Atypical infections and Tb

Question 1

List the 3 organisms that commonly cause atypical pneumonia.

Answer 1

Mycoplasma pneumoniae
Legionella pneumophila
Chlamydophila pneumoniae

Question 2

How do you treat atypical pneumonia?

Answer 2

Macrolides, Tetracyclins or Fluoroquinolones

Question 2

Why can’t you do a gram stain for atypical pneumonia infections?

Answer 2

The organisms have little to no peptidoglycan

Question 2

How is chlamydophila pneumoniae transmitted?

Answer 2

Human - human

Question 3

How do you diagnose mycoplasma pneumoniae?

Answer 3

PCR

Question 3

What does mycoplasma pneumoniae cause?

Answer 3

Upper, lower URTI in children and teens

Question 4

How do you diagnose Legionella Pneumophilia?

Answer 4

Urine antigen test

Question 4

What is legionella pneumoniae associated with and what is legionaries disease?

Answer 4

Water environment (ac units or showers)
Severe pneumonia

Question 5

What is the nature of chlamydia trachomatis

Answer 5

Obligate intracellular pathogen

Question 5

What are the 4 clinical manifestations of chlamydia trachomatis and their clinical presentations?

Answer 5

Trachoma = recurrent eye infection causing corneal scarring and clouding from in turn eyelids and damage, resulting in blindness

STI = urethritis, conjunctivitis, reactive arthritis (+cervicitis in women leading to PID)

Extragenital = proctitis

Neonatal = conjunctivitis and pneumonia

Question 5

How is chlamydia trachomatis transmitted?

Answer 5

Sexual, eye, vertical

Question 5

What is the organism responsible for Tb?

Answer 5

Mycobacterium Tb

Question 6

What is the character of mycobacterium Tb?

Answer 6

Aerobic fast-acid bacilli

Question 6

How is Tb transmitted?

Answer 6

Inhalation of droplet nuclei, aerosolised in coughing, talking, sneezing

Question 7

What are the risk factors of Tb?

Answer 7

Nutrition (malnourished)
Age (very young and old)
Immunocompromised
Social (homeless)
Environment (prison inmates)

Question 8

What is the pathophysiology of Tb?

Answer 8

MTb is engulfed by alveolar macrophages

Infected macrophages die from MTb multiplication, attracting more macrophages

Infected macrophages spread by lymphohematogenous dissemination to regional lymph nodes and extra pulmonary organs

Followed by unrestrained MTb multiplication

Cell immunity and hypersensitivity develops within 3-9 weeks, forming granulomas

Question 9

What are the symptoms of latent and active Tb?

Answer 9

Latent Tb is asymptomatic
Active Tb = Weight loss, Bloody cough, Chest pain, Night sweats, Fever

Question 10

How do you diagnose Tb?

Answer 10

Latent = Tb skin test, IFN G release assay
Active = Sputum smear and culture, PCR

Question 11

What is the preventive treatment for Tb and when is it used?

Answer 11

Latent Tb
Isoniazid and rifapentine

Question 11

What is the curative treatment for Tb and when is it used?

Answer 11

Active Tb
Rifampin, Isoniazid, Pyraziramide, Ethambutol

Question 12

How long should RIPE and RI treatment last?

Answer 12

RIPE for 4 months
RI for 2 months

Question 13

What does pyrzinamide cause?

Answer 13

Gout like symptoms

Question 14

What does isoniazid cause?

Answer 14

vitamin B6 deficiency

Question 15

Who is rifampicin safe to use in and who is it not safe to use in?

Answer 15

Safe for renal impairment
Not safe for liver disease

Question 16

What does ethambutol cause?

Answer 16

Visual toxicity

Question 17

Patient presents with dysuria and thin penile discharge. What is the causative organism?

Answer 17

Chlamydia trachomatis

Question 18

What is the empirical treatment for Chlamydia?

Answer 18

Macrolides or tetracyclines