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DEN 7102 Micro & Immuno Concepts > Exam 3 Mycobacteria > Flashcards

Exam 3 Mycobacteria Flashcards

1
Q

Mycobacteria contain ____ in their cell wall

A

Mycolic acids

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2
Q

Which Mycobacterial species cause chronic granulomatous diseases?

A
  • Mycobacterium tuberculosis
  • Mycobacterium leprae
  • Mycobacterium bovis
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3
Q

____ causes tuberculosis

A

Mycobacterium tuberculosis

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4
Q

_____ causes leprosy/Hansen’s disease

A

Mycobacterium leprae

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5
Q

Leprosy is now called:

A

Hansen’s Disease

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6
Q

____ is transmitted via food and then by aerosol. It is identical to ____

A

M. bovis; Tuberculosis

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7
Q

____ is a complex of 2 mycobacteria

A

Mycobacterium avium complex

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8
Q

Mycobacteria must be stained using:

A

Acid fast (Ziehl-Neelsen) staining

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9
Q

Acid fast bacteria have:

A
  • mycolic acid
  • fatty acids
  • waxes
  • complex lipids
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10
Q

Acid fast staining method (4)

A
  1. Apply Carbolfuchsin (lipid soluble)
  2. Apply heat
  3. Decolorizer (acid alcohol) - does not affect acid fast bacteria
  4. Apply methylene blue counter stain (taken up by non-acid fast cells)
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11
Q

Most Mycobacteria grow ____

A

Slowly

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12
Q

____ cannot be cultured on bacteriological media

A

M. leprae

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13
Q

Mycobacteria form ____ when cultured

A

Waxy colonies

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14
Q

Worldwide, ____ is a common cause of infection related mortality

A

Tuberculosis

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15
Q

TB is/is not common in the US

A

Not very common anymore, we no longer vaccinate for TB

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16
Q

Highest rates of M. tuberculosis is among:

A

Non-US born

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17
Q

Countries with highest rates of TB cases

A
  • Mexico
  • Philippines
  • India
  • Vietnam
  • China
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18
Q

Which US states have the highest rates of TB cases?

A
  • California
  • Texas
  • New York
  • Florida

have the most immigrants

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19
Q

Tuberculosis is historically known by the names:

A
  • Wasting disease
  • Consumption
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20
Q

Tuberculosis transmission

A

Respiratory - spread by airborne droplets (coughing, sneezing, speaking)

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21
Q

Most people exposed to Tuberculosis do or do not become infected?

A

Do not become infected

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22
Q

What are some susceptibility factors to contracting tuberculosis?

A
  • overcrowding
  • HIV infection
  • Health care workers
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23
Q

M. tuberculosis virulence factors

A
  • Lipid coat
  • Sulfatides
  • Cording factor
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24
Q

M. tuberculosis lipid coat is:

A

Antiphagocytic

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25
Q

M. tuberculosis sulfatides function

A

Glycolipids that inhibit phagolysosome formation, allows intracellular survival in macrophages

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26
Q

M. tuberculosis cording factor is derived from:

A

Mycolic acid

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27
Q

What do cording factors do?

A

Arrange M. tuberculosis cells into long and thin serpentine cord formation

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28
Q

Cording factors activate ____ which induces the formation of _____

A

Macrophages; granuloma

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29
Q

Granuloma

A

Masses of immune cells

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30
Q

3 primary infection outcomes of tuberculosis

A
  1. Resolution
  2. Latent infection
  3. Progressive primary infection
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31
Q

Tuberculosis: Resolution

A
  • also known as healing
  • organisms are eliminated
  • patient remains aymptomatic
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32
Q

Tuberculosis: Latent infection

A
  • aka dormant
  • Organisms in a dormant state within granuloma
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33
Q

Tuberculosis: Progressive primary infection

A
  • Active TB
  • Organism breaks out of granuloma and can infect another person via aerosol
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34
Q

Ghon (primary) complex

A
  • lung lesions
  • granuloma and mediastinal lymph node
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35
Q

Granuloma formation induces ____ response

A

CD4+ T-cell mediates (Th1)

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36
Q

Structure of granuloma - what is in it?

A
  • M. tuberculosis organisms in the center
  • surrounded by macrophages
  • Th1 surrounds macrophages
  • surrounded by fibroblasts
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37
Q

Giant cells are found in ____ and are formed by _____

A

granulomas; fused epithelioid cells

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38
Q

What are Epithelioid cells?

A
  • End stage (unhealthy) macrophages
  • activates macrophages that look like epithelial cells
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39
Q

TB granuloma center is ____

A

Necrotic/dead (caseous necrosis)

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40
Q

TB granuloma may undergo ____ and ____

A

necrosis (caseation) and cavitation

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41
Q

What stage of TB does granuloma form?

A

Can occur in any stage of TB

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42
Q

Latent TB is described as:

A

Presence of M. tuberculosis infection without signs and symptoms

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43
Q

Converters

A

Those whose M. tuberculosis skin/blood tests were previously negative but now positive

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44
Q

An example of a converter could be:

A

Health care workers

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45
Q

Active TB is more likely to occur in ____

A

Immune deficient patients (HIV/AIDS)

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46
Q

Active TB is usually localized to the _____ with ____ spread. This can lead to :

A

Lungs; local spread; systemic spread or miliary TB

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47
Q

Systemic spread of active TB can cause:

A

Pott’s disease (bone)

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48
Q

Massive bacterial overload of active TB can lead to

A

Miliary TB (usually in immunocompromised subjects)

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49
Q

Miliary TB can spread to

A

Multiple organs (hematogenous spread)

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50
Q

Miliary TB usually occurs in

A

Compromised subjects

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51
Q

Miliary TB mortality

A

High

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52
Q

Tuberculosis clinical presentations

A
  • persistent, productive cough
  • Hemoptysis (bloody sputum)
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53
Q

TB meningitis (neurotuberculosis) presentation

A
  • WBC: 25-500
  • Cell type: Lymphocyte
  • Glucose: Low
  • Protein: High
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54
Q

Neurological TB can cause:

A
  • Cranial nerve 6 palsy
  • left eye complete ophthalmoplegia
55
Q

Pott’s disease affects

A

Spine (TB infection in the vertebrae)

56
Q

________ is almost always secondary to pulmonary TB

A

Oral TB

57
Q

TB diagnosis

A
  • PPD skin test
  • Acid fast stain of sputum, etc
  • culture on Lowenstein-Jensen medium (8 weeks)
58
Q

PPD test stands for:

A

tuberculin purified protein derivative

59
Q

True or false: Acid fast stain of sputum shows many organisms

A

False - may be very few

60
Q

Mantoux skin test

A

PPD (tuberculin) injected intradermally

61
Q

PPD skin test measures degree of _____

A

Hypersensitivity to tuberculin

62
Q

True or false: PPD skin test measures immunity to tuberculin

A

False - does not

63
Q

PPD skin test is associated with _____ reaction

A

Delayed type hypersensitivity reaction (Th1)

64
Q

During delayed-type hypersensitivity reaction, _____ cells are previously activated by APCs when antigen in the ____ is presented again. ____ cells activate ____ to cause an ____ response

A

Th1 helper T cells; PPD; Th1; macrophages; inflammatory

65
Q

____ is measured 48-72 hours after PPD is injected

A

Induration

66
Q

Induration is measured in ____, not:

A

mm; not negative or positive

67
Q

Is there a correlation between induration size and current TB disease?

A

No

68
Q

What does induration size correlate with?

A

Future risk of developing TB disease

69
Q

Tuberculosis skin test - positive result for any person

A

> = 15 mm

70
Q

Tuberculosis skin test - positive result for living or working in high risk social setting

A

> =10mm

71
Q

Induration of____ is positive in HIV/AIDS patient

A

> = 5mm

72
Q

TST interpretation for healthcare workers - baseline

A

> =10mm is a positive result
= 5 mm if HCW has HIV

73
Q

If you have gotten BCG vaccine, you may get:

A

False positive result on TST

74
Q

False negative TST result may be due to

A
  • anergy (inability to react to test)
  • recent TB infection
  • very young age (less than 6 mo)
  • live virus vaccination if within 2 months (measles, smallpox)
  • overwhelming TB infection
  • incorrect administration of test
75
Q

TST is done in ___ steps

A

2

76
Q

Ability to react to tuberculin ___ over time

A

Decreases

77
Q

First TST ____. Second TST is done ___ weeks later and may have ____ reaction

A

stimulates immune system; boosted or no reaction

78
Q

True or false: blood testing can be done for TB

A

True - interferon-gamma release assays (IGRA)

79
Q

IGRA blood testing for TB steps

A
  • add M. tuberculosis antigens to blood sample
  • IFN-gamma will be released if T cells are infected with M. tuberculosis
80
Q

True or false: PCR can be used to test for M. tuberculosis

A

True - detects DNA + gene using sputum sample for resistance to rifampicin/rifampin

81
Q

Latent TB - tx for subjects who convert to positive skin test/asymptomatic/clear chest xray

A

1 drug regimen - Isoniazid daily or twice weekly for 9 months

82
Q

If Isoniazid can’t be taken or INH-resistant TB:

A

Rifampin daily for 4 months

83
Q

Active tuberculosis therapy

A
  • Initial phase (first 8 weeks): 4 drugs used at same time (INH, RIF, ethambutol, pyrazinamide)
  • Continuation phase: INH and RIF
84
Q

True or false: there is antibiotic resistance associated with TB

A

True

85
Q

Multidrug resistant TB (MDR-TB) is resistant to:

A
  • INH
  • Rifampin
86
Q

MDR-TB is more common in:

A
  • foreign-born US patients
  • HIV-infected patients
87
Q

Extensively drug resistant TB (XDR-TB) is resistant to:

A

Both first and second line drugs

88
Q

How many high multi-drug resistant TB countries are there?

A

30

89
Q

1 extensively drug resistant TB case cost ____ to treat

A

$568,000

90
Q

Tuberculosis vaccine is called:

A

BCG vaccine (Bacille Calmette Guerin)

91
Q

BCG vaccine is protective against:

A

Meningitis and disseminated TB in young children

92
Q

BCG vaccine does not prevent:

A

Primary infection and latent pulmonary infection reactivation

93
Q

Previous BCG vaccine can result in ____ PPD skin test

A

Positive

94
Q

Treating a dental patient with latent TB requires:

A

Standard infection control precautions

95
Q

If a patient comes in for dental treatment with active TB:

A
  • defer elective treatment until patient is declared non-infectious
  • urgent dental care done in airborne infection isolation
  • dental team needs to use respiratory protection (fitted N95 mask)
96
Q

___ of those exposed to tuberculosis results in infection

A

30%

97
Q

TB is the one leading cause of: (2)

A
  • opportunistic infection in HIV-infected patients
  • cause of death in HIV/AIDS
98
Q

____ is the strongest risk factor for progressing to TB disease and have an increased frequency of extrapulmonary infection

A

HIV infection

99
Q

M. leprae is an acid-fast ____

A

Bacillus

100
Q

M. leprae is endemic in:

A

Armadillos in TX and LA - same leprosy strain as in humans

101
Q

M. leprae mode of transmission

A

Probably respiratory, direct contact with nasal discharge

102
Q

Hansen’s disease has ____ infectivity

A

Low - only 5% humans are susceptible

103
Q

Hansen’s disease - mode of attack

A

Attacks nerves - pts lose the ability to sense touch and pain

104
Q

What are the major forms of Hansen’s disease?

A
  • Tuberculoid (mild form)
  • Lepromatous (more severe)
105
Q

Hansen’s disease - tuberculoid form is associated with:

A

Good delayed-type hypersensitivity (Th1) response to bacterium

106
Q

Hansen’s disease - tuberculoid form has ___ organisms in lesions

A

Few (Paucibacillary)

107
Q

Hansen’s disease - lepromatous form is associated with:

A

Poor delayed-type hypersensitivity (Th2) response to bacterium

108
Q

____ organisms are found in lesions of lepromatous form of Hansen’s disease

A

Many

109
Q

Hansen’s disease, lepromatous form is a ____ disease

A

Severe, disfiguring

110
Q

Another term for tuberculoid leprosy

A

Paucibacillary

111
Q

Tuberculoid leprosy clinical presentations

A
  • few localized, well circumscribed hypopigmented lesions
  • anesthesia of affected skin due to dermal nerve involvement
112
Q

Borderline lepromatous leprosy involves:

A

Scattered and generalized lesions (more severe)

113
Q

Lepromatous leprosy clinical presentations

A
  • numerous, hypopigmented, thickened skin lesions
  • sensory nerve involvement beginning in the extremities
  • tissue destruction, significant scarring
114
Q

____ is commonly involved and becomes distorted with lepromatous leprosy

A

Face (leonine facies)

115
Q

Collapsed nose bridge (saddle nose) can develop from

A

Lepromatous leprosy

116
Q

Lepromatous leprosy can cause ____ lesions in up to 60%

A

Oral (tongue, palate)

117
Q

Another term for lepromatous leprosy

A

Multibacillary

118
Q

WHO recommends ___ regimens for leprosy treatment

A

Multidrug

119
Q

Tuberculoid leprosy - treatment

A

rifampin and dapsone for 12 months

120
Q

Lepromatous leprosy - treatment

A

Rifampin, dapsone, clofazimine for 24 months

121
Q

M. bovis causes TB in:

A

Many mammals (ex, cattle, deer)

122
Q

M. bovis is usually transmitted by:

A

2 steps
1. consumption of contaminated food (dairy products or meat)
2. then spreads by aerosol

123
Q

___ is clinically identical to classical TB

A

M. bovis

124
Q

M. bovis outbreak - pregnant mom acquired it from _____ in Mexico. Gave birth to twins prematurely at Summerlin hospital, mom died from TB meningitis. Then was spread by ___ from the ___ similarly to classical TB. Both newborn twins died

A

unpasteurized cheese; aerosol; infected twins

125
Q

What species make up Mycobacterium avium complex?

2 species - complex

A
  • Mycobacterium avium
  • Mycobacterium intracellulair
126
Q

Mycobacterium avium complex is also referred to as:

A
  • Mycobacterium avium-intracellulair (MAI)
  • Mycobacterium avium-intracellulair complex (MAC)
127
Q

Mycobacterium avium complex is considered ____ mycobacteria

A

Non-TB; atypical

128
Q

Mycobacterium avium complex is mainly ____ in humans

A

Opportunistic

129
Q

How is Mycobacterium avium complex transmitted?

A
  • inhalation of contaminated aerosols and dust
  • ingestion
  • direct inoculation
130
Q

NTB Mycobacteria can cause infection in ___ and ____patients

A

immunocompetent and AIDS

131
Q

Immunocompetent patients who contract MAC have ____ disease presentation

A

Chronic pulmonary

132
Q

The most common mycobacterial infection in AIDS patients is:

A

Mycobacterium avium complex - typically cause disseminated diseases in AIDS patients

AIDS-defining opportunistic infection

133
Q

Mycobacterium avium complex is highly resistant to

A

Anti-TB drugs

134
Q

Disseminated MAC can go to:

examples

A
  • jejunum
  • brain lesions

DEN 7102 Micro & Immuno Concepts (26 decks)

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