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Clin Med: Pulmonary > Pneumonia > Flashcards

Pneumonia Flashcards

1
Q

Describe the general pathophysiology of pneumonia?

A

Increased # of microbial pathogens @ alveolar level

Host’s inability to fight off said pathogens

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2
Q

How do pathogens gain access to the pulmonary cavity to cause pneumonia?

A

Aspiration from oropharynx = MOST COMMON

Inhaled as contaminated droplets

Hematogenous spread = rare

Extension from infected pleural or mediastinal space

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3
Q

What are the defense mechanisms of the respiratory system?

A

Hairs/turbinates of nares

Branch architecture of tracheobronchal tree –> traps particles in lining

Mucociliary clearance

Local antibacterial factors

Gag reflex

Cough mechanism

Normal flora of the oropharynx

Body’s Immune Response

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4
Q

When will pneumonia occur?

A

When 1 or more of the bodies defense mechanisms fail

Large Infectious inoculum/virulent pathogen overwhelms immune response

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5
Q

What are the immune responses that triggers the clinical syndrome of pneumonia and what are their symptoms?

A

Alveolar capillary leak = infiltrate/rales

Alveolar filling = hypoexmia

Leakage of erythrocytes = hemoptysis

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6
Q

What is CAP?

A

Community Aquired Pneumonia

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7
Q

What is the epidemiology of CAP?

A

8th most common cause of death in the US –> 25% = hospitalized

4 - 5 million cases/year –> 12/1000

Most common cause of death from infectious disease

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8
Q

Which populations have the highest incidence of CAP?

A

Extremes of ages: very young and very old

12-18/1000 60 yo

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9
Q

What are the mortality rates of CAP?

A

Out patient = < 1%

In patient = 10 - 12%

1 year mortality of patents > 65 = 40%

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10
Q

What is the presentation of CAP dependent on?

A

Progression

Severity

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11
Q

What are the classic signs/symptoms of CAP?

A

Acute or subacute cough w/ or w/o sputum

Dyspnea

Fever

Chills

Sweats

Chest pain (esp. plueritic) w/ deep breath

Hemoptysis

GI complains = 20% have n/v and/or diarrhea

Fatigue

Head Ache

Myalgias (body Aches)

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12
Q

What is the etiology of CAP?

A

Strep. pneumonia = MOST common

H. Influenza

S. aureus

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13
Q

In pts w/ a Hx of aspiration, abscess formation, empyemas or parapneumonic effusions, what is the most common cause of CAP?

A

Anaerobes

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14
Q

In pts w/ a Hx of alcohol abuse, what is the most common cause of CAP?

A

Klebsiella pneumonia, Strep pneumonia

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15
Q

What are the signs/symptoms of CAP caused by Klebsiella pneumonia?

A

Necrosis

Hemorrhage

Sputum looks like currant jelly

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16
Q

What is the most common cause of CAP in a pt w/ a Hx of aspiration?

A

Pseudomonas aeroginose

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17
Q

What are the common risk factors/comorbidities of pneumonia (14)?

A

Alcoholism

Asthma/COPD

Immunosupression –> chronic steroid use

Institutionalism

> 70

Smoking = STRONGEST RISK FACTOR IN NON ELDERLY/NON IMMUNOCOMPROMISED
increase chance 2-4x

Dementia

Seizure disorder

Cerebrovascular dz

HIV

Structural lung DZ

Introvenous Drug Abuser

Gastric Acid Suppression Therapy

Short duration H+ inhibitors

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18
Q

What would you expect to see on physical exam of a pt w/ pneumonia?

A

Fever

Tachypnea

Tachycardia

Hypoxia

Increased tactile fremitus (increased chest wall vibration near infection)

Egophony over infected area (E sounds like A)

Altered breath sounds

Crackles

Ronchi

Bronchial breath sounds

Dullness to percussion over infection

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19
Q

When treating an outpatient CAP, should you culture for a specific pathogen?

A

Not at first

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20
Q

What test do you perform on EVERYONE w/ pneumonia?

A

Chest X-ray = Classic Exam

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21
Q

What would you expect to see on a chest x-ray of a pt w/ pneumonia?

A

Patchy airspace infiltrates

Lobar consolidation

Diffuse alveolar/interstitial infiltrates

may or may not see pleural effusion

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22
Q

When would you do a CT scan on a pt suspected of having pneumonia?

A

Severe cases

Unresolving cases

Complicated Cases

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23
Q

When do you do a follow Chest X-Ray for a pt w/ pneumonia?

A

At least 6 weeks (otherwise won’t see a difference in X-ray)

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24
Q

What are the Ddx for CAP?

A

Acute bronchitis

COPD exacerbation

CHF

Lung Cancer

Pulmonary Embolism

Atelectasis

Pulmonary Vasculitis

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25
Q

When would you admit a pt for pneumonia?

A

Pneumonia Severity Index

CURB-65 criteria

Outpatient treatment failed

Exacerbation of underlying disease

Complications

Hypoxemia

Pleural effusion

Sepsis

Other medical/psychosocial needs
             Cognitive dysfunction
             Homelessness
             Drug abuse
             Lack of outpatient resources
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26
Q

How would you treat out patient pneumonia?

A

Antibiotics 5 - 10 days

Treat empirically to cover most likely pathogens (based on acuity, risk factors, local antibiotic resistance)

Don’t wait for culture results to start!

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27
Q

What is your first line antibiotic to treat outpatient CAP in a healthy pt w/ no antibiotic use in the last 3 months?

A

Macrolide:

erythromycin

clarithromycin

azithromycin

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28
Q

What is your second line antibiotic to treat outpatient CAP in a healthy pt w/ no antibiotic use in the last 3 months?

A

Doxycycline

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29
Q

What is your first line antibiotic to treat outpatient CAP in a pt with a comorbidity or has had antibiotic treatment in the last 3 months?

A

Respiratory Fluoroquinolones:

Levofloxacin

Moxifloxacin

Gemifloxacin

Beta-lactam antibiotics:

Amoxacillin/Augmentin + macrolide

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30
Q

What are the complications associated w/ pneumonia?

A

Respiratory failure

Shock

Multi-organ failure

Coagulopathy

Exacerbation of comorbidity -> COPD/chronic bronchitis

Metastatic (spread) infection (10% of bacterial pneumonia) –> meningitis, pericarditis, peritonitis, parapneumonic effusion, empyema

Pulmonary embolism w/ infarction

Acute MI

Acute respiratory distress syndrome (ARDS)

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31
Q

Which types of patient will get a full diagnostic work-up for pneumonia?

A

ALL inpatients

Pt w/ weird presentation

Public health concerns

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32
Q

In a pt w/ a Hx of COPD, what are the most common causes of CAP?

A

H. influenza

Moraxella catarrhalis

S. pneumonia

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33
Q

In a pt w/ a Hx of Cystic Fibrosis (CF) what are the most common causes of CAP?

A

Pseudomonas species

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34
Q

In Young adults what is the most common cause of CAP?

A

Atypicals:

Mycoplasma

Chlamydia

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35
Q

If a pt were to have gotten pneumonia from shitty air conditioning, what is the most common pathogen?

A

Legionella pneu.

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36
Q

In pts w/ suffering from leukemia/lymphoma what are the most common cause of CAP?

A

Fungus

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37
Q

In pts w/ a Hx of IV drug abuse, what is the most common causes of CAP?

A

Hematogenous spread of S. auerus ( (+) MRSA)

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38
Q

In a pt post CVA (stroke) aspiration, what is the most common cause of pneumonia?

A

Oral flora (including S. pneumonia)

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39
Q

In a pt post influenza, what is the most common cause of pneumonia?

A

S. pneumonia

S. aureus

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40
Q

In children < 1 yo, what is the most common cause of pneumonia?

A

RSV (respiratory syncytial virus)

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41
Q

In children > 2 yo, what is the most common cause of pneumonia?

A

Parainfluenza virus

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42
Q

What is the atypical pneumonia presentation?

A

Low grade fever

Mild pulmonary symptoms = non productive cough

Myalgias

Fatigue

No lobar consolidation

Small increases in WBCs

**Pt looks better than symptoms/CXR suggest

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43
Q

What is the cause of atypical pneumonia?

A

Mycoplasma pneumonia = MORE common in young

Chlamydia pneumonia = most common in out patient (10% CAP); younger population

Legionella spp. = most common inpatient
Exposure to contaminated H2O drops
from cooling and ventilation system
Nursing Homes
Rehab Facilities

Moraxella species

Viruses
Influenza/RSV = most common
Adenovirus

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44
Q

What are the signs and symptoms in elderly patients?

A

Subtle!

Cognitive impairment or change in mental status

Anorexia

Functional Decline

Falls

Weight Loss

Slight increase in respiratory rate

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45
Q

What are the labs for inpatient treatment?

A

Point of care diagnostic testing (POC)

Pre-antibiotic sputum cultures

Blood cultures

ABG (arterial blood gas) if hypoxic

CBC w/ differential

CMP

HIV testing in any pt who is at risk

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46
Q

When is POC diagnostic testing done and why is it done?

A

Usually ER

Helps in broadening Abx coverage in pts being hospitalized

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47
Q

What is included in POC?

A

Sputum gram stain

Urinary antigen tests for Legionella species/S. pneumonia

Rapid antigen testing for influenza (nasal swab)

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48
Q

When is it most important to do sputum cultures and blood cultures?

A

PRIOR to starting Abx

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49
Q

How are the blood cultures done?

A

2 sets from 2 separate needle sticks @ 2 different sites

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50
Q

Why is it important to do POC, Pre-antibiotic sputum tests, and blood cultures?

A

Allows the adjustment of Abx coverage based on results

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51
Q

How would you treat inpatient, non-ICU patients?

A

Respiratory Fluoroquinolone PO/IV

Beta lactam (ceftriaxone/cefotaxime) + macrolide (clarithromycin/azithromycin)

Hydration

Room air if O2 sat is > 90%; supplemental O2 if sat is < 90%

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52
Q

What is the treatment for inpatient ICU patients?

A

IV Macrolide

IV Respiratory fluoroquinolone + anti-pseudomonal B-lactam

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53
Q

How do you prevent CAP?

A

Annual influenza vaccine (6 mo (+))

Polyvalent pneumococcal vaccine

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54
Q

What does the polyvalent pneumococcal vaccine do?

A

Potential to prevent

Less severity

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55
Q

Which patients are recommended to get the pneumococcal vaccine?

A

> 65 yo

Hx of chronic illness

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56
Q

What are the follow up recommendations for outpatient CAP?

A

2 - 3 days if no improvement (sooner if worse)

57
Q

In an otherwise healthy pt when will fever/leukocytosis resolve?

A

2 - 4 days

58
Q

How long will the physical findings of CAP persist?

A

Much longer (fatigue/cough)

CXR won’t clear for 4 - 12 weeks depending on pt age/underlying lung dz

59
Q

What are the follow up recommendations for inpatient CAP?

A

Discharge once conditions are stable

Repeat CXR in 4 - 6 wks

60
Q

When would you consider an underlying neoplasm?

A

If relapse/recurrence occurs (particularly in same segment of lung)

61
Q

What is HCAP?

A

Health Care-Associated Pneumonia

virulent/drug resistance pathogens (MDR)

62
Q

What are the factors responsible for the development of HCAP?

A

Widespread use of potent Abx

Early transfer of pts out of acute care hospital to homes/lower acuity facilities

Increased use of outpatient IV Tx

Aging population

More extensive immunomodulatory therapy

63
Q

What are the risk factors for HCAP?

A

Abx therapy in past 90 days

Acute care hospitalization for at least 2 days in the last 90 days

Residence in nursing home or extended care facility

Home infusion therapy w/in past 30 days

Home wound care

Family member w/ infection involving MDR pathogen

Immunosuppresive disease or immunosuppresive therapy

64
Q

What is the definition of HAP?

A

Caused by organisms that colonize ill patients, staff and equipment, producing clinical infx more than 48 hours after admission to the hospital or other health care facility and excludes any infection present at the time of admissio

65
Q

What is the epidemiology of HAP?

A

ICU pts @ increased risk

2nd most common cause of hospital acquired infection

Leading cause of death d/t infection

Mortality = 20 - 50%

66
Q

What is VAP?

A

Ventilator Associated Pneumonia

“Pneumonia that has developed more than 48 hours following endotracheal intubation and mechanical ventilation”

67
Q

What is important about VAP?

A

Higher mortality rate

68
Q

What are the risk factors for VAP?

A

Endotracheal tube (microaspiration)

Cross infection from other infected/colonized patients

Contaminated Equipment

Malnutrition

69
Q

What are the common organisms that cause HCAP/HAP/VAP

A

S. pneumonia - often drug resistant in HCAP

S. aureus (MSSA/MRSA)

Pseudomonas aeruginosa

Klbsiella

E. coli

Enterobacter

VRE (Vancomycin resistant enterococci)

70
Q

What is the most likely pathogen in the ICU?

A

Pseudomonas aeruginosa

71
Q

Which of the organisms that cause HCAP/HAP/VAP carries the worst prognosis?

A

Pseudomonas aeruginosa

72
Q

What are the common signs/symptoms of HCAP/HAP?

A

Similar to CAP but may be nonspecific

2+ clinical findings (fever, purulent sputum, leukocytosis) in setting of new or progressive pulmonary opacity on Chest X-Ray is highly suggestive of pneumonia

73
Q

What are the clinical signs/symptoms of VAP?

A

Fever

Leukocytosis

Increase in respiratory secretions

Pulmonary consolidation on physical exam

New or changing infiltrate on CXR

Tachypnea

Tachycardia

Worsening oxygenation = hypoxia

Increased minute ventilation

74
Q

What is the most important thing in diagnosing VAP?

A

Physical Exam, patients can’t talk

75
Q

What is the Ddx of HCAP/HAP/VAP

A

CHF

Atelectasis

Aspiration

ARDS

Pulmonary Embolism

Pulmonary Hemorrhage

Drug Reactions

76
Q

What are diagnostic tests of HCAP/HAP/VAP?

A

Gram stain

Sputum culture

Blood culture (2 different sites)

WBC

ABG

Pulse Ox

Thoracentesis in pts w/ pleural effusion (culture)

CXR

Endotracheal aspiration cultures (VAP)

Procalcitonin levels

77
Q

What would you expect the WBC findings to be in a pt with HCAP/HAP/VAP?

A

Elevated

Increased Bands

78
Q

Why are the procalcitonin levels checked in a pt who you’re trying to diagnose w/ HCAP/HAP/VAP?

A

Studies show can help to distinguish bacterial pneumonia from noninfectious causes of fever w/ pulmonary infiltrates in hospitalized pts

79
Q

What is the treatment of HCAP/HAP/VAP?

A

Start empirical therapy

Tailor when cultures come back

80
Q

When do anaerobic pneumonia and lung abscesses happen?

A

Secondary to aspiration

81
Q

What are the risk factors for aspiration (and therefore anaerobic pneumonia/lung abscess)

A

Decreased LOC d/t drug or ETOH use

Siezure

General anesthesia

CNS disease

Esophageal disease

Tracheal or NG tubes

Periodontal diseases/poor dental hygiene (increases chances fo anaerobic infection)

82
Q

Which part of the lungs infected is the most likely by anaerobic pneumonia and lung abscesses?

A

Posterior segments of upper lobes

Superior/basilar segments of lower lobes

**body position @ time of aspiration determines which lung zone are affected

83
Q

Describe the onset of anaerobic pneumonia and lung abscess?

A

Insidious –> gradual and harmful

84
Q

What kinds of complications may accompany anaerobic pneumonia and lung abscess?

A

Abscess

Empyema

Necrotizing pneumonia

**because onset is gradual but harmful

85
Q

What is the cause of anaerobic pneumonia and lung abscesses?

A

Multiple anaerobes typically present

Can also have aerobic bacteria

Prevotella melaninogenica

Peptostreptococus

Fusobacterium nucleatum

Bacteroides species

86
Q

What is the clinical presentation of anaerobic pneumonia and lung abscess?

A

Fever

Weight Loss

Malaise

COUGH w/ FOUL-SMELLING PURULENT SPUTUM (don’t have to have cough)

Dentition = poor

87
Q

What diagnostic tests are done to diagnose anaerobic pneumonia and lung abcess?

A

Labs

CXR

88
Q

What types of labs are done and how are they done?

A

Sputum culture

BUT must be obtained by transthoracic aspiration, thoracentesis or bronchoscopy

**Expectorated sputum cultures contaiminated w/ mouth flora

** rarely indicated b/c pts usually respond well to empiric therapy

89
Q

What would you expect to see on a CXR in a pt with anaerobic pneumonia and lung abscess?

A

Lung Abscess

Empyema

Thick walled solitary cavity surrounded by consolidation

Air fluid level usually present

Necrotizing pneumonia

90
Q

In addition to CXR what do you want to do in a pt w/ anaerobic pneumonia and lung abscess?

A

Ultra sound (helps located fluid/reveal loculations)

91
Q

What does necrotizing pneumonia look like on a CXR?

A

Multiple areas of cabiation w/ in an area of consolidation

92
Q

What is the treatment of anaerobic pneumonia?

A

Clindamycin OR

Amoxicillin-clavulanate OR

Penicillin G + metronidazole

93
Q

What is the treatment of empyema/lung abscess?

A

Clindamycin OR

Amoxicillin-clavulanate OR

Penicillin G + metronidazole

AND

Drainage –> tube thoracostomy or open pleural drainage (NEED TO DO THIS!!)

94
Q

What is one of the most frequent complication of HIV?

A

Pneumonia

95
Q

What is one of the 3 most common AIDS defining illnesses?

A

Recurrent bacterial pneumonia

96
Q

What are the most common causes of pneumonia in a pt w/ AIDS?

A

Streptococcus

Haemophilus

Pseudomonas

TB

Pneumocystis jiroveci (PCP)

97
Q

What is the epidemiology of Pneumocystis pneumonia (PCP)?

A

decreaed incidence d/t prophylaxis and improved treatment of HIV/AIDS

MOST COMMON CAUSE of pneumonia in pts w/ HIV in US

50% occur in pts unaware that they have HIV

Increased risk if pt has previous bout of PCP, those who have CD4+ T cell count < 200/uL

98
Q

What should all pts w/ CD4+ T cell counts < 200 do?

A

Be on prophylaxis

Vaccinate w/ pneumocci vaccine

99
Q

What are the signs/symptoms of HIV related pneumonia?

A

Nonspecific symptoms

Fever

Cough

SOB

Unexplained weight loss

Severity of symptoms can vary significantly

Hypoxia = severe

100
Q

What diagnostic testing is done in pts suspected of HIV related pneumonia?

A

Definitive diagnosis REQUIRES organism in sputum sample

CXR

CT Scan

101
Q

What would you expect CXR of HIV related pneumonia to look like?

A

Normal (5 - 10%)

Diffuse/perihilar infiltrates = most characteristic

Ground glass appearance** (test question)

102
Q

What would you see in the CT Scan of HIV related pneumonia?

A

Patchy ground glass appearance

103
Q

What is the STANDARD treatment of PCP?

A

Trimethoprim/Sulfamethoxazole = Bactrim

104
Q

What would you add if you pt who has PCP is hypoxic?

A

Steroids

105
Q

What happens if PCP is untreated?

A

100% mortality rate

106
Q

How long is PCP treatment?

A

21 days

Prophylaxis w/ Bactrim or Dapsone in all pts w/ CD4 count < 200 or hx of PCP

107
Q

What is the cause of tuberculosis pneumonia?

A

Mycobacterium tuberculosis

108
Q

How is tuberculosis spread?

A

Airborn droplets

109
Q

What is the epidemiology of tuberculosis pneumonia?

A

World’s most widespread and deadly illness

3 million ppl die/yr worldwide

Estimated 15 million infected in US

Increased drug resistance (have to treat w/ multi drugs for longer)

110
Q

Which populations have the greatest occurrence of Tuberculosis?

A

HIV (+)

Foreign born

Disadvantaged populations –> malnourished, homeless, living in overcrowded/substandard housing

111
Q

What would you see with primary tuberculosis?

A

Clinically/radiographically silted

May lie dormant for years –> decades

T cells/macrophages contain the infection in granulomas but don’t eradicate it from the body

112
Q

What is primary progressive TB?

A

5% of primary tuberculosis cases

immune response = inadequate

pulmonary/constitutional symptoms develop

113
Q

What is latent tuberculosis infection?

A

Pt doesn’t have active disease

Can’t transmit to others

114
Q

What is secondary tuberculosis?

A

Reactivation of the disease

115
Q

When does secondary tuberculosis occur?

A

When host’s immune system is impaired

Develop in 10% of pts that have latent TB infection who haven’t been given preventive therapy

116
Q

When is there increased risk of reactivation (secondary tuberculosis)?

A

Immunosuppression –> HIV, immunosuppressive Tx

Gastrectomy

Silicosis

Diabetes Mellatus

117
Q

What are the signs/symptoms of tuberculosis pneumonia?

A

Chronic cough = MOST COMMON PULMONARY SYMPTOM
(initially dry –> productive; blood streaked sputum)

Slow progressive constitutional symptoms = classic
           Anorexia
           Weight Loss
           Fever
           Night Sweats

Pt Looks ill/malnourished

Auscultation can be normal OR post-tussive apical rales

118
Q

What are the labs that are done for a pt suspected to have tuberculosis pneumonia?

A

Culture or ID bacteria by PCR (need 3 consecutive morning sputum samples)

Fiberoptic bronchoscopy (if sputum smear = (-); and you suspect TB)

Transbronchial lung biopsy

119
Q

What do CXR look like in a pt w/ tuberculosis pneumonia?

A

Ghon = calcified primary focus –> healed primary TB

Ranke = calcified primary focus/calcified hilar lymph nodes –> healed primary TB

Small homogenous infiltrates

Hilar/parathracheal lymph node enlargement

Segmental atelectasis

Pleural effusion

Cavitation may be seen w/ progressive primary TB

120
Q

What kind of test can you do to ID pts who have been infected w/ TB?

A

Tuberculin Skin Test –> Mantoux Test/PPD

121
Q

What is the problem with the Tuberculin Skin/ PPD Test?

A

Doesn’t distinguish between active and latent infection

122
Q

Describe the method of the tuberculin skin/ PPD test?

A

0.1 mL of purified protein derivative (PPD) contain 5 tuberculin units injected intradermally on forearm

Transverse width in mm of induration (elevation) @ site of injection is measured w/in 48 - 72 hrs

123
Q

What are considered a (+) tuberculin skin test/ PPD?

A

> /= 15 mm in person w/o risk factors

> /= 10 mm for recent immigrants, IVDU, lab personnel, residents/employees in high risk setting, person w/ medical conditions that increase risk of TB, children < 4 or infant, child, or adolescent exposed to high risk adults

> /= 5 mm for HIV (+) pts, recent contacts of individual w/ active TB, person w/ CXR indicative of TB, pts w/ organ transplants, other immunosuppressed pts

124
Q

How long after TB infection does it take for a (+) Tuberculin skin test/PPD test?

A

2 - 10 weeks

125
Q

What can give a false positive tuberculin skin test/PPD test?

A

Pts who have been vaccinated against TB w/ BCG

BCG = bacillus calmette-guerin (foregin vaccine)

126
Q

What are the treatment goals against pulmonary tuberculosis?

A

Eliminate all tubercle bacilli from individual

Prevent morbidity/death while avoiding emergence of drug resistance

127
Q

Who do you need to report any suspected/confirmed cases of TB?

A

Local/State Public Health

128
Q

What is the major cause of treatment failure?

A

Non-adherence –> continued transmission and drug resistance

129
Q

Which 4 drugs are the first line drugs against pulmonary tuberculosis?

A

Isoniazid

Rifampin

Pyrazinamide

Ethambutol

130
Q

What is a side effect of isoniazid?

A

Neuropathy

131
Q

What should be given with isoniazid?

A

Vitamin B6

132
Q

Who should be give vitamin B6 w/ isoniazid?

A

Alcoholics

Malnourished

Pregnant/lactating women

Pts w/ CRF

Pts w/ Diabetes Mellitus

Pts w/ HIV

133
Q

Describe the treatment of tuberculosis pneumonia in a HIV (-) patient?

A

6 - 9 month regimen

1st phase (first 2 months) –> bacilli is killed, symptoms resolve, pt = noninfectious

2nd phase (4 - 7 months) –> continuation/sterilizing to eliminate persisting mycobacteria and prevent relapse

134
Q

During the first phase of treatment for tuberculosis pneumonia in a HIV (-) pt which drugs are given?

A

4 drug therapy:

Isoniazid

Rifampin

Pyrazinamide

Ethambutol

135
Q

During the 2nd phase of treatment for tuberculosis pneumonia in a HIV (-) pt which drugs are given?

A

at least 4 months of:

Isoniazid

Rifampin

136
Q

What is the treatment of tuberculosis pneumonia in HIV (+) pt?

A

Similar to HIV (-) but longer duration

**important to monitor drug interactions

Requires specialists in management of TB and HIV

Direct observation therapy to confirm adherance

B6 supplementation

137
Q

What is the treatment of latent tuberculosis?

A

Isoniazid x 9 months

Rifampin and pyrazinamide x 2 month = usually treatment of choice b/c of length

Rifampin x 4 months

138
Q

When would you treat for latent tuberculosis?

A

(+) mantoux and high risk

if pt had close contact w/ active disease –> repeat PPD if initial test = (-) (b/c takes 2 - 10 wks before you can have (+) ppd test)

Clin Med: Pulmonary (3 decks)

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