity of illness
2. Possible complications
3. Status of underlying conditions
●ABG’s
●Complete blood counts
●Electrolytes → determine how hydrated they are
●Renal and liver function tests
○Kidneys will reveal if client is at risk for sepsis
○Stress on kidneys = poor prognosis
●Blood cultures x 2 sets
○2 tubes at each venipuncture
○1 anaerobic and 1 aerobic
```
92
Other diagnostic tests: Pathogen specific
●Sputum Gram stain and culture
○ Quickly identify microorganism
○ Need to determine if antibiotics will be effective
●Nasopharyngeal swab if viral etiology suspected
○ This is where the greatest density of virus will be
●Sputum for AFB and MTb culture
93
CURB-65 →: C
```
C → Confusion
● Earn a point for confusion
● Severe infection = inflammation = evolve into inflammation of blood brain barrier
● Immune cells penetrate the brain
● Indicates severe systemic inflammation
```
94
CURB-65: U
U → Urea
● Earn a point for high urea
● Above 7 mmol/L
● High urea = stress on kidneys
95
CURB-65 ; R
R → Respiratory Rate
| ● Higher than 30 breaths a min = earn a point
96
CURB-65: B
B → Blood pressure
● Systolic less than 90 and diastolic less than 60 = earn a point
● Consistent with sepsis
97
CURB-65
65 → Age
| ● Over the age of 65 = increased risk = earn a point
98
Outpatient Treatment: Pneumonia Considerations
```
● Hemodynamic instability
● Hypoxemia
○ PO2 < 60 mm Hg
○ O2 saturation < 90 %
● Presence of empyema
○ Pus in pleural cavity
○ HOSPITALIZED
○ Suggests significant risk for invasive disease
● Active co-existing condition
○ Other comorbidities need to be managed
● Lack of home support
● Unable to tolerate PO antibiotic
○ Stroke = have trouble swallowing
```
99
Antibiotic Therapy: Target responsible pathogens
●Antibiotic susceptibility profile
| ●Penetration of bronchial tree
100
Antibiotic Therapy: Consider antibiotic exposure within past 3 months
● Treated for strep throat → resistant to certain antibiotics
● To ensure the correct one is chosen
101
Systemic corticosteroid therapy in clients with severe CAP to reduce the rate of:
● Mechanical ventilation
● Acute Respiratory Distress Syndrome
● Time to clinical stability
● Duration of hospitalization
102
Prevention of Pneumonia
Hand-washing
Annual influenza vaccine
●Reduces risk of influenza and bacterial superinfection
●Patients with chronic medical conditions
●All healthcare providers
●Household contacts of high-risk patient
Pneumococcal vaccines
●Routine infant immunization:
○Prevnar-13 → covers 13 different serotypes
●Pneumococcal polysaccharide vaccine
Pneumovax23
○Protect against invasive pneumococcal disease
○All Individuals ≥ 65 years of age
○Individuals at increased risk for invasive pneumococcal disease (pneumonia, bacteremia, meningitis) ≥ 2 years of age
103
Hand-Washing
Incidence of invasive pneumococcal disease in the elderly
● Big spike between late Dec and early Jan
● Little people are going to visit older people
● Grandchild-associate Pneumonia
● Carry organism in their normal flora
● Peaks start to decline
○ Incidence of invasive pneumococcal in elderly decreased
○ Due to immunization of children against streptococcus pneumonia
104
Efficacy of Pneumococcal Polysaccharide Vaccine in High Risk Groups: Controversial
●Doesn’t prevent pneumonia in elderyl
○Prevents invasive disease
○Immunosenescence
○Do acquire pneumonia → likelihood of complication is much lower
●Most think it reduces the risk of invasive pneumococcal disease
105
Efficacy of Pneumococcal Polysaccharide Vaccine in High Risk Groups: Bottom line
● Cheap & safe
● Data suggests a reduction in hospitalization rates
● Still recommended for all ≥65 years
106
Tuberculosis
```
→ most common infectious cause of death worldwide
● 30% of world’s population infected
● Incidence
○ 8 million active cases
○ 3 million deaths → most are children
```
107
What causes TB?
Mycobacterium tuberculosis → causes tuberculosis
● Rod-shaped = bacillus
● Aerobic bacteria
● Non-spore forming
108
Tuberculosis: Resists decolorization by alcohol “acid-fast bacilli”
● Requires an acid fast stain for identification
● Surrounded by mycolic acid
● AFB
109
Tuberculosis: Resistant to chemical agents
● Resistant to cleaning strategies in environment
● Some bacilli can survive acidic/alkaline environments
● Resistant to drying and can survive in dried sputum
○ Additional Airborne Precautions required
110
Tuberculosis:Common mode of transmission
● Inhalation of organism laden droplet nuclei
● Infective in dried aerosol droplets for up to 8 months
● High risk of transmission
111
Tuberculosis: Actual infection risks
```
● Organism load of the droplet, frequency and efficiency of cough
● Closeness of contact & adequacy of ventilation in the contact area
● Host factors:
○ DM
○ Poor nutrition
○ Stress
○ Alcohol & drug use
○ Smoking
```
112
Primary TB
● Inhalation and deposition of bacilli in lungs
○ Inhale organism and become sick
● 5% of individuals will develop primary “active” TB
● Mostly children
● Clients are actively sick and infectious
113
Primary TB: Symptoms:
```
● Serious, productive cough (blood & sputum) lasting 3 weeks or longer
● Chest pain
● Weakness or fatigue
● Weight loss
● Lack of appetite
● Chills
● Fever and night sweats
```
114
TB confirmed by
Positive chest x-ray and sputum
115
Latent TB
● ~95% of individuals
○ Exposed but they do not show any signs/symptoms of infection
● Immune system prevents spread and progression of the disease
○ Keeps it in hibernated state
○ Waits for immune system to be weakened
● Clients are asymptomatic
○ They are not infectious
116
Latent TB: Negative chest x-ray and sputum
● Present with a positive TB skin test or TB blood test
At risk for development of tuberculosis disease if latent TB is not treated
● Must assess risk factors
117
Latent TB: treat with
● Isoniazid (6 – 9 months; pregnant women & children < 11 yrs, HIV)
● Rifampin (4 months)
118
Investigation for Latent TB: Tuberculin skin test
● Tuberculin (antigen) is injected into the skin of the lower arm
● 48 – 72 hrs after → client is assessed for a reaction
119
Positive skin test
● Hard, red swelling at the test site
| ● Client is infected with TB bacteria
120
Negative skin test
● No reaction, latent TB infection is unlikely
● Lacks utility in active TB
○ Not used to diagnose those with active TB
○ Negative result does not exclude active TB
● 20-25% of those with active TB will show a negative result
121
Secondary TB
● Immune system changes
● Latent infection reactivates
● Client exhibits symptoms of post-primary “active” tuberculosis
122
Secondary TB: Signs and symptoms
```
same as active TB
● Serious, productive cough last 3+ weeks
○ Blood & sputum
● Chest pain
● Weakness or fatigue
● Weight loss
● Lack of appetite
● Chills
● Fever and night sweats
```
123
Secondary TB: Require the following to make diagnosis:
● Medical history
● Physical exam
● Chest x-ray
● Diagnostic microbiology
124
Secondary TB: treated vs untreated
Treated → 15% mortality
| Untreated → 55% mortality
125
Investigations for Active Pulmonary TB: Best diagnostic samples
```
● Early AM sputum
○ 3 daily collections
○ Yield positive results in most cases (> 90%)
○ Maximize sensitivity of organism
● Induced sputum
○ Give hypertonic heated saline aerosols
○ Help moisten lungs and get sputum up
● If unable to produce sputum
○ Early AM Gastric aspirates (children)
○ Bronchoscopy, BAL
■ Invasive
■ Infectious risks
■ Less sensitive than sputum samples
```
126
Tuberculosis → Disease Course: Risk of reactivation
● 5 - 10% will reactivate during their lifetime
127
Those at high risk for developing active TB disease include:
● HIV infection
● Infected with TB bacteria in the last 2 yrs
● Babies and young children
● Inject illegal drugs
● Sick with other diseases that weaken the immune system
● Elderly people
● Not treated correctly for TB in the past
128
Extrapulmonary Tuberculosis
```
Disseminated tuberculosis
● Tuberculous lymphadenitis
○ Moves to lymph nodes
● Brain
● Spine
● Kidneys
```
129
Always consider active TB when: TB disease should be suspected with the following symptoms:
```
● Unexplained weight loss
● Loss of appetite
● Night sweats
● Fever
● Fatigue
● Non-resolving “pneumonia”
```
130
TB disease should be suspected with the following symptoms:Suspected → referred for:
```
● Complete medical evaluation
● Medical history
● Physical examination
● Chest x-ray
● Diagnostic microbiology
```
131
Treatment of TB
```
● Select treatment regimen (6 – 9 months)
○ Isoniazid
○ Rifampin
○ Ethambutol
○ Pyrazinamide
● Modify when susceptibility test available
○ Weeks for growth + additional time for testing
● Address Public Health Issues
● Monitor for drug toxicity
○ e.g. liver, kidney, eye damage
● Monitor for adherence
● Evaluate response to therapy
○ Multi-drug resistant (MDR)
○ Extensively MDR strains (XDR)
```
