Mycobacteria + Fungi Flashcards
What is the transmission for Tb?
Aerosol droplets deposit into the lungs; household exposure, incarceration, drug use, travel to/from endemic areas; disadvantaged populations include malnourished, homeless, overcrowded housing, HIV+
What is primary Tb?
Often clinically and radiographically silent (contained within granulomas), may have low grade fever 14-21 days, pleuritic or retrosternal pain
What are the CXR findings for primary TB?
Hilar adenopathy, pleural effusions, pulmonary infiltrates, cavitary lesion in a lower or middle lobe + hilar adenopathy = ghon complex
What are the signs and sx for reactivation TB?
Insidious onset, may go undiagnosed for 2-3 years, fatigue, weight loss, night sweats, diurnal fever peaks in the evening, advanced dz (anorexia, wasting and malaise), chronic cough MC (Dry first and productive later), blood streaked sputum
What are the PE findings for reactivation TB?
appears ill and malnourished, clubbing, dullness and decreased fremitus indicate pleural effusion, posttussive crackles at apices, distant hollow breath sounds over cavities (amphoric sound)
What is the general diagnostics for TB?
CXR + 3 sputum specimens
What is the traditional regimen for TB infection treatment?
RIPE for 2 months + 4 months (rifampin, isoniazid, pyrazinamide, ethambutol)
What is the treatment for multi drug resistant TB?
Intensive 4 months of tx with 7 drugs (IPE + bedaquiline + moxi/levofloxacin + prothionamide/ethionamide + clofazimine) then continue 5mo with 4 drugs (PE, moxifloxacin, clofazimine)
What is allergic bronchopulmonary aspergillosis?
Hypersensitivity to aspergillus species; characterized by chronic asthma, recurrent pulmonary infiltrates, bronchiectasis; almost exclusively in cystic fibrosis or asthma pts; tx = systemic glucocorticoids
What are the 3 most important pulmonary fungal infections?
Aspergillus species, pneumocystis jirovecii, cryptococcus neoformans
What are the signs and sx for invasive pulmonary aspergillosis?
Fever, CP, SOB, cough, hemoptysis, classic triad in neutropenic pts (fever, pleuritic CP, hemoptysis)
What is seen on imaging in invasive pulmonary aspergillosis?
CXR is insensitive to aspergillosis; classic halo sign on CT
What is the treatment for invasive pulmonary aspergillosis?
triazole antifungs = 1st line voriconazole or 2nd line echinocandins
What are the signs and sx of pneumocystis jiroveci pneumonia?
Progressive dyspnea on exertion, nonproductive cough, chest discomfort, fever (variable); PE shows tachypnea, tachycardia, hypoxia, diffuse fine end inspiratory crackles but may be normal
What is seen on imaging in pneumocystis jiroveci pneumonia?
CXR, HRCT if equivocal CXR; definitive = sputum or bronchoalveolar lavage (cysts on stained specific is gold standard)
What is the empiric tx for pneumocystis jiroveci?
TMP/SMX 1st line
What is the presentation for cryptococcus neoformans for immunocompetent people?
Mostly asx, small areas of granulomatous inflammation, occasionally found after lung biopsy suspicious for malignancy
How is cryptococcus neoformans diagnosed?
Encapsulated years forms in sputum bronchoalveolar lavage or tissue biopsy, exudative pleural effusions can be cultured, serum cryptococcal Ag
What does imaging reveal in cryptococcus neoformans infection?
Pleural used well defined solitary non-calcified nodules
What is the presentation of cryptococcus neoformans in immunocompromised pts?
Asx to acute repsiroatry failure, more acute and severe if HIV+, sx include fever, CP, dyspnea, cough, hemoptysis
What is the treatment for cryptococcus neoformans infection?
1st line = fluconazole, 2nd line = itraconazole
