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CMT-uno > Acid-Fast Infections > Flashcards

Acid-Fast Infections Flashcards

1
Q

Pulm TB

non distiguishable Sx

A

Fatigue, weight loss, fever, night sweats, and productive cough w possible blood smears.

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2
Q

Pulm TB

Risk factors

A

household exposure, incarceration, drug use, travel to/from an endemic area.

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3
Q

Pulm TB

Transmission

A

resp droplets

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4
Q

TB

TST terminology

A

TB Skin Test

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5
Q

TB

LTBI term infection

A

Latent TB

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6
Q

TB

Active TB term

A

primary TB, progressive primary TB

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7
Q

TB

Dx

A

non specific
acid fast smear

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8
Q

TB

who is disproportionally affected?

A

Malnourished
Homeless
Overcrowded, substandard housing
Prisoners
HIV-positive
Endemic areas

DISPROPORTIONALLY AFFECTED

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9
Q

TB

additional risk factors

A

Diabetes mellitus
Immunosuppressive meds
Chronic renal failure
Hematologic malignancy
Head/neck cancer

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10
Q

TB

After infection

4 possibilities

A
  1. Cleared by host immune system
  2. Contained - inactive: latent tuberculosis infection (LTBI)
    3.Reactivated
    4.Not contained and progresses through lungs and possibly extra-pulmonary sites
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11
Q

TB

Clinical manifestations

A

Constitutional symptoms: malaise, anorexia, weight loss, fever, night sweats.
Chronic cough is most common pulmonary symptom, productive of purulent sputum as disease progresses. Blood-streaked sputum common
Dyspnea unusual unless extensive disease

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12
Q

TB

Extrapulmonary

A

~20% (higher in HIV+)

Sites in order of frequency:
Lymph nodes (mediastinal, retroperitoneal, cervical)
Pleura
Genitourinary
Bones and joints (vertebral bodies)
Meningitis
Serosal surfaces-pericarditis, peritonitis
Cutaneous
Intestinal

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13
Q

TB

Pott’s disease

A

TB of the vertebrae

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14
Q

TB

Scrofula

A

TB lymphadenitis of cervical in the cervical region
Think dracula!

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15
Q

TB

Dx imagining

A

Chest x-ray to diagnose primary/secondary TB

CT more sensitive

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16
Q

TB

difference between primary and secondary TB in imaging

A

Primary = middle/lower lobe consolidation

Reactivation = apices

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17
Q

TB

Ghon Focus

A

calcified granuloma

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18
Q

TB

Ghon complex

A

Ghon focus + enlarged/calcified hilar nodes

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19
Q

TB

Cautions about pulm imaging

A

Non specific

20
Q

TB

Cavitary lesions

A

Necrosis progresses to wall of airway and liquid necrotic material is discharged into bronchial tree

If swallowed, GI tract infection may result

21
Q

TB

Miliary TB

A

massive dissemination of M. tuberculosis bacilli in lungs(tiny widespread nodules)

looks like bird seed

22
Q

TB

testing

A

Sputum AFB smear and/or nucleic acid amplification testing, 3 consecutive morning specimens
NAAT (PCR) more specific than AFB stain smear
AFB stain is quick but requires very high organism load
*Isolate bacteria in AFB and then confirm from M. tuberculosis with NAAT/PCR

Sputum culture very slow but most sensitive and specific (can take 2 months)

23
Q

TB

Screening for LTBI

A

Mantoux test

24
Q

TB

Purified Protein Derivative (PPD)

A

Extract of killed tubercle bacilli
Stimulates CMI at injection site
Injected into skin & read in 48-72 hours

Measure area of induration, not area of erythema

25
Q

BCG vaccine

A

Live strain of Mycobacterium bovis.
Produces some protection against M tb
Immune response to common mycobacterial antigens

May cause a false +PPD

26
Q

TB

PPD interpretation

A

> or= to 15 is + for healthy
or= to 10 for people at risk of reactivation/high risk from work
or= to 5 is + for HIV/close contact w + TB

slide 32

27
Q

TB

One time blood test

A

single patient visit, results available within 24 hours, not affected by BCG vaccine
However, it’s expensive

28
Q

TB

what does + screen mean?

A

tells us those alveolar macrophages did not succeed in killing all the bacilli
Doesn’t tell us if TB is latent or active
we need to confirm w further testing

29
Q

TB

How long do we keep pts isolated?

A

until sputum smears are negative x 2-3

30
Q

TB

Managing LTBI

A

Isoniazid +/- Rifampin, varying duration

31
Q

TB

Tx active TB

A

Active TB disease (ill with TB): usually 4-drug regimen for 6-9 months (9-12 months when extrapulmonary/miliary)
*Rifampin – ADR: turn secretions red
*Isoniazid – ADR: peripheral neuropathy (take B6)
*Pyrazinamide – ADR: uric acid stones, photosensitive
*Ethambutol – ADR: optic neuritis
All RIPE drugs are hepatoxic

32
Q

TB

ADR for RIPE

A

Adverse Dx rxn
Rifampin - turns secretions red
Isoniazid - peripheral neuropathy(take B6)
Pyrazinamide - Uric acid stones and photo sensitivity
Ethambutol - optic neuritis

All are hepatotoxic

33
Q

TB

What are the proportion of TB presented?

A

90% of TB represents reactivation of LTBI.

DNA fingerprinting suggests 30% of new cases in urban populations are primary infections resulting from person-to-person transmission

34
Q

What does leprosy rash look like? How does it feel to pt?

A

Pale/pink colored patches that are sensitive to temp

Feels like insects

35
Q

Leprosy digits

A

Shortened and deformed due to secondary infection

36
Q

How is leprosy transmitted

A

Respiratory droplets

37
Q

What pathogen causes leprosy

A

Mycobacterium Leprae

38
Q

Leprosy presentations

A
  1. Paucibacillary
  2. Multipaucibacillary
39
Q

Paucibacillary leprosy / multi

A

5 or fewer numb skin patches

More than 5

40
Q

Tx for leprosy

A

Dapsone
Rifampin
Clofazamine

41
Q

Where does atypical mycobacterium live

A

Soil and water

42
Q

Clinical presentation of atypical mycobacteria

A

Pulm disease (most common)
Lymphadenitis
Skin/soft tissue/bone disease
Disseminated disease

43
Q

Dx atypical mycobacterium

A

Sputum culture

44
Q

MAC Sx

A

More coming in men
Apical fibrocavitary lung disease

More common in women
Nodular bronche disease -aka lady Windermere syndrome

45
Q

MAC Tx

A

Rifampin
Ethambutol
Macrolide

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