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Year 5 - Alex's Pathology Guide 2018 > Microbiology: Mycobacteria > Flashcards

Microbiology: Mycobacteria Flashcards

1
Q

Tuberculosis and other Mycobacteria

Outline the microbiology Mycobacteria

A

Microbiology of Mycobacteria:

  1. Gram positive
  2. Aerobic
  3. Acid alcohol fast
  4. Cell wall with long chain (mycolic) acids, as well as glycolipids which is Thick, waxy and with complex immunogenics
  5. Nonmotile rod shaped bacteria
  6. Relatively slow growing for bacteria
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2
Q

Tuberculosis and other Mycobacteria

Exaplain how the host’s immune response shapes the clinical outcome

A
  • (Different types of disease with worse immune response going down)
  • Healthy contact (LTBI)
  • Lymph node
  • Localised Extraplumonary
  • Pulmonary (localised)
  • Pulmonary (widespread)
  • Meningeal
  • Miliary
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3
Q

Tuberculosis and other Mycobacteria

Outline the presentation of TB

A

Presentation:

  • Cough in 80%
  • Haemoptysis in 6 to 40%
  • Fever
  • Weight loss
  • Malaise
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4
Q

Tuberculosis and other Mycobacteria

Outline the classification of Mycobacteria

A
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5
Q

Tuberculosis and other Mycobacteria

Outline the first line treatment of TB

A
  • 6 month treatemnt, RIPE for 2 months then just Rifampicin and Isonazid for 4 months
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6
Q

Tuberculosis and other Mycobacteria

What are the main types of investigation for TB?

A

Types of TB Investigations

  • Imaging CXR/CT
  • Sputum microscopy
  • Cultures
  • Histology
  • Mantoux test:
  • Interferon gamma release assay (IGRA)
  • Nuclear Acid Amplification test (NAAT)
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7
Q

Tuberculosis and other Mycobacteria

Outline the features of Extrapulmonary TB

A

Extrapulmonary TB:

  • Lymphadenitis:
    • Known as scrofula or King’s disease
    • Cervical Lymph nodes are most common
    • Abscesses and sinuses
  • GI:
    • Swallowing of tubercules
    • Dominant form in children
  • Peritoneal:
    • Ascitis or adhesive
  • Genitourinary:
    • Can present with just epydidimytis
  • Bone:
    • Spinal TB most common
  • MIliary:
    • ​Millet seeds on CXR
    • Progressive disseminated haemtogenous TB
    • Increasing due to HIV
  • Caridac:
    • ​Pericarditis
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8
Q

Tuberculosis and other Mycobacteria

Outline the pathopysiology, investigations and treamtent of Spinal TB

A

Pathophysiology:

  • Haematogenous spread
  • Initial discitis
  • Vertebral destruction and collapse
  • Anterior extension

Investigations:

  • MRI/CT
  • Biopsy/Aspirate

Treatment:

  • 12 months of anti-TB
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9
Q

Tuberculosis and other Mycobacteria

Outline the main types of Non Tuberculous TB

A

Two types of NTMs:

  1. Slow growing
    1. M.Amvium
    2. M.Marinum
    3. M.Ulcerans
  2. Rapidly growing
    1. M.Abscessus, M.Chelonae. M.Foruitum
    2. Skin and soft tissue infections
    3. In hospital settings, isolated from blood cultures
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10
Q

Tuberculosis and other Mycobacteria

Outline the features of TB Vaccination

A
  • BCG= Bacille Calmette-Guerin
  • Live attenuated vaccine
  • Only given to babies in areas of >10/100,000, since 2005
  • Efficacy is 70 to 80%
  • Doesn’t work well in adults
  • Treatment with biologics, Infliximab: Anti TNF, screens for latent TB before giving the vaccine.
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11
Q

Tuberculosis and other Mycobacteria

Outline the 3 types of Leprosy

A

3 Types:

  • Paucibacilliary: Tuberculoid leprosy
    • Few bacilli
    • Large and vigorous cell mediated immune response
    • Develop peripheral neuropathy > lose limbs
  • Multibacilliary: Lepromatous leprosy
    • ​Heavy bacterial loads
    • Smaller cell response
    • Develop lumps and bumps
  • Boarderline (BB)
    • ​Multiple plaques

EMQ Buzzwords: Thickened sural nerve, Shaved outer eyebrows

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12
Q

Tuberculosis and other Mycobacteria

Outline the features of Primary TB

A
  • Multiplies at the pleual surface (Ghon focus)
  • Rarely can get allergic reactions such as erythema nodosum
  • Taken to a lymph node (primary complex)
  • Granulomata is the characteristic lesion with Langhan’s giant cells
  • Can be asymptomatic, especially in children
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13
Q

Tuberculosis and other Mycobacteria

Outline the presentation of TB in HIV

A
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14
Q

Tuberculosis and other Mycobacteria

Outline the features of Post Primary TB

A

Post Primary:

  • Reactivation is over 5 years since last infection
  • 5 to 10% lifetime risk
  • Upper lobes affected
  • Classic lesion = caseating granuloma
  • healing = fibrosis and calcification
  • Risk factors:
    • immunosupression,
    • alcoholism,
    • malnutrition,
    • aging
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15
Q

Tuberculosis and other Mycobacteria

Outline the resistance of TB

A

Resistance:

  • Mono= 1 drug only
  • MDRTB= Rifampicin and Isonazid
  • XDRTB= Rifampicin and Isonazid + Injecatables and Quinolones
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16
Q

Tuberculosis and other Mycobacteria

What are the side effects of Rifampicin?

A

Side effects:

  • Organge sectrations
  • Induce cP450
  • Hepatoxtoicity
  • Increased transmaminases
17
Q

Tuberculosis and other Mycobacteria

What are the side effects of Isoniazid?

A

Side effects:

  • Peripheral neuropathy (give B6/pyridoxine)
  • Hepatotoxicity
18
Q

Tuberculosis and other Mycobacteria

What are the side effects of Ethambutol?

A

Side effects

  • Optic Neuritis
  • Visual disturbances
19
Q

Tuberculosis and other Mycobacteria

What is the treatment for TB Meningitis?

A

TB Meningitis Treatment:

  • RIPE for 4 months
  • R and I for 8-10 months
20
Q

Tuberculosis and other Mycobacteria

What is is 2nd line treatment for TB?

A

2nd Line treament for TB:

  • Injectables
    • ​Capreomycin
    • Kanamycin
    • Amikacin
  • Quinolones
    • ​Moxifloxacin
  • Cycloserine
  • Ethionamide/Protionamide
  • PAS
  • Linelozid
  • Clofazamine
21
Q

Tuberculosis and other Mycobacteria

What is the treatment for latent TB?

A

Latent TB treatment:

  • 6-9 months of Isoniazid
22
Q

Tuberculosis and other Mycobacteria

What is used for T Prophylaxis?

A

Just Isoniazid

23
Q

Tuberculosis and other Mycobacteria

What are the features of Sputum Microscopy and Cultures for TB?

A
  • Sputum Microscopy
    • Zeihl Neelson/Auramine staining
    • Gram +ve rods, acid fast
  • Cultures:​
    • Sputum:
      • on 3 different occasions
    • Bronchoalveolar lavage
    • Urine
    • Gold standard = Pus in lowenstein jensen medium
    • Can take 6 weeks (more like 1 to 3 though)
24
Q

Tuberculosis and other Mycobacteria

What are the features of the Mantoux for TB?

A
  • Mantoux test:
    • Inject 2 units of tuberculin to check previous exposure
    • Looking for induration not erythema!
    • Poor sensitivity
    • Positive result if:
      • >5mm in immunocompromised pateint
      • >10mm if recent immigrant
25
Q

Tuberculosis and other Mycobacteria

What are the features of the IGRA and NAAT?

A

Interferon Gamma Release Assay:

  • ​Episilot quantification

NAAT:

  • PCR-line probe analysis. tests for sensitivities
26
Q

Tuberculosis and Other Mycobacteria

What are the symptoms of TB Meningitis?

A
  • Subacute presentation
  • (Classic TB) weight loss, fever, night sweats
  • Signs of meningism:
    • Headache
    • Neck stiffness
  • Personality changes
  • Reduced GCS
  • Focal Neurological deficit
27
Q

Tuberculosis and Other Mycobacteria

What are the investigations for TB Meningitis?

A
  • CT: Tuberculomata
  • LP: Lymphocytic
28
Q

Tuberculosis and Other Mycobacteria

What are the treatment for TB Meningitis?

A
  • 12 months of Anti-TB treatment
  • Steroids
29
Q

Tuberculosis and other Mycobacteria

What are the featutres of M.Avium?

A
  • Children:
    • ​Pharyngitis/cervical adenitis
  • Pulmonary
    • ​Underlying lung disease
  • Disseminated
    • ​Cytotoxics, lymphoma
  • AIDS:
    • ​Disseminated infection.
    • Mycobacteraemia
    • consider in HIV pateints with longstanding diarrhoea
30
Q

Tuberculosis and other Mycobacteria

What are the featutres of M.marinum?

A
  • Also called Fish tank granuloma
  • Single or in clusters papules/plaques
  • Swimming pool/aquarium owners
31
Q

Tuberculosis and other Mycobacteria

What are the featutres of M.Ulcerance?

A
  • Insect transmission (tropics/Australia)
  • Early: painless nodules
  • Usually slowly progressive leading to ulceration
  • Seldom fatal, hideous deformity
32
Q

Tuberculosis and other Mycobacteria

How is the TB vaccine contraindicated in HIV pateints?

A
  • BCG is contraindicated in HIV pateints
  • HIV -ve
    • latent TB > active
    • risk is 5 - 10% lifetime risk
  • HIV +ve
    • latent TB > active
    • risk is 5 - 10% YEARLY RISK
33
Q

Tuberculosis and other Mycobacteria

What is the incubation period, transmission route and main damage site in Leprosy?

A
  • Incubation 2-10 years
  • Poor transmission via nasal secretion
  • Most damage is secondary effects to nerves
34
Q

Tuberculosis and other Mycobacteria

What is the treatment of Leprosy?

A
  • Rifampicin
  • Dapsone
  • Clofazimine (if multibacliliary)
35
Q

Tuberculosis and other Mycobacteria

What are the key manifestations of Leprosy?

A
  • Skin
    • ​Depigmentation, macules, plaques, nodules, trophic ulcers
  • Nerves
    • Thickened nerves, sensory neuropathy
  • Eyes
    • ​Keratinitis, Irdocyclitis
  • Bones
    • ​Periositis nasecptic necrosis
36
Q

Tuberculosis and other Mycobacteria

Outline the features of “Progressive” Primary TB

A
  • Progressive primary
  • Rarely, focus or node ulcerates into bronchus
  • causing
    • pneumonia
    • cavity formation
    • bronchiectasis
    • consolidation
    • collapse
37
Q

Tuberculosis and other Mycobacteria

Outline the features of Miliary TB

A
  • Miliary TB:
    • progressive, disseminated haematogenous spread with rich foci

Year 5 - Alex's Pathology Guide 2018 (70 decks)

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