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CP3 = Respiratory System Diseases > Mycobacterial Diseases > Flashcards

Mycobacterial Diseases Flashcards

1
Q

What type of bacillus is Mycobacteria?

A

A slender bacillus

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2
Q

Why does Mycobacteria have an unusually waxy cell wall?

A

Because of its high lipid content

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3
Q

How often does Mycobacteria replicate?

A

Once every 24 hrs.

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4
Q

What staining technique does not work with Mycobacteria?

A

Gram stain

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5
Q

Why is Mycobacteria called an “Acid-fast bacilli” ?

A

No decolorisation by acid/alcohol

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6
Q

What staining techniques should be used with Mycobacteria?

A

Ziehl-Nielsen and Auramine Phenol

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7
Q

What bacteria presents as a chronic infection and why?

A

Mycobacteria because of its slow growth.

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8
Q

What duration of treatment does Mycobacterium need?

A

Long term

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9
Q

What mycobacterium causes TB?

A

M. Tuberculosis

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10
Q

What mycobacterium causes fish tank granulomas?

A

M.Marinum

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11
Q

What percentage of the world’s population are infected with M. Tuberculosis?

A

1/3rd world’s pop

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12
Q

How many deaths a year from TB?

A

2 million

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13
Q

How is TB spread?

A

Through infected respiratory droplets

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14
Q

What does TB cause in 50% of cases?

A

Pulmonary Disease

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15
Q

What is the most common site for Primary TB?

A

The periphery of the lung midzone

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16
Q

What is the step by step pathogenesis of Primary Tuberculosis?

A

> Inhaled bacilli are ingested by macrophages - not killed
Macrophages move to hilar lymph nodes
Form a primary lesion - Ghon focus
Intracellularly multiple
Disseminate via lymphatics/bloodstream.

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17
Q

What is the body’s primary response to TB?

A

Forms a granuloma

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18
Q

What is in the centre of a granuloma?

A

Epithelioid cells
Giant cells
> Infected macrophages

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19
Q

What is surrounding a granuloma?

A

Lymphocytes

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20
Q

What is the step by step of a granuloma to fibrosis?

A

Granuloma –> Caseous necrosis –> Fibrosis/calcifications

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21
Q

What are the mild clinical symptoms of TB?

A

“Influenza-like” symptoms.

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22
Q

In what percentage of people does TB reactivate?

A

10%

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23
Q

What does reduced immunity in reactivating TB not allow the formation of?

A

A granuloma

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24
Q

What pathological process occurs in reactivating TB? (Think: tubercle)

A

Tubercles coaslesce (mass together) –> caseous necrosis in centre –> cavity in tubercle

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25
Q

What disease reactivates in the lung apices and why?

A

Tuberculosis, because Mycobacteria needs oxygen to survive.

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26
Q

What are the symptoms of Reactivation TB?

A

> Chronic productive cough (2/3 weeks)

> Haemoptysis - torrential or not.

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27
Q

What are the signs of reactivation TB?

A

> Fever
Weight loss
Night sweats

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28
Q

What are the risk factors for reactivation TB?

A 
> Alcoholism
> Chronic Renal Failure
> HIV
> Malnutrition
> Gastrectomy
> Silicosis
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29
Q

What is the treatment for reactivation TB and why?

A

Anti-TNFa blockade - TNF-a maintains the granuloma.

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30
Q

What is Miliary TB?

A

When the tb has disseminated to other areas of the body

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31
Q

The young/old and immunocompromised are affected by what type of TB?

A

Miliary (Extra-Pulmonary )

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32
Q

What is the primary presentation of Miliary TB?

A

Disease

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33
Q

What is the secondary presentation of Miliary TB?

A

Tubercle necrosis erodes into blood vessel –> INFECTION

34
Q

What are the symptoms of TB Meningitis?

A

> Insidious (gradual) onset

> Mild headache/ meningism

35
Q

What makes up the constitutional quartet of TB?

A

> Fever
Night sweats
Anorexia
Weight loss

36
Q

In what may the constitutional quarter symptoms of TB be lacking?

A

TB Meningitis

37
Q

What clinical tests confirm diagnosis of TB?

A

> Ziehl Nielsen

> Granuloma

38
Q

What blood test would confirm TB?

A

Interferon- Y release assay.

39
Q

When should sputum be taken for TB testing and how many?

A

3 “Early Morning” samples

40
Q

What confers a risk positive when testing Acid Fast Bacilli’s (AFB’s) ?

A

5000 organisms per ml sputum.

41
Q

What does a risk positive for AFB’s increase the risk of?

A

Transmission

42
Q

What are the culture methods for microbiology?

A

> Lowenstein-Jensen 2/3 wks

> Broth culture

43
Q

Why does species testing need to be done for a positive acid fast bacilli culture?

A

Because not all mycobacteria are TB causing.

44
Q

If pt’s do not cough up sputa what 3 things can be tested?

A

> Induced Sputa
Gastric Aspirates
Bronchial aspiraties

45
Q

What is induced sputa?

A

Nebulized saline given and causes cough.

46
Q

What is found in the positive AFB test for Renal TB?

A

White cells in the urine.

47
Q

What is tested in TB Meningitis?

A

CSF

48
Q

What should be tested in CSF for TB meningitis?

A

Cell count, protein, glucose.

49
Q

What are the positives of using PCR for TB testing?

A

> Rapid
Can be used directly on clinical samples
Not 100% specific- false positives.
Can look for resistance mutations

50
Q

What are the negatives of using PCR for TB testing?

A

> Expensive

> Less sensitive

51
Q

What does the MTB/RIF test look for?

A

TB resistance

52
Q

What is the duration of TB treatment?

A

6 mnths min bar meningeal

53
Q

What is the duration of meningeal TB?

A

12 months

54
Q

What is the standard treatment of TB?

A

> Isoniazid

> Rifampicin

55
Q

What two drugs are also used for TB treatment at 2 months?

A

> Pyrazinamide

> Ethambutol

56
Q

What should TB meningitis/pericarditis also initially be treated with?

A

> Corticosteroids

57
Q

What are amikacin, ethionamide/prothionamide, cycloserine, flouroquinolones used for?

A

TB second line agents.

58
Q

What drugs is multi-drug resistant TB resistant to?

A

> Isoniazid and Rifampicin

59
Q

What drugs is extensive-drug resistant to ?

A

> First line drugs

> Flouroquinolone and injectable (amikacin and ethionamide) resistance.

60
Q

If a patient has active TB disease what control should be enforced?

A

Patient isolation for ~2 weeks.

61
Q

What is contact tracing?

A

Identifying people with the disease that have come into contact with infected people.

62
Q

What is involved in the Mantoux Test?

A

TEST FOR TB

1) Purified protein derivative of TB.
2) Read at 48-72 hrs

63
Q

What blood test is used to diagnose TB?

A

Interferon-gamma release assay

64
Q

What type of TB does the interferon-y release assay detect?

A

Active not latent.

65
Q

What does the interferon-y test look for?

A

T cells that produce interferon- y.

66
Q

How does the interferon-y test not interfere with the TB vaccine?

A

It uses specific antigens that don’t cross react with M. Bovis BCG.

67
Q

What does the BCG vaccine treat?

A

TB

68
Q

What is the BCG vaccine made up of?

A

Attenuates strain of M.Bovis

69
Q

What is the chemoprophylaxis for TB?

A

> 3 mnths Rifampicin/Isionazid

> 6 mnths Isionazid

70
Q

What transmission does Non-tuberculosis mycobacteria not do?

A

Typically, person to person.

71
Q

What determines what type of symptoms that Mycobacterium Avium causes?

A

Whether HIV infected or not.

72
Q

What does M.Avium cause in those with HIV?

A

Disseminated disease

73
Q

What does M.Avium cause in adults without HIV?

A

TB like disease

74
Q

What does M.Avium cause in children without HIV?

A

Cervical lymphadenitis

75
Q

How is M.Avium treated?

A

Combined, prolonged Macrolide - clarithromycin or azithromycin.

76
Q

What causes Leprosy?

A

M.Leprae

77
Q

What are the two forms of leprosy?

A

Tuberculous and Lepromatous

78
Q

What occurs in Tuberculosus leprosy?

A

> Macules/plaques

> Damage to ulnar and common peroneal nerve.

79
Q

What occurs in lepromatous leprosy?

A

> Subcutaneous tissue accumulation - ear lobes, face (lion like)

80
Q

What drugs are used to treat Leprosy?

A

> Dapsone
Rifampicin
Clofazimine

CP3 = Respiratory System Diseases (4 decks)

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