MYCOBACTERIA

Question 1

Disseminated Mycobacterium Avium Complex Disease (MAC)- diagnosis

Answer 1

cultures, very sensitive, grow for 7-14 days

Question 2

Dissem MAC Disease- management/tx

Answer 2

decide med based on susceptibility to macrolides
- AZITHromycin
- can add riffamycin abx and ethambutol
- IONIZING MONOTHERAPY if they CANNOT have rifomycin

Question 3

Dissem MAC Manifestations in an immunocomp pt

Answer 3

GI, Pulm, disseminated

Question 4

Mycobacteria- characteristics

Answer 4

• acid fast, aerobic, non spore forming bacilli
• mycolic acid and waxy cell structure
• SLOW growing (need special media), cell mediated immunity
• BETALACTAM IMMUNE. (no pcn for you)

M. tuberculosis, M. leprae

Question 5

Mycobacteria- structure

Answer 5

waxy lipid rich outer layer in cell wall
high conc. mycolic acid

makes beta lactams INEFFECTIVE (penicillin will not work)

Question 6

Tuberculosis- epidemiology/risk factors

Answer 6

• HIV, nutrition, immunocomp
• enviro risks: household contact, occupation exposure, place you love

Question 7

TB types

Answer 7

latent, pulmonary, extra pulmonary, miliary/disseminated (very sick)

Question 8

TB infection vs TB disease

Answer 8

infection no S+S
- latent TB

disease YES S+S
- ACTIVE TB

Question 9

TB is caught by

Answer 9

inhalation of viable tuberculous bacili
usually in latent state

Question 10

Who do you screen for TB

Answer 10

• healthcare workers, correctional facility, homeless shelter

Question 11

TB tests

Answer 11

tuberculin skin test (TST)
interferon gamma release assay (IGRA blood test)
Quantiferon gold blood test

Question 12

TST- positivity depends on what?

Answer 12

size of the reaction (bump on the skin) adjacent to medical history
ex) 5mm, 10mm, 15mm

Question 13

TB Infection- treatment

Answer 13

• Chest XR
• rifamycin (4 month dose)
• Isoniazid ALTERNATIVE (6-9 months)
• AZITHROMYCIN

Question 14

TB Disease- how do we diagnose

Answer 14

• CXR (show nodules, pleural effusion, small cavities)
• mycobacterial culture and acid-fast stain
• PCR for rapid Dx

Question 15

Pulmonary TB
(S+S)

Answer 15

• fever, prolonged cough, night sweats, hemoptysis, weight loss
• pleural effusions and MILIARY OPACITIES (small lung nodule)

Question 16

for TB infection what meds do you give and NOT give

Answer 16

Tb infection DO NOT give amoxicillin
DO NOT give +4 drugs

YES give isoniazin and rifamycin