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Pulmonology > Infectious Lung Diseases: TB, Pertussis, Croup, Epiglottitis > Flashcards

Infectious Lung Diseases: TB, Pertussis, Croup, Epiglottitis Flashcards

1
Q

Tuberculosis

TB Infection v. TB Disease

A
  • TB Infection:
    • Eaiser to treat than Dz
    • People can get this with NO presentation
  • Infection….Latency… Disease!
  • Disease:
    • Bacteria overcome the Immune System, mutiply & progress from latent infection to DISEASE
    • Some symptoms:
      • Weight loss, Loss of Appetite, Fatigue, Chills, Fever
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2
Q

TB

A Quick History

A
  • Has affected humans for millennia
  • Historic names:
    • Consumption
    • Wasting Disease
    • White Plague
  • Used to cause many deaths, not well-controlled
  • Before 1800’s, thought was hereditary
  • 1882- R. Koch disovered M. tuberculosis
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3
Q

TB

Sanatoriums

A
  • Before Abx, many sent to locations where they were isolated
    • Provided with: open air, bed rest, sunshine
    • Lots of people could not afford this
  • 70-75% fatalities in the “olden days”
  • As drugs were created, death rates dropped
    • Sanatoriums closed by mid-1970’s
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4
Q

TB

Drugs created in the 1940’s & 50’s

A
  • 1943: Streptomycin
  • 1943-1952:
    • Isonizaid (INH)*
    • p-aminosalicylic acid (PAS)

*Same drug formula used today!!

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5
Q

TB

Why was there a resurgence in 1980’s?

A
  • Inadequate funding
  • HIV epidemic
  • Increase immigration from countries were TB is common
  • Spread in close-quarters (shelters)
  • Multi-drug resistant TB increase and spread

*Still a global issue!

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6
Q

TB

Epidemiology

‘The study of the distribution & causes of disease and other health problems in different groups of people”

A
  • One of the leading causes of death due to infectious disease in the world
  • ~2 Billion people are Infected!
  • About 9 million people develop TB/year

– About 2 million people die of TB/year

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7
Q

TB

Trend in the U.S.

A
  • Before 1953, more than 84,000 cases in US
  • Declined by 6%/year after 1953
  • Reached a low in 1985, but then picked up again in 1986…
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8
Q

TB

Transmission

A

“Transmission is defined as the spread of an organism, such as M. Tuberculosis from one person to another”

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9
Q

TB

Transmission

A
  • There are several type of Mycobacteria that cause TB
    • M. tuberculosis is the most common
    • Some others: M. bovis, M. africanum, M. microti, M. canetti

***M. avium complex DOES NOT caused TB

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10
Q

TB

Transmission

A
  • Air Droplet Nuclei - spread person-to-person
    • The other person inhales the nuclei and BAM!
  • Can catch it from:
    • Coughing
    • Sneezing
    • Speaking
    • Singing…
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11
Q

TB

Transmission

Probability of Transmission

A
  • Chance of Transmission depends on:
    • Infectiousness of person w/ TB dz
    • Enviroment in which exposure occured
      • Blewett 15… no good.
    • Length of Exposure
    • Virulence (strength) of tubercle bacilli
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12
Q

TB

How to stop transmission!

A
  • Isolate the infected person(s)
    • Negative pressure room in hosp.
  • Provide effective treatment to infectious persons ASAP
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13
Q

TB

High Risk Groups

@ High Risk for Becoming Infected

A
  • Close contacts
  • Foreign born
  • Low-income & homeless
  • Healthcare workers serving high-risk groups
  • Racial and ethnic minorities
  • Infants, children, & adolescents
  • Injectable drug users
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14
Q

TB

High Risk Groups

People at High Risk for developing TB Dz after Infection!!!

A
  • People living with HIV
  • W/ medical condition that increases the risk
  • Those infected w/ M. tuberculosis ​w/in past 2 years
  • Ages 4+ younger
  • Injectable drug users
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15
Q

TB

High Risk Groups

People Living with HIV

A
  • HIV is the Strongest known risk factor for developing the disease
  • TB is the Leading Cause of Death for those w/ HIV/AIDs
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16
Q

TB

High Risk Groups

People with Certain Medical Conditions

A
  • Prolonged therapy w/ corticosteroids & other immunosuppresive therapy
    • ex: TNF-a antagonists
  • Silicosis
  • Diabetes
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17
Q

TB

High Risk Groups

Recently Infected

A
  • If you are infected w/in past 2 years, more likely to develop disease!!
    • 5% risk of developing disease in the first two years
    • 10% risk over a lifetime
      • (unless you get treated)
18
Q

TB

High Risk Groups

Ages under 4 Years

A
  • Undeveloped Immune System =’s Higher Risk!
19
Q

TB

Pathogenesis: Latent TB Infection

“How an Infection or Disease develops in the Body”

A
  • Latent TB Infection (LBTI)
    • Tubercle bacilli in are in body, but
    • Immune System is keeping them under control!

*NOT INFECTIOUS!!!

  • Dectected by:
    • Mantoux TB Skin Test (TST)
    • Blood tests: Interferon-gamma release assays (IGRAs); ex: T-SPOT
20
Q

TB

Pathogenesis

TB Disease

A
  • Immune System CANNOT keep tubercle bacilli under control
    • May develop soon after infection, or man y years later
      • About 10% w/ LTBI will develop TB

If you have the Disease, you are often Infectious!!

21
Q

TB

Pathogenesis, pt. 1

A
    1. Droplet Nuclei containg the Tubercle Bacilli are inhaled
      * Enter the lungs &
      * Travel to the small air sacs (alveoli)
      * These nuclei just sneak through your system!
    1. They mutiply in your alveoli (asymptomatic)
      * Infection begins…
    1. Small number of Bacilli enter bloodstream & spread through the body!
    1. See next flashcard
22
Q
A
23
Q

TB

Pathogenesis, pt. 2

A
    1. In 2-8wks, immune system produces Macrophages that surround tubercle bacilli & keep it in check!
      * Macrophages form a barrier shell keeping the bacilli contained (LTBI)
  • 5.
24
Q

TB

LTBI vs. Disease

A
  • Latent:
    • Inactive/contained
      • TST or blood test
    • Normal CXR
    • No Symptoms, not infectious, not a Case!
  • Disease:
    • Active/bacilli are multiplying in body
      • TST or blood test
    • Abnormal CXR
    • Symptoms: cough, fever, weight loss
    • Infectious b4 treatment
    • THIS IS A CASE OF TB!
25
Q

TB

Diagnosis

A
  • Mantoux tuberculin skin test (TST)
    • Tuberculin injection
      • Tuberculin = proteins from inactive bacilli
      • test = reaction at injection site
        • Induration (swelling), measure swelling in mm.
        • 15mm = + in healthy person
  • Blood-tests: Interferon-gamma release assays (IGRAs)
    • Measures immune reactivity
    • Pros:
      • Single patient visit, fast results
      • More accurate results than skin test
    • Cons:
      • Process blood samples quickly
      • Limited data in use 4 some pops
      • Errors can occur in running/interpreting tests
26
Q

TB

Treatment

LTBI

A
  • LTBI treated to prevent development into disease
  • Treated with medication
    • ex: Isoniazid for ~9months
27
Q

TB

Pathogenesis

Progression from LTBI to TB Disease

A
  • Highest risk first 2 years after infection
  • Detect early!
    • Prevents new cases
  • Conditions = increasing probability
    • HIV infection
    • Organ Transplant
    • CXR suggestive of previous TB
    • DM
    • Silicosis
28
Q

TB

Diagnosis

Medical Evaluation

A

Components include:

  1. Medical Hx
  2. PE
  3. TB Test
  4. CXR
  5. Bacteriological Exam
29
Q

TB

Diagnosis

A

Medical Hx:

Does patient have…

  1. Disease sxs
  2. Been exposed
  3. Any risk factors
  4. LTBI or TB dz before?
30
Q

TB

Lungs

A
31
Q

TB

General Symptoms

A
  • Fever
  • Chills
  • Night Sweats
  • Weight Loss
  • Appetite Loss
  • Fatigue
  • Malaise

*Cough lasting 3+ weeks

**Chest pain

** Sputum or blood coming up wit cough

32
Q

TB

Chest X-Ray

Inflitrates & Cavities

A
  • CXR may show:
    • Inflitrates
      • Collections of fluid & cells in lung tissue
    • Cavities
      • Hollow Spaces w/in lung
33
Q

TB

Bacteriologic Examination

Pulmonary TB

A
  • Sputum Sample Specimen Collection:
    • Patient cough into sterile container
    • 3 sputum samples for examination
      • Collect in 8-24 hour intervals
      • One early in the morning!
  • Induced Sputum Collection = use when patient cannot cough up sputum on their own. Label “induced specimen”
  • Bronchoscopy: Use if the 2 above fail
  • Gastric Washing: Use is all above fail. Used more often in children
34
Q

TB

Bacteriologic Examination

Extrapulmonary TB

A
  • Can collect samples other than Sputum depending on affected body part
    • Ex: Urine samples for TB of kidneys
    • Fluid samples from around Spine
35
Q

TB

Bacteriologic Examination:

Examination of AFB Smears

A
  • Specimens smear onto glass slide
  • AFB = mycobacteria that remain stained after being washed in acid solution
    • “Red Snappers”
36
Q

TB

Bacteriologic Examination

  • Nucleic Acid Amplification Tests (NAA)*
  • &*
  • Culturing*
A
  • Directly ID M. tuberculosis from sputum specimens by:
    • Amplification of DNA & RNA segments
  • Can guide clinical decisions
  • Does not replace the AFB smear
  • Culture all specimens!! IDs TB
37
Q

TB

Bacteriologic Examination

Drug Susceptibility Testing

A
  • Conducted when patient is first found to have positive TB culture
  • Determines which drugs kill the TB Bacilli
  • Resistance vs. Susceptibility!!!
    • Resistance = drugs can no longer kill bacteria
38
Q

TB

Drug-Resistant TB

Primary & Secondary

A
  • Primary:
    • Caused by person-to-person transmission of drug resistant organism
  • Secondary:
    • Develops during treatment
      • Bad practices:
        • Inappropriate regimen
        • Incompliance
39
Q

TB

Drug Resistant TB

A
  • Mono-resistant: Resistant to any one TB Treatment
  • Poly-resistant: Resistant to any 2 TB drugs
    • (not Isoniazid & Rifampin together)
  • Multidrug Resistant: Resistant to Isoniazid & Rifampin
  • Extensively Drug Resistant: Resistant to so many drugs!!
40
Q

TB

Sites of TB Disease

A
  • Common sites:
    • LUNG
    • Brain
    • Lymph nodes
    • Pleura
    • Spine
    • Larynx
    • Bone
    • Kidney

*Extrapulmonary locations are found more often in HIV-infected, immunocompromised

41
Q

TB

Treatment of TB Disease

A
  • TB disease must be treated for at least 6 months, sometimes longer
  • Initial Phase - 4 drugs used:
    • First 8 weeks
    • More bacilli killed during this phase
  • Continuation Phase - at least 2 drugs used
  • Relapse:
    • Occurs when treatment is not continued for long enough
    • Surviving bacilli may cause TB at a later time
42
Q

TB

Treatment

Drugs

A

Inital regimen should include these 4 drugs:

  1. Isoniazid
  2. Rifampin
  3. Pyrazinamide
  4. Ethambutol

(At least 2 of these drugs should be susceptible to dz; using only 1 drug can create a population that is resistant to drugs)

*TB is a treatable, curable disease!

**Work with patients to adhere to treatment regimen

Pulmonology (5 decks)

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