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Infectious Disease > 2: Mycobacterial Infection > Flashcards

2: Mycobacterial Infection Flashcards

1
Q

What is mycobacterium TB

A

Infection with mycobacterium TB

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2
Q

What countries have the highest incidence of TB

A

Phillipines
Indonesia
China

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3
Q

What type of organism is mycobacterium TB

A

Aerobic gram-positive, acid-fast bacilli

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4
Q

What is mycobacterium bovis

A

Mycobacterium bovis causes GI TB leading to increase incidence of colorectal cancer

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5
Q

What are 4 RF for mycobacterium TB

A
  • Immunosuppressed
  • High-risk setting
  • Malnutrition
  • Lung disease
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6
Q

Name 3 immunosuppressed patients

A

HIV
Diabetics
Corticosteroids
Alcoholics

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7
Q

What is the biggest killer in HIV patients

A

TB

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8
Q

How do patients present in latent infection

A

Asymptomatic

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9
Q

Are patients contagious in latent infection

A

No

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10
Q

What are the two types of active infection

A

Primary and re-activation

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11
Q

Are individuals contagious in active infection

A

Yes

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12
Q

How does active infection of TB present

A
  • Constitutional: weight-loss, night sweats, malaise, fever

- Pulmonary: haemoptysis and dyspneoa

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13
Q

What % of individuals with TB have extra-pulmonary features

A

20

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14
Q

What are the symptoms of TB lymphadenitis

A

Painless enlargement of sub-clavicular and axillary lymph nodes

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15
Q

How does GI TB present

A

Vomiting, colicky abdominal pain as inflammation can cause adhesions and bowel obstruction

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16
Q

What is spinal TB called

A

Pott’s disease

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17
Q

What is miliary TB

A

Haematogenous spread of TB throughout the lung

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18
Q

How does CNS TB present

A

Rupture of foci can cause meningitis

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19
Q

What is a feature of GU TB

A

Sterile pyuria

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20
Q

How does cutaneous TB present

A

Painful red nodules usually on the face

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21
Q

Explain pathophysiology of TB infection

A
  • TB enters lungs
  • Macrophages engulf TB into a phagosome
  • Lysosome then fuses with phagosome. This environment enables TB to survive
  • TB proliferates to cause a localised infection
  • Cell-immunity is then activated and surrounds TB to form a granuloma
  • TB in the centre then dies - presenting as caseous necrosis
  • TB also enters Hilary lymph node carried by lymph and other immune cells. Ghon focus and lymph node involvement is termed the Ghon complex
  • The tissue in the ghon complex calcifies to form a ranke complex
  • If a person is immunocomprimsied it becomes reactivated and moves to the upper part of the lung
  • When re-actvate immune system memory T cells try to fight infection causing damage resulting in cavitation causing infection to disseminate
  • If haematogenously it causes miliary TB
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22
Q

What type of hypersensitivity reaction is TB

A

Type IV hypersensitivity reaction

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23
Q

What is the Mantoux test

A

Intradermal infection of purified protein derivative tuberculin

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24
Q

What does a induration of less than 6mm mean

A

Negative

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25
Q

If induration is less than 6mm what should you do

A

Give TB vaccine

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26
Q

If induration is 6-15mm what does it mean

A

Hypersensitive to TB

- Previous infection or vaccine

27
Q

If 6-15mm on TST should individual have vaccine

A

No

28
Q

What does induration of more than 15mm mean

A

Strongly positive to TB - likely current infection

29
Q

What can cause false negatives of TST

A
  • Miliary TB
  • Sarcoidosis
  • HIV
  • Lymphoma
  • < 6 months
30
Q

What interferon gamma release assay (IGRAS)

A

Interferon gamma release from T-cells

31
Q

what investigations are used to identify TB

A
  • CXR
  • Sputum smear
  • Sputum culture
32
Q

what will be seen on CXR

A
  • Upper lobe opacities

- Miliary disease

33
Q

how is a sputum smear taken

A

3 deep coughs - one early morning sample

34
Q

what is alternative to sputum smear in children for TB

A

gastric acid lavages - 3 samples

35
Q

what is used to test for TB

A

ziehl-neelsen stain

36
Q

how will TB present on ziehl-neelsen stain

A

red (due to being acid-fast)

37
Q

what is the gold-standard investigation for TB

A

sputum culture

38
Q

how long does sputum culture take in liquid media

A

1-3W

39
Q

how long does sputum culture taken in solid media

A

4-8W

40
Q

what media is used for sputum culture

A

Lowenstein Jensen

41
Q

how will TB present in lowenstein-jensen media

A

Ruff, Buff and tough

42
Q

what is the role of nucleic acid amplification testing

A

identify DNA or RNA

43
Q

what is the diagnosis time for RAAT

A

8-hours

44
Q

what may be performed for CNS TB

A

LP

45
Q

what will be seen in LP for CNS TB

A
  • Leucocytosis
  • Low glucose
  • High protein
46
Q

explain notification for TB

A

TB is a notifiable disease and CDC should be contact in in 3-days

47
Q

explain contact tracing for TB

A

All individuals who do not have TB are sent an anonymous letter inviting them to screening

48
Q

how is TB managed

A

RIPE - for 2 months

RI - for 4 moths

49
Q

what is directly observed therapy

A

indicated for people with poor concordance - individuals attending 3 times PW where they are rewarded for taking treatment

50
Q

what are 3 side effects of rifampicin

A
  • Hepatitis
  • Orange-secretions
  • Flu-like symptoms
51
Q

explain relationship between rifampicin and CYP450

A

Rifampicin induces CYP450

52
Q

what are 3 side effects of isoniazid

A
  • Hepatitis
  • Agranulocytosis
  • Peripheral neuropathy
53
Q

how are the side effects of isoniazid controlled for

A

Give vitamin B6 (pyroxidine) to prevent peripheral neuropathy

54
Q

what is pyroxidine

A

vitamin B6

55
Q

explain relationship between isoniazid and CYP450

A

isoniazid inhibits CYP450

56
Q

what are 4 side effects of pyrazinamide

A
  • Hyperuricaemia = precipitate gout
  • Arthralgia
  • Myalgia
  • Hepatitis
57
Q

what is the side effect of ethambutol

A

Optic neuritis

58
Q

what should be checked prior to giving ethambutol

A

Visual acuity

59
Q

what drug causes orange secretions

A

Rifampicin

60
Q

what drug causes optic neuropathy

A

Ethambutol

61
Q

what drug can precipitate gout

A

Pyrazinamide

62
Q

what is multi-drug resistant TB

A

TB resistant to rifampicin and isoniazid

63
Q

what vaccination is given for TB

A

BCG

Infectious Disease (8 decks)

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