"Other" Infectious Disorders Flashcards by Kellie Wheeler

Chronic infection with mycobacterium tuberculosis leading to granuloma formation; high mortality rates in untreated smear positive.

Tuberculosis

How well did you know this?

Not at all

Perfectly

Close contact of patient with active TB, health care workers are at an increased risk of _____

Exposure

How well did you know this?

Not at all

Perfectly

Immigrants from high-prevalance areas and homeless are at an increased risk of _______

Infection

How well did you know this?

Not at all

Perfectly

Immunodeficient patients, such as those with HIV, CRI, DM, IVDA, ETOHics, and those with malignancy are at a high risk of ?

Active TB once infected

How well did you know this?

Not at all

Perfectly

Inhalation of air droplets –> Mycobacterium reaches alveoli and is ingested by alveolar macrophages –> Mtb remains viable within macrophage, bypasses or escapes defense –> active infection

Tuberculosis

How well did you know this?

Not at all

Perfectly

What are the three different outcomes of a TB infection?

Primary
Chronic (Latent) infection
Secondary (reactivation)

How well did you know this?

Not at all

Perfectly

The outcome of initial infection (usually self-limited)

Primary TB

How well did you know this?

Not at all

Perfectly

Most exposed people mount an immune response sufficient to prevent further profession from initial infection to clinical illness. T cells and macrophages surround the organism and form a granuloma.

Primary TB

How well did you know this?

Not at all

Perfectly

How many people who are infected with TB will develop the disease?

10%

How well did you know this?

Not at all

Perfectly

When a person fails to contain the primary TB infection and progresses to active TB

Progressive primary TB

How well did you know this?

Not at all

Perfectly

Are patients with primary progressive TB contagious?

YES!

How well did you know this?

Not at all

Perfectly

How many patients will contain the TB bacterium without becoming contagious? What is this called?

95%; Latent TB infection (Chronic TB)

How well did you know this?

Not at all

Perfectly

Do patients with chronic/latent TB have a positive PPD? Are they contagious?

Yes, usually within 2-4 weeks post infection

Not contagious!

How well did you know this?

Not at all

Perfectly

What keeps patients with chronic/latent TB from having a primary TB infection?

Granuloma formation of T cells and macrophages around the bacteria

How well did you know this?

Not at all

Perfectly

What is it called when someone has chronic/latent TB that is reactivated by a waning immunity? (Elderly, HIV, steroid use, malignancy)

Secondary reactivation TB

How well did you know this?

Not at all

Perfectly

Where is TB usually located in the lungs?

Apex/upper lobes with cavitary lesions

How well did you know this?

Not at all

Perfectly

Are patients with reactivation TB contagious?

YES!

How well did you know this?

Not at all

Perfectly

What are the two types of TB?

Pulmonary and extra-pulmonary

How well did you know this?

Not at all

Perfectly

Classically presents with pulmonary symptoms and constitutional symptoms

Pulmonary TB

How well did you know this?

Not at all

Perfectly

Chronic, productive cough, chest pain (pleuritic), hemoptysis in advanced disease; Drenching night sweats, fever/chills, fatigue, anorexia, weight loss

Pulmonary symptoms of TB

How well did you know this?

Not at all

Perfectly

What would you expect to see on a physical exam in a patient with pulmonary TB?

Signs of consolidation: Rales or rhonchi near apices/involved areas, rhonchi, dullness.

How well did you know this?

Not at all

Perfectly

Which organs can extra-pulmonary TB affect?

Any organ!

How well did you know this?

Not at all

Perfectly

Vertebral TB

Pott’s disease

How well did you know this?

Not at all

Perfectly

Lymph node TB

Scrofula

How well did you know this?

Not at all

Perfectly

Meningitis caused by TB

TB meningitis

Other extra-pulmonary infections caused by TB

Pericarditis, peritonitis, joints, kidney, adrenal, cutaneous infections

What is the change yearly of having a reactivation of LTBI in patients with HIV?

7-10%

For an immunosuppressed patient, a patient who has had close contact with active TB, or a CXR consistent with old or healed TB (granuloma), what is the reaction size of a PPD that would be considered positive?

>/= 5mm

For all other high-risk populations and high prevalence populations, what is the reaction size of a PPD that is considered positive?

>/= 10mm

How do you diagnose suspected TB? What is considered non-infectious?

Acid-fast smears and sputum culture for 3 days 3 negative smears = non-infectious

What is the gold standard for diagnosing TB?

Acid fast bacillus culture

How do you exclude active TB in a patient with a new + PPD?

CXR

CXR shows apical upper lobe fibrocavitary disease

Reactivation

Middle/lower lobe consolidation on CXR

Primary TB

CXR shows small *millet0seed* like nodular lesions (2-4mm)

Miliary TB

Pleural effusion on CXR

TB Pleurisy

Detected as residual evidence of healed primary TB on CXR

Granuloma

What is the 4 drug regiment to treat an active TB infection?

Isoniazid, rifampin, pyrazinamide, ethambutol OR streptomycin RIPE: Rifampin, INH, Pyrazinamide, Ethambutol

When are patients considered to no longer be infectious?

2 weeks after initiation of therapy

TB resistant to both INH and rifampin

Multi drug resistant TB

Which TB drug has an adverse side effect of hepatitis and peripheral neuropathy?

Isoniazid

Which TB drug has an adverse side effect of thrombocytopenia and orange colored secretions?

Rifampin

Which TB drug has an adverse side effect of Which TB drug has an adverse side effect of hepatitis and hyperuricemia, GI sx, arthritis, and a photosensitive dermatologic rash?

Pyrazinamide

Which TB drug has an adverse side effect of optic neuritis, scooter, color perception problems, red-green visual changes, and peripheral neuropathy?

Ethambutol

Which TB drug has an adverse side effect of ototoxicity with CN8 and nephrotoxicity?

Streptomycin

Highly contagious infection secondary to bordetella pertussis; Rarely seen due to widespread vaccination Gram negative coccobacillus. Most commonly seen in children under 2 years old.

Pertussis (Whooping cough)

What are the 3 phases of pertussis?

1. Catarrhal phase 2. Paroxysmal phase 3. Convalescent phase

URI symptoms for 1-2 weeks

Catarrhal phase Pertussis

Severe paroxysmal coughing fits (with inspiratory whooping sound after coughing fit) with or without post coughing emesis

Paroxysmal phase Pertussis

Resolving of cough and emesis (Coughing phase may last up to 6 weeks)

Convalescent phase Pertussis

How can you diagnose whooping cough?

Nasopharyngeal swab | Severe lymphocytosis seen on differential

How soon does a nasopharyngeal swab need to be done to diagnose pertussis?

First 3 weeks of symptom onset

What is the mainstay of treatment with pertussis?

Supportive Rx

If you choose to treat pertussis, what are some drugs you could use?

Macrolides or Bactrim (use if allergic to macrolides)

According to the green PANCE book, what is the DOC for pertussis?

Erythromycin (macrolide)

Pneumonia, encephalopathy, otitis media, sinusitis, and seizures are all complications of?

Pertussis

What is treatment of Pertussis aimed at?

Treatment is aimed at stopping transmission

Inflammation of the epiglottis that can interfere with breathing. MEDICAL EMERGENCY!

Epiglottitis

What is the common etiology of epiglottitis? What else could cause it?

Primarily Haemophilus influenzae B Can be caused by s. pneumoniae, s. aureus, GABHS

What are the "3 D's" that characterize epiglottitis?

Drooling, distress, dysphagia

What are some addition clinical manifestations of epiglottis other than the "3 D's?"

Fevers Odynophagia Inspiratory stridor **tripoding**

If you have a suspicion of epiglottis, what should you never do?

Try to visualize epiglottis --> this can obstruct the airway!

How should you diagnose epiglottitis?

Lateral cervical X-ray: Look for "thumb sign" of swollen, enlarged epiglottis

What is the mainstay of treatment with epiglottitis?

Supportive Rx and maintain airway use dexamethasone to reduce airway edema Tracheal intubation for severe cases

What type of abx should you use to treat epiglottitis?

2nd/3rd gen cephalosporins

AKA acute viral laryngotracheobronchitis, commonly affects children 6 months to 5 years. Most common cause is parainfluenza type 1 and 2. RSV, adenovirus, influenza, and rhinovirus are also implicated.

Croup

Symptoms for this disease are a harsh, barking, seal-like cough; inspiratory stridor, hoarseness, aphonia, low-grade fever; and rhinorrhea.

Croup

How do you diagnose croup?

Clinically

What would a PA neck film show in a patient with croup?

subglottic narrowing (steeple sign)

Why should you do a lateral neck film when you diagnose croup?

To differentiate between croup and epiglottitis

How do you treat croup?

Typically does not require treatment; hydrate

What are some things you can give your patient to help them recover from croup?

Humidified air or oxygen, nebulizer epinephrine

When should you hospitalize your patient with croup?

Severe symptoms

Acute respiratory illness caused by influenza A or B viruses with outbreaks mainly in fall/winter; spreads primarily via airborne secretions

Influenza

Which strain of influenza is associated with more severe, extensive outbreaks?

What is characteristic about flu symptoms?

They usually have a very abrupt onset

How do you usually diagnose influenza?

Clinically or with a culture

What are the two types of influenza vaccine?

Influenza trivalent vaccine | Intranasal (live attenuated)

Who should always get a flu shot?

everyone! More specifically >50 years of age and those with underlying chronic medical conditions like asthma, sickle cell disease, and COPD

How do you manage the flu?

Best if begun within 48 hours of onset of symptoms: Acetaminophen or salicylate for symptoms Antivirals