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Clin Med II > flu and TB > Flashcards

flu and TB Flashcards

1
Q

influenza

A
  • upper and lower respiratory tract illness
  • cannot be flu without respir involvement
  • systemic si/sx with sudden onset
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2
Q

flu has increased morbidity and mortality in which populations

A
  • pregnant women
  • kids
  • > 65
  • pts with comorbidities
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3
Q

types of the flu

A
  • A
  • B
  • C
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4
Q

subtypes of flu

A
  • based on hemagglutin (H) and neuramidinase (N) antigens

- A has 16 H and 9 N subtypes

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5
Q

major subtypes of the flu that affect humans

A
  • H1, H2, H3

- N1, N2

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6
Q

antigenic shift

A
  • major change in H and N
  • causes pandemics and epidemics
  • change in RNA of virus
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7
Q

antigenic drift

A
  • point mutations if RNA
  • small changes
  • happen almost annually -> outbreaks of varied extent and severity
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8
Q

clinical manifestations of flu

A
  • sudden onset
  • HA
  • fever- usually high grade
  • myalgia
  • cough
  • sore throat
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9
Q

dx of flu

A
  • rapid influenza antigen tests
  • immunofluorescence- not used often
  • RT-PCR- used more in research
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10
Q

who should be tested for flu

A
  • Immunocompetent at risk for flu complications with acute febrile illness within 5 days onset
  • Immunocompromised with febrile respiratory illness regardless of onset
  • Inpatients with febrile respiratory illness
  • Acute respiratory illness after admission
  • Local surveillance
  • Health care workers, residence, or visitors to institution with outbreak
  • Linked to flu outbreak i.e. on cruise ship
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11
Q

ddx for flu

A
  • strep pharyngitis
  • mononucleosis
  • pneumonia
  • acute bronchitis
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12
Q

what is the first line tx for flu

A
  • oseltamivir (tamiflu)
  • given BID X 5 days for tx
  • give QD X 7 days for prophylaxis
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13
Q

alt treatments for flu

A
  • zanamivir (relenza)- inhaled
  • peramivir (rapivab)- IV
  • baloxavir (xofluza)- given as 1x weight based dose
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14
Q

who should get treated for flu and when?

A
  • everyone should be treated
  • greatest benefit in first 24-30 hours but can still treat
  • especially want to target populations at risk for complications
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15
Q

pts who are at risk for complications from flu

A
  • chronic disease and immunocompromised
  • > 65
  • kids <5
  • pregnant women and 2 weeks post partum
  • american indians and alaska natives
  • nursing home residents
  • morbid obesity- BMI > 40
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16
Q

TB

A
  • bacterial infection with mycobacterium tuberculosis
  • generally impacts lungs but can affect other body parts
  • if left untreated kills 50% of pts
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17
Q

where is TB prevalent

A
  • Sub-Saharan Africa
  • india
  • islands of southeast Asia and micronesia
18
Q

reasons for resurgence of TB

A
  • drug resistance
  • poverty
  • HIV
19
Q

risk factors for TB

A
  • substance abuse
  • HIV
  • poor nutrition, low SES
  • men > women
  • household contact
  • born in endemic region
  • community setting
  • minority
20
Q

how is TB transmitted

A
  • respiratory droplets
21
Q

risk factors for TB transmission

A
  • active untreated disease
  • cavitary disease
  • sputum pos for m. tuberculosis, acid fast bacilli
22
Q

risky procedures for pt with TB

A
  • intubation
  • bronchoscopy
  • sputum induction
  • chest PT
  • admin aerosolized drugs
  • irrigation of TB abscess
  • autopsy
23
Q

outcome of m. tuberculosis inhalation

A
  • immediate clearance
  • primary disease- immediate onset sx
  • latent infection- pos PPD but no sx
  • reactivation- onset of active disease many years after latent infection
24
Q

when is the greatest risk for progression of TB to active disease?

A
  • within first 2 years of infection
25
Q

clinical manifestations of TB

A
  • cough 3+ weeks
  • chest pain
  • hemoptysis
  • fatigue, weakness
  • weight loss, anorexia
  • low grade fever, chills
  • night sweats
  • latent TB is asymptomatic
26
Q

screening for TB

A
  • mantoux tuberculin skin test (TST)
  • purified protein derivative (PPD)
  • pos PPD supports dx but is not diagnostic
  • BCG can interfere- neg result does not r/o TB
27
Q

when is 5 mm PPD test pos

A
  • HIV infected*
  • recent contact with TB case
  • fibrotic changes on CXR
  • pts who are immunocompromised
28
Q

when is a 10 mm PPD test pos

A
  • residence or employees of high risk setting
29
Q

when is 15 mm PPD test pos

A
  • majority of population
30
Q

BCG vaccine

A
  • TB vaccine used in high risk countries
  • prevents childhood TB
  • not recommended in US
  • can cause false pos PPD
31
Q

who gets a CXR for TB dx

A
  • anyone with suspected TB
  • pos PPD
  • pos IGRA
  • doesnt establish dx but can r/o TB
32
Q

IGRA

A
  • TB blood testing
  • good specificity
  • preferred in pts with BCG vaccine
  • can use in pts who wont or cant return for PPD reading
33
Q

what is the gold std for TB dx

A
  • sputum culture
34
Q

main drugs used to treat TB

A
  • isoniazid (INH)
  • rifampin (RIF)
  • pyrazinamine (PZA)
  • ethambutol (EMB)
  • +/- streptomycin
35
Q

how long are most TB treatments

A
  • 9 months
36
Q

tx for active TB

A
  • intensive phase: INH + RIF + PZA + EMB X 2 months

- Continuation phase: INH + RIF for 18 weeks

37
Q

tx for active TB in pregnancy

A
  • Intensive phase: INH, RIF, EMB X 2 mo
  • Continuation phase: INH + RIF X 7 mo
  • do not use streptomycin or pyrazinamide in pregnancy
38
Q

treatment for LTBI

A
  • INH + RIF X 3 months weekly

- Not recommended if <2, HIV, resistant TB, or pregnant

39
Q

treatment for LTBI in pregnancy

A
  • INH QD or 2X week for 9 mo

- Supplement with pyridoxine (B6)

40
Q

MDR- TB

A
  • resistant to at least isoniazid and rifampin, possibly other drugs
41
Q

XDR- TB

A
  • resistant to at least isoniazid, rifampin, and one of three injectable second line drugs
  • Capreomycin, kanamycin, amikacin

Clin Med II (16 decks)

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