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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
What disease reactivates in the lung apices and why?
Tuberculosis, because Mycobacteria needs oxygen to survive.
26
What are the symptoms of Reactivation TB?
> Chronic productive cough (2/3 weeks) | > Haemoptysis - torrential or not.
27
What are the signs of reactivation TB?
> Fever > Weight loss > Night sweats
28
What are the risk factors for reactivation TB?
``` > Alcoholism > Chronic Renal Failure > HIV > Malnutrition > Gastrectomy > Silicosis ```
29
What is the treatment for reactivation TB and why?
Anti-TNFa blockade - TNF-a maintains the granuloma.
30
What is Miliary TB?
When the tb has disseminated to other areas of the body
31
The young/old and immunocompromised are affected by what type of TB?
Miliary (Extra-Pulmonary )
32
What is the primary presentation of Miliary TB?
Disease
33
What is the secondary presentation of Miliary TB?
Tubercle necrosis erodes into blood vessel --> INFECTION
34
What are the symptoms of TB Meningitis?
> Insidious (gradual) onset | > Mild headache/ meningism
35
What makes up the constitutional quartet of TB?
> Fever > Night sweats > Anorexia > Weight loss
36
In what may the constitutional quarter symptoms of TB be lacking?
TB Meningitis
37
What clinical tests confirm diagnosis of TB?
> Ziehl Nielsen | > Granuloma
38
What blood test would confirm TB?
Interferon- Y release assay.
39
When should sputum be taken for TB testing and how many?
3 "Early Morning" samples
40
What confers a risk positive when testing Acid Fast Bacilli's (AFB's) ?
5000 organisms per ml sputum.
41
What does a risk positive for AFB's increase the risk of?
Transmission
42
What are the culture methods for microbiology?
> Lowenstein-Jensen 2/3 wks | > Broth culture
43
Why does species testing need to be done for a positive acid fast bacilli culture?
Because not all mycobacteria are TB causing.
44
If pt's do not cough up sputa what 3 things can be tested?
> Induced Sputa > Gastric Aspirates > Bronchial aspiraties
45
What is induced sputa?
Nebulized saline given and causes cough.
46
What is found in the positive AFB test for Renal TB?
White cells in the urine.
47
What is tested in TB Meningitis?
CSF
48
What should be tested in CSF for TB meningitis?
Cell count, protein, glucose.
49
What are the positives of using PCR for TB testing?
> Rapid > Can be used directly on clinical samples > Not 100% specific- false positives. > Can look for resistance mutations
50
What are the negatives of using PCR for TB testing?
> Expensive | > Less sensitive
51
What does the MTB/RIF test look for?
TB resistance
52
What is the duration of TB treatment?
6 mnths min bar meningeal
53
What is the duration of meningeal TB?
12 months
54
What is the standard treatment of TB?
> Isoniazid | > Rifampicin
55
What two drugs are also used for TB treatment at 2 months?
> Pyrazinamide | > Ethambutol
56
What should TB meningitis/pericarditis also initially be treated with?
> Corticosteroids
57
What are amikacin, ethionamide/prothionamide, cycloserine, flouroquinolones used for?
TB second line agents.
58
What drugs is multi-drug resistant TB resistant to?
> Isoniazid and Rifampicin
59
What drugs is extensive-drug resistant to ?
> First line drugs | > Flouroquinolone and injectable (amikacin and ethionamide) resistance.
60
If a patient has active TB disease what control should be enforced?
Patient isolation for ~2 weeks.
61
What is contact tracing?
Identifying people with the disease that have come into contact with infected people.
62
What is involved in the Mantoux Test?
TEST FOR TB 1) Purified protein derivative of TB. 2) Read at 48-72 hrs
63
What blood test is used to diagnose TB?
Interferon-gamma release assay
64
What type of TB does the interferon-y release assay detect?
Active not latent.
65
What does the interferon-y test look for?
T cells that produce interferon- y.
66
How does the interferon-y test not interfere with the TB vaccine?
It uses specific antigens that don't cross react with M. Bovis BCG.
67
What does the BCG vaccine treat?
TB
68
What is the BCG vaccine made up of?
Attenuates strain of M.Bovis
69
What is the chemoprophylaxis for TB?
> 3 mnths Rifampicin/Isionazid | > 6 mnths Isionazid
70
What transmission does Non-tuberculosis mycobacteria not do?
Typically, person to person.
71
What determines what type of symptoms that Mycobacterium Avium causes?
Whether HIV infected or not.
72
What does M.Avium cause in those with HIV?
Disseminated disease
73
What does M.Avium cause in adults without HIV?
TB like disease
74
What does M.Avium cause in children without HIV?
Cervical lymphadenitis
75
How is M.Avium treated?
Combined, prolonged Macrolide - clarithromycin or azithromycin.
76
What causes Leprosy?
M.Leprae
77
What are the two forms of leprosy?
Tuberculous and Lepromatous
78
What occurs in Tuberculosus leprosy?
> Macules/plaques | > Damage to ulnar and common peroneal nerve.
79
What occurs in lepromatous leprosy?
> Subcutaneous tissue accumulation - ear lobes, face (lion like)
80
What drugs are used to treat Leprosy?
> Dapsone > Rifampicin > Clofazimine

CP3 = Respiratory System Diseases (4 decks)

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