Mycobacterial Diseases

Question 1

Atypical Mycobacterial DZ:

Answer 1

1. Mycobacterium avium complex (MAC)
2. 2nd MC opportunistic infection in pedi HIV pts
3. Primary routes of admin for MAC→GI tract/ Respiratory tracty
4. Lady Windermere syndrome: RML MAC pulm infection in elderly women w/ pre-existing lung dz
5. “Swimming pool granuloma”
6. Unique MAC syndrome in AIDS in the 1-2 months of HAART
7. Tenosynovitis, bone/joint infections
8. Labs: PCR/Culture of blood and bone marrow
9. Surgical TX: Excision of infected nodes/ I&D abscesses
10. ABX TX for disseminated MAC: 2 antimicrobials→Clarithromycin or azithromycin AND ethambutol

Question 2

Tuberculosis:

Answer 2

1. Red box car obligate aerobe that lives and proliferates w/in mononuclear phags that ingest bacterium→spreads to extrapulmonary sites
2. MC Extrapulm site: mediastinal/retrostinal/cervical lymph nodes/ vertebral bodies/adrenals/meninges &GI Tract
3. MDR-TB: resistance to the 2 most effective first line drugs→INZ and rifampin

• MD resistant TB-send to specialist, empirical tx
  3-5 new drugs (never add a single new drug to failing regiment) - 3 of the following (aminoglycosides, fluoroquinolone, thioamides
  consider rifabutin if rifampin resistant

4. 50% US cases from CA/ FL/NY/TX
5. 60% of all cases from foreign born persons
6. Contracted through aerosolized exposure through the lungs or mucus membrane
7. Labs: Sputum for acid fast bacillus/ DNA probes/ Lumbar puncture/PPD Test/IGRA/CT/MRI
8. • CXR and AFB in sputum=Initiation of TX
9. Pulmonary TB: Productive cough/fever/wt loss→CXR: Apical lung infiltrates/cavitations
10. TB Meningitis: H/A for 2-3 wks/ thick grey exudates encasing CNs and BV
11. Skeletal TB: Spine is MC site→ back pain/ stiffness→Pott’s DZ
12. GU TB: Flank pain/dysuria/ frequency
13. GI TB: Non healing ulcers of mouth or anus