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HDID Block 2 > L44 > Flashcards

L44 Flashcards

1
Q

What are 3 diseases that could result if TB from the lung moves extra-pulm via bacteremia?

A

Meningitis
Tuberculoma = cavitary lesions
Pott’s disease of the spine

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2
Q

What are tell tale signs/symptoms of TB meningitis?

A

Sub-acute neuro signs: headache, fever, AMS
High WBC
Low glucose

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3
Q

What is miliary TB?

A

TB bacteremia –> dissemination into various organs

  • Often liver
  • *MILLET SEEDS on CXR**
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4
Q

What is the difference between pulmonary vs extra-pulm TB cultures?

A

Take cultures from the tissues you’re concerned about

  • Pulm = chest
  • Extra = could be anywhere
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5
Q

What is a major drawback of PPD/IGRA tests?

A

CANNOT distinguish between active and latent TB!!!!

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6
Q

Describe the AFB sputum culture to diagnose pulmonary TB.

A

Rapid
Cheap
Determine drug susceptibility
CanNOT distinguish M.TB from non-tuberculine mycobacterium

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7
Q

Describe NAAT to diagnose pulmonary TB.

A

Rapid
$$
Higher sen & spec

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8
Q

How do mycobacterium stain?

A

Acid fast!
Red b/c of carbol fuschin
Other body cells stain blue b/c methylene blue is the counter stain

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9
Q

Which culture techniques do you use for M.TB? (the 1 solid mediums vs 2 liquid mediums)

A 
1. L-Jensen agar (slow)
OR
2. MGIT = liquid media
- Detects release CO2 by growing M.TB 
- FASTER!
3. Microscopic Observational Drug Susceptibility Assay
- Cheap & fast in liquid media
- Susceptibility testing too
- **Developing world**
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10
Q

In cultures, what shape characteristic tells you M.TB from other mycobacteria?

A

Cording!

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11
Q

Which diagnostic test would you use to determine rifampin resistance for M.TB fast?

A

Molecular assays - GeneXpert
= PCR
Looking at rpoB gene

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12
Q

What conditions must be met to take a possible TB patient out of airborne isolation?

A

3 negative AFB sputum cultures

Alternative diagnosis

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13
Q

If you think a patient has TB, what must you also test them for?

A

HIV

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14
Q

Is pulm or extra-pulm TB more common in HIV patients?

A

W/ low CD4 counts - extra-pulm

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15
Q

What are the 1st line TB drugs? Include mechanism of each.

A 
RIPE
Rifampin - X protein synthesis 
Isoniazid - X mycolic acid synth
Pyrazinamide - impact plasma mem, disrupts E metabolism
Ethambutol - X arabnoglyctan synthesis
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16
Q

What are 2nd line TB drugs?

A

Fluoroquinolones (often substituted for ethambutol w/ TB meningitis)
Injectables - amkicain
Give if resistant to 1st line

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17
Q

Describe the time course & combinations that TB drugs are given in.

A

2 mos = RIPE

4 mos –> on = RI

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18
Q

What do you give with isoniazid to prevent neuropathy?

A

Vit B6

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19
Q

What are the side effects of the RIPE drugs?

A

Rifampin - hepatitis, organ body fluids
Isoniazid - hepatitis, peripheral neuropathy (neurons & hepatocytes)
Pyrazinamide - hepatitis, GI upset
Ethambutol - optic neuritis, impaired color vision

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20
Q

What animals carry M.leprae?

A

Amradillos!

And humans…

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21
Q

Can M. leprae be cultured?

A

No

Doesn’t take up stain - must use acid fast stain

22
Q

Where does M.leprae grow on the body?

A

Cooler areas - skin & extensor surfaces

23
Q

What cells does M.leprae infect?

A

Obligate INTRACELL

Prefers macrophages & Schwann cells

24
Q

How is M.leprae transmitted?

A

Nasal droplets

25
Q

Which form of leprosy is more infectious: tuberculoid or lepromatous?

A

Lepromatous > tuberculoid

B/c multibacillary bacterial burden (aka many M.leprae) > paucibacillary

26
Q

Why do you describe leprosy as a spectrum?

A

Tubercolid and lepromatous are the extremes - can present with some spectrum in between
Borderline symptoms/skin lesions

27
Q

Which type of leprosy is a Th2 response? What are the main cytokines?

A

Lepromatous
IL 4, 5, 10 mediated
Therefore no T cell response

28
Q

Which type of leprosy is a Th1 response? What are the main cytokines?

A

Tuberculoid
IL2, IFNg, TNF beta mediated
Therefore T cell response specific to M.leprae antigens

29
Q

Which form of leprosy is contained in granulomas with only localized inflammation and peripheral nerve damage?

A

Tuberculoid (Th1)

Single but progressive nerve involvement

30
Q

Which form of leprosy results in a disseminated infection including diffuse bone, cartilage, and nerve damage?

A

Lepromatous (Th2)

Several nerves affected but slow progression

31
Q

Which form of leprosy shows organisms growing in macrophages?

A

Lepromatous (Th2)

32
Q

What are the common clinical symptoms for both types of leprosy?

A

Common = skin lesions + thickened peripheral nerves

  • Loss of eyebrows
  • Saddle nose deformity
  • Ear lobe nodules
33
Q

Name the specific symptoms for tuberculoid vs lepromatous.

A

Tuberculoid = few, discrete lesions
- 1 nerve, FAST
Lepromatous = many symmetrical lesions, thickened skin, nodules
- Many nerves, slow

34
Q

How do diagnose leprosy?

A

Biopsy = gold standard

- Granulomas w/ mycobacteria

35
Q

How do you treat leprosy?

A

Multidrug to prevent resistance
Paucibacilliary (tuberculoid, Th1) - 6 mo rifampin/dapsone
Multibacillary (lepromatous, Th2) - 12 mo rifampin/clofazamine/dapsone

36
Q

How can you prevent disease in close contacts?

A

Single dose rifampin

37
Q

How is non-TB mycobacterium spread?

A 
Found everywhere in the environment
Inhalation
Ingestion 
Inoculation 
NOT person-person
38
Q

What are the 2 categories of non-TB mycobacterium?

A

Rapid growers

Slow growers

39
Q

What are 3 types of NTM slow growers?

A

Nonchromagen
Photochromagen - yellow colonies in light
Scotochromagen - yellow/orange colonies in dark or light

40
Q

What temps do NTM prefer?

A

Colder (few strains)

41
Q

Which clinical syndroms do NTM cause?

A

Pulmonary disease
Skin/ST infections
Lymphadenitis

42
Q

What are the clinical finding of NTM pulmonary disease? Which strain of bacteria is the most likely culprit?

A

Mycobacterium avium complex
Non-transmissible form of disease
Chest CT: disseminated nodules

43
Q

If you get 1 positive sputum culture for NTM - myco avium complex, what’s your next step?

A

Confirm with serial sputum cultures

Need at least 2 + cultures for MAC

44
Q

What are the big 4 drugs for NTM MAC pulmonary disease?

A

Rifampin
Ethambutol
Azithromycin
Clarithromycin - need to susceptibility test this

45
Q

What type of ulcer is caused by NTM?

A 
Buruli ulcer - mycobacterium ulcercans 
Transmitted via skin trauma 
B/c cytotoxin 
Treat:
- Rifampin + streptomycin or claruthromycin
46
Q

Which strain of NTM causes “fish tank granuloma”? Treat severe vs mild?

A 
M.marinum
Treat SEVERE disease:
- Rifampin
- Clarithromycin + ethambutol 
Treat disease confined to skin:
- Cipro, doxy, bactrim, or clathithro
47
Q

Which skin lesions should you suspect for NTM?

A

Chronic, indolent skin lesions

Unresponsive to standard antimicrobials

48
Q

Which NTM bug is going to cause disseminated disease? Which patient populations are at risk?

A 
Myco avium complex
Immunosuppressed pts (HIV)
49
Q

Symptoms and organs involved in disseminated MAC disease.

A 
Symptoms:
- Fevers, night sweats
- Weight loss
- Abd pain, diarrhea
Organs:
- Biliary
- Hepato-spleno-megaly 
- Bone marrow
- Colitis
50
Q

How do you treat disseminated MAC?

A

Macrolide + ethambutol + rifamycin

HDID Block 2 (39 decks)

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