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MID EXAM 2 > Mycobacteria > Flashcards

Mycobacteria Flashcards

1
Q

Mycobacterium

morphology, etc

A 
aerobic
non-spore forming
nonmotile
bacillus
acid-fast (mycolic acid)
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2
Q

M tuberculosis

transmission/epi

A 
1/3 of world pop has latent TB
transmissible person-to-person
inhaled droplets
establishes latency
time+ closed space
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3
Q

M. tuberculosis

primary infection

A 
asymptomatic
posterior apices
macrophage ingestion
local focus (Gohn)
hilar nodes (complex of Ranke)
delayed hypersensitivity
granuloma
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4
Q

M. tuberculosis

primary progression

A

often asymptomatic
3 mos: miliary TB or meningitis
3-4 mos: TB pleurisy
up to 3 yrs: boint/joint/renal/ TB

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5
Q

M. tuberculosis

active infection

A 
fever, cough, night sweats
tissue hypersensitivity
apical TB cavitation
caseous necrosis
may be asymptomatic
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6
Q

M. tuberculosis

reactivation

A

stress

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7
Q

M. tuberculosis

risk

A

DM
ESRD
immunosuppression
cancer

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8
Q

M. tuberculosis

PPD test parameters

A 
>5mm HIV+, HIV? & IDU, fibrotic CXR,
 close relative, steroids
>10mm HIV- & IDU, high prev country,
underserved area, high risk medical, long-term care
>15mm everyone else
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9
Q

M. tuberculosis

lab diagnostics

A

intial: direct sputum smear
acid fast or fluorescent test
conirm: egg/agar culture (5 days)

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10
Q

M. tuberculosis

BCG vaccination

A

attenuated vacc
intradermal
can affect PPD test

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11
Q

M. tuberculosis

latent treatment

A

isonazid (6-9 mos)
isonazid + rifapentine (3 mos)
rifampin (4 mos)

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12
Q

M. tuberculosis

active treatment

A

RIPE intensive
isonazid+rifampin continuation
6-9 mos

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13
Q

M. tuberculosis

HIV

A 
note: often smear negative
HAART causes IRIS
tx even if latent
contra'd: rifamycins
CD4>50, tx w/in 2 wks
CD4<50, tx w/in 8-12 wks
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14
Q

M. tuberculosis
resistance profiles
(MDR vs. XDR)

A

MDR: resist isonazid, rifampin
XDR: MDR plus fluoroquinolone, mycins

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15
Q

Non-TB mycobacteria

morphology etc

A 
grow slowly (generally)
environmental (water, soil)
NOT human-human transmission
nosocomial outbreaks
pseudo-outbreaks (tap water)
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16
Q

Non-TB mycobacteria

rapid grower spp.

A

M. abscessus
M. fortuitum
M. chelonae
M. immunogenum

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17
Q

Non-TB mycobacteria

slow grower spp.

A 
M. avium
ulcerans
kansasii
xenopi
scrofulaceum
gordonae
genevase
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18
Q

Non-TB mycobacteria
nosocomial infections
(causes)

A

surgical wounds, injections, LASIK,
pneumonia, central catheters
don’t tx empirically

19
Q

Non-TB mycobacteria
MAC
(clinical manifestations)

A 
more common in SE
pulm dz elderly men with COPD
pulm dz in elderly non-smoking women
pulm dz with CF
hypersensitivity pneumoitis (hot tub lung)
disseminated dz in AIDS
lymphadenitis in children
AFB smear positive
20
Q

Non-TB mycobacteria
nodular MAC lung dz
(Pt profile/risks)

A

Pt profile:
taller, leaner, pectus excavatum, scoliosis, MV proplaps
CF mutations

21
Q

Non-TB mycobacteria

MAC hypersens pneumonitis

A 
hot tub lung
dyspnea, cough fever
CXR diffuse infiltrates
positive cultures
tx: steroids, antimycobx, observation
22
Q

Non-TB mycobacteria

diagnosis

A

3 criteria, all met:
1) clinical sx w/o other etiology
2) abnormal CXR/HRCT (inflitrates, cavitation, bronchiectasis)
3) bacteriologic criteria (2 pos sputum culture OR
positive BAL culture OR pos biopsy of granuloma/AFB w/ NTM from sputum)
*BAL is bronchoalveolar lavage

23
Q

Non-TB mycobacteria

treatment, general

A

NOT empiric

12+ mos of tx

24
Q

Non-TB mycobacteria

MAC tx

A

clarithromycin+ethambutol+rifampin
mothly sputum cultures
tx until culture negative for 12 mos

25
Q

Non-TB mycobacteria

MAC w/ HIV/AIDS tx

A

CD4100 for 3 months

may experience IRIS from ART

26
Q

Non-TB mycobacteria
M. kansasii
(general)

A

more common in midwest and south
tuberculosish
probe available for culture dx
increased risk for HIV with CD4<200

27
Q

Non-TB mycobacteria

M. kansasii tx

A

INH + ethambutol + rifampin for 12 mos cult neg

28
Q

Non-TB mycobacteria
M. xenopi
distribution

A

UK, Europe, Canada, China, rural

29
Q

Non-TB mycobacteria
M. xenopi
(clinical pres)

A

tuberculosish

30
Q

Non-TB mycobacteria
M. xenopi
(treatment)

A

clarithromycin+IRE for 12 mos cult neg

31
Q

Non-TB mycobacteria
Lymphadenitis
(cause, dx, tx)

A 
MAC or scrofulaceum
usually unilateral
ddx: TB
dx: fine needle aspiration
tx: surgery, chemotherapy
32
Q

Non-TB mycobacteria
M. marinum
(cause, dx, tx)

A

low temp required for culture
water, fish
granulomatous nodular-ulcerative lesions (hands)
dx: biopsy, culture
tx: clarithromycin/rifampin +ethambutol for 4 mos

33
Q

Non-TB mycobacteria
M. ulcerans
(cause, dx, tx)

A

low temp required for culture
Africa
chronic cutaneous ulcers
tx: debridement

34
Q

Non-TB mycobacteria
M. haemophilum
(cause, dx, tx)

A

low temp required for culture
needs Fe
risk: immunocompromised (HIV+, ESRD)
sx: skin lesions on extremities, ulcerative/nodular
culture from skin, blood
tx: combo rifampin, clarithromycin, etc etc

35
Q

Non-TB mycobacteria
rapid grower infx’n
(general profile)

A

soft tissue infx’ns (all spp.)
pulmonary infx’n (abscessus>fortuitum)
no cavitation

36
Q

Non-TB mycobacteria
M. fortuitum
(cause, clinical pres)

A

furunculosis from nail salon

ear piercing infection

37
Q

Non-TB mycobacteria

M. fortuitum tx

A

1) susceptibility testing
2) clarithromycin + 2 from cipro, doxy, sulfaonamide
4-12 mos

38
Q

Non-TB mycobacteria

M. chelonae tx

A

1) susceptibility testing
2) clarithromycin + cipro/doxy/linezolid
4-6 mos

39
Q

Non-TB mycobacteria

M. abscessus tx

A

poor tx prognosis

period tx w/ clarithromycin + amikacin + cefoxitin

40
Q

Non-TB mycobacteria
M. immunogenum
(cause, tx)

A

rapid grower
risk: IV, catheters, leukemia
drug tx prognosis poor
combination tx

41
Q

Non-TB mycobacteria
M. leprae
(general cause, dx)

A 
cannot be cultured
slow growing (5-20 yr incubation)
risk: armadillos, India, Brazil
transmission: droplets
dx: acid fast bacillus, skin biopsy of cutaneous nerve
42
Q

Non-TB mycobacterium
lepromatous leprosy
(clin pres, tx)

A

mulitbacillary
diffuse skin involvement: plaques, nodules
facial deformity
anergy
tx: dapsone + rifampin + clofazimine 12 mos

43
Q

Non-TB mycobacteria
tuberculoid leprosy
(clin pres, dx, tx)

A 
paucibacillary
<5 skin lesions
anesthesia, nerve involvement
dx: skin tests
tx: dapson + rifampin 6 mos

MID EXAM 2 (11 decks)

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