Microbio- mycobacterial infections Flashcards

1
Q

2 broad groups of mycobacteria - phylogenetically and clinically

A

Clinically: Mycobacterium tuberculosis + Non-tuberculous mycobacteria

Phylogenetically - slow growing + rapid growing

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2
Q

Mycobacteria - morphology? do they grow fast?

A

Non-motile, rod shaped

Slow growing compared to other bacteria

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3
Q

Stains for Mycobacteria

A

Ziehl- Neelsen

Auramine

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4
Q

NTM - how do people get infected i.e. where do they come from?

A

Found in water and soil

No person-to person transmission

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5
Q

Name 3 slow growing NTM

A

M. avian intracellular

M. marinum

M. ulcerans

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6
Q

NTM often acquired from swimming pools

A

M. marinum

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7
Q

Which NTM results in huge chronic painless ulcers

A

M. ulcerans

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8
Q

Which NTM is associated with HIV? how does this same organism affect immunocompetent individuals

A

M. Avium

Will affect immunocompetent people if they have pre-existing bronchiectasis/cavities

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9
Q

M. abscessus/chelonae/fortuitum

What type of mycobacteria are these? when are they seen?

A

Rapid growing, in hospital settings

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10
Q

Requirements for diagnosis of NTM?

A

Lung disease AND

1 +VE sputum culture
OR
\+ve BAL
OR
\+ve biopsy w granulomata
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11
Q

Leprosy - name the causative organism

A

Mycobacterium leprae

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12
Q

Which type of leprosy –> limb loss?

A

Paucibacillary tuberculoid

V LITTLE PERSON-PERSON TRANSMISSION

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13
Q

Which type of leprosy is contagious?

A

Multibacillary lepromatous

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14
Q

A 23 year old HEALTHY male is aCLOSE CONTACT of a person with smear positive pulmonary TB, What is his lifetime risk of developing active TB?

A

10%

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15
Q

One person is exposed to TB. What are the 5 possible outcomes

A
  1. Uninfected
  2. Infection is cleared
  3. Contained infection (localised infection)
  4. Active TB
  5. Latent TB (at risk of developing active TB w triggers)
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16
Q
  1. Uninfected
  2. Infection is cleared
  3. Contained infection (localised infection)
  4. Active TB
  5. Latent TB (at risk of developing active TB w triggers)

^who will have a +ve mantoux test?

A

Latent TB

Active TB

17
Q

3 most common forms of MTB

A

M. tuberculosis
M. bovis
M. africanum

18
Q

Which form of TB is associated with contaminated milk

19
Q

Why is TB so infectious? how is it transmitted?

A

Particles <10mcM therefore suspended in air and infectious for 30 mins

V low infectious dose

20
Q

How can TB be prevented? Give 3 ways

A
  1. BCG vaccine
  2. -ve pressure isolation
  3. Detection of cases (mantoux)
21
Q

Skin manifestation of TB?

A

Erythema nodosum

22
Q

Wtf is miliary TB

A

Widespread and looks dotty on CXR

Due to haematogenous spred

23
Q

What is post-primary TB? TF?

A

Latent TB that is reactivated approx 5 years later.

EtOH excess, immunosuppression, malnutrition, aging

24
Q

Where are caseating granulomas seen in pulmonary TB?

A

Lung parenchyma
Mediastinal LNs

often upper lobe

25
In extra-pulmonary TB, which LNs tend to be affected?
cervical
26
Eggs of extra pulmonary TB?
``` LNs Peritoneal --> ascites GU --> renal disease Spine (eg Potts) Miliary Meningitis ```
27
Ix for clinical suspicion of TB
``` Sputum x 3 Histology Biopsy Stain for acid fast bacilli Culture NAAT - detecting mutations for MDR IGRA Mantoux test ```
28
Gold standard Ix for TB? how long does it take for results?
Culture Takes up to 6 weeks!
29
what is IGRAs? | is it better than mantoux test?
detection of antigen specific IFNgamma production It doesn't cross react with BCG vaccine whereas Mantoux does (thus mantoux gives false positive result)
30
Tx of TB
RIPE | all drugs for 8 weeks. RI for a further 8 weeks
31
SEs of TB meds
Rifampicin - CYP450 inducer Isoniazid - peripheral neuropathy Pyrazinamide - hepatotoxicity Ethambutol - visual disturbance
32
How to improve adherence to TB Tx?
Directly or video observed therapy
33
How does MDR arise?
Inadequate treatment or spontaneous mutation
34
Risk factors for MDR TB
Poor adherence to TB tx HIV Known contact
35
How does management of MDR TB differ to non-MDR?
Longer regimen | Quinolones, ahminoglycosides,
36
Why is diagnosis of TB so hard in HIV+ patients?
Less classical history - more likely extra pulmonary Smear and mantoux test is more likely to be -ve despite active disease