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Ash's Certification Study > Pneumonia, TB, C. Diff, and Influenza > Flashcards

Pneumonia, TB, C. Diff, and Influenza Flashcards

1
Q

What are important acid fast organisms

A

TB
Leprosy
Opportunistic wound infections

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2
Q

Can acid fast bacteria grow inside macrophages?

A

Yes

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3
Q

What other organisms get dyed with acid fast stain?

A

Norcardia

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4
Q

Skin and soft tissue infections associated with fish tanks

A

Mycobacterium marinum

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5
Q

Rapid grower and often a water contaminant. It is part of a group of environmental mycobacteria and is found in water, soil, and dust. It has been known to contaminate medications and products, including medical devices. It causes chronic lung disease, disseminated cutaneous disease in immunocompromised patients, and post traumatic wound infections.

A

Mycobacterium abcessus

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6
Q

Rapid grower, often found in water and sewage and will cause occasional opportunistic infections

A

Mycobacterium chelonae

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7
Q

A slow grower that is a water contaminant and may cause disease in patients with severely impaired cellular immunity

A

Mycobacterium kansasii

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8
Q

Hansen’s disease, it can affect the nerves, skin, eyes, and lining of the nose. It may take up to 20 years to develop signs of infection

A

Mycobacterium leprae

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9
Q

Rapid grower or slow grower? Mycobacterium abcessus

A

Rapid

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10
Q

Rapid grower or slow grower? Mycobacterium chelonae

A

Rapid

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11
Q

Rapid grower or slow grower? Mycobacterium kansasii

A

Slow

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12
Q

Rapid grower or slow grower? Mycobacterium chimaera

A

Slow

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13
Q

Rapid grower or slow grower? Mycobacterium fortuitum

A

Rapid

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14
Q

Rapid grower or slow grower? Mycobacterium avium complex

A

Slow

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15
Q

Rapid grower or slow grower? Mycobacterium mucogenicum

A

Rapid

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16
Q

C. Diff basics

A

Gram positive, spore forming rod
anaerobic

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17
Q

What are the main toxins of C. Diff

A

Toxin A
Toxin B
Binary Toxin

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18
Q

Describe Toxin A in C Diff

A

entertoxin and cytotoxin

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19
Q

Describe toxin B in C. Diff

A

cytotoxin

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20
Q

What isolate is binary toxin primarily found in?

A

B1/NAP1/027 isolate

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21
Q

Threat level of C. Diff

A

Urgent (highest level)

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22
Q

What antibiotics are the highest risk for CDI?

A

third gen cephalosporins

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23
Q

Description of stool related to CDI

A

Soft, unformed stools to watery or mucoid

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24
Q

How many bowel movements a day for C. Diff

A

3-20

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25
Q

How common are fever and abdominal pain with C. Diff

A

about 25%

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26
Q

What non-culture labs may be indicative of C. Diff

A

High WBC (ex 25k)
Positive occult fecal blood test

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27
Q

Predominant method of dx testing utilized for ID of C. Diff?

A

NAAT (nucleic acid amplification test)

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28
Q

Gold standard for C. Diff? Issue?

A

culture
takes 7 days

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29
Q

common complications of C. Diff

A

Pseudomembranous colitis
Toxic megacolon
Ileus
Perforation

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30
Q

Percentage of patients that exhibit pseudomembranous colitis

A

50%

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31
Q

What does pseudomembranous colitis look like?

A

White/ yellow plaques that show in endoscopy

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32
Q

what is toxic megacolon?

A

Extremely enlarged colon+ abdominal distention

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33
Q

What is ileus

A

painful obstruction of the ileum or other part of the intestine

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34
Q

Concern for perforation resulting from C. Diff

A

fecal matter leaks out - peritonitis

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35
Q

Where is BI/NAP1/027 strain widespread?

A

Throughout the U.S. and Europe

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36
Q

Concerns with B1/NAP1/027

A

Higher mortality (6.7%)
Can cause outbreaks in hospitals
Highly resistant to antimicrobials

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37
Q

General treatment options for C. Diff

A

Vancomycin
Fidaxomicin

Fecal microbiota transplantation

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38
Q

When would fecal microbiota transplantation be considered?

A

Multiple recurrances

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39
Q

What are the concerns with hypochlorite solution in cleaning for C Diff

A

Odor
Respiratory irritation
skin irritation
Damage to surface
has not been evaluated sufficiently for efficacy

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40
Q

What cleaner to use for C. Diff

A

Bleach

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41
Q

Where do the highest incidences of TB occur?

A

Africa (363/100,000)
Asia (180/100,000)

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42
Q

When did TB rates rise in the US?

A

1985-1992

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43
Q

Reason TB has decreased so much from the early 90s until 2011

A
  • DOT
  • Expanded treatment regimens
  • CDC infection control recommendations
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44
Q

TB with resistance to INH, Rifampin, any fluoroquinolone, and at least 1 injectable second line drug

A

XDR-TB (extensively drug resistant TB)

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45
Q

Basics of M. tuberculosis

A

aerobic, acid fast bacillus

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46
Q

transmission of M. tuberculosis

A

Mainly via inhalation

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47
Q

Have caused a variety of skin diseases including pulmonary, skin, and soft tissue infections, esp in immunocompromised individuals

A

Nontuberculosis mycobacteria

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48
Q

Size of TB

A

1-5 um

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49
Q

who generates airborne TB particles

A

Patients with pulmonary and laryngeal TB

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50
Q

what is the concern for TB and ventilation

A

Can remain suspended in the air for a very long time and travel through ventilation system to other areas of building

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51
Q

What happens when the infectious droplet is breathed in?

A

Goes to the macrophages, gets phagocytised by macrophages, survive in macrophages and produce local infection. May also disseminate

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52
Q

If TB disseminates, where does it spread to first?

A

The regional lymph node

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53
Q

What is the initial infection of TB like?

A

Some have mild symptoms
usually goes unrecognized

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54
Q

Is the individual TB patient infectious during the initial infection?

A

No, not unless active disease developes

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55
Q

When does specific immunity develop for TB?

A

10-12 weeks

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56
Q

What happens when specific immunity developes?

A

Further spread of the organism is prevented

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57
Q

What does PPD stand for?

A

Purified protein derivative

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58
Q

What does IGRA stand for?

A

Interferon gamma release assay

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59
Q

when do the PPD/ IGRA tests become positive after infection?

A

2-12 weeks

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60
Q

What is LTBI?

A

Latent TB Infection - asymptomatic stage of TB

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61
Q

What is TB in the spine?

A

Potts Disease

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62
Q

How long after initial infection do some people develop active TB?

A

Within 2 years

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63
Q

Why do people develop active TB?

A

Failure of immune system to control mycobacteria

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64
Q

What percentage of people develop active TB?

A

5%

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65
Q

What is the annual risk for people with latent TB to develop TB if they do not develop it within the first 2 years?

A

5-10 percent

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66
Q

What is the total lifetime risk for developing active TB after initial infection?

A

10-15 percent

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67
Q

Symptoms of primary TB infection

A
  • asymptomatic* (most) or
  • fever
    -cough
    -erythema nodosum
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68
Q

Type of skin inflammation that is located in part of the fatty layer of the skin

A

Erythema nodosum

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69
Q

Where does erythema nodosum typically occur?

A

Front of legs below the knees

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70
Q

presentation for erythema nodosum

A

Reddish, painful, tender lumps

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71
Q

What is the radiological presentation of primary TB infection?

A

-Gohn complex
-miliary pattern in progressive cases
- Central casieous necrosis

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72
Q

Describe central caseous necrosis

A

encased mycobacteria in the lymphocytes

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73
Q

Unique form of cell death in which the tissue maintains a cheese-like appearance and the dead tissue appears as soft and white proteinaceous dead cell mass

A

Caseous necrosis

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74
Q

Frist symptoms of post primary TB

A

-Productive Cough
-Fever (37-80%)
-Night sweats

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75
Q

What does chest radiology show for postprimary TB?

A
  • infiltrates on the upper lobes or superior segments of lower lobes
  • cavitation on chest xrays
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76
Q

How to differentiate TB cough from other resp coughs

A

Last >2-3 weeks and produces sputum

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77
Q

Spitting of blood that originated in the lungs

A

Hemoptysis

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78
Q

Later symptoms of TB

A

-productive cough
- hemoptysis
- weight loss
- chest pain
-anorexia
-malaise
-debilitation

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79
Q

How does TB present (chest imagining) in patients with TB with higher CD4 T-cell counts

A

Typical infiltrates of postprimary TB

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80
Q

How do patients with HIV and low CD4 counts typically present with pulmonary TB in chest imaging?

A

Atypical
Miliary pattern
Lower lobe infiltrates
Sometimes normal chest xrays

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81
Q

_____ cell is the masterpiece of the immune response in TB, while the ______ is the effector cell

A

CD4 cell….
Macrophage

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82
Q

What are the names of the acid-fast stains?

A

Kinyoun or Ziehl Neelsen

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83
Q

What other organisms may stain acid-fast under some conditions?

A

Norcardia
Rhodococcus
Legionella micdadei

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84
Q

What is the fastest that MTB can be cultured?

A

With newer broths, a few days

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85
Q

What tests are commonly used to is TB before a sputum specimen is AFB positive

A

NAAT test

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86
Q

Why are cultures required for TB?

A

test for antimicrobial sensitivity

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87
Q

When to do susceptibility testing

A

initial isolate on every patient

+ if patient remains culture positive after 3 months of treatment

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88
Q

Injection of purified protein derived from mycobacterial cell wall

A

Tuberculin Skin Test (TST)

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89
Q

What does the TST rely on?

A

People who have been infected with TB will have a delayed-type hypersensitivity reaction to the PPD

90
Q

Does a positive TST mean the person has active TB?

A

No, could have LTBI

91
Q

Will a TST be positive if someone was cured of TB?

A

Yes

92
Q

Does a positive TST rule out active TB infection?

A

No, people with active TB may have a negative TST

93
Q

Preferred way to perform the TST

A

Mantoux method

94
Q

How many TB units are injected in the mantoux method of the TST?

A

5

95
Q

What happens at the site of injection in a TST?

A

Small wheal raises

96
Q

When is the TST read?

A

48-72 hours after placement

97
Q

What should be measured in a TST test?

A

millimeters of induration

98
Q

What results to record for TST

A

millimeters of induration, not just negative or positive

99
Q

When is a test considered a conversion in serial testing?

A

If there is an increase in the amount of induration by 10mm with the previous test

100
Q

-HIV positive
-Recent contact TB case
-Fibrotic changes on chest xray –consistent with old TB
-organ transplants/ immunosuppressed

TST positive mm?

A

5mm

101
Q

Recent arrival from high prevalence country
- IV drug users
- HCP and other high-risk settings (congregate care, prisons, etc.)
- Mycobacteria lab personnel
- High risk clinical conditions (ie chronic renal failure)
- Medically underserved high risk minorities
- children under 4 or infants and children exposed to adults in high risk settings

TST positive mm?

A

10mm

102
Q

persons with no risk factors for TB

TST positive mm?

A

15 mm

103
Q

These tests evaluate the release of interferon gamma from the host cell when exposed to TB proteins such as the early secretory antigenic target 6 (ESAT-6) and the culture filtrate protein 10 (CFP-10)

A

IGRA- interferon gamma release assay

104
Q

When to use IGRA

A

-unlikely to return for reading if TST is administered
- BCG vax

105
Q

attenuated strain of M. bovis that is given as a live bacterial vax to prevent to development of active TB

A

Bacille Calmette-Guerin (BCG)

106
Q

When BCG is used?

A

In countries where TB endemic, esp in children

107
Q

Should you consider BCG status when reading TST in the U.S.?

A

No, more likely to have LTBI in the US

108
Q

Who is at risk for TB infection?

A
  • close contact with pulmonary or laryngeal TB cases
  • foreign borne persons
  • Residents and employees in crowded settings
  • HCP
  • infants exposed to high risk adults
109
Q

Timeframe to be considered a close contact with a TB case

A

days to weeks

110
Q

What can contribute to environmental transmission of TB?

A
  • inadequate ventilation
  • poor management of specimens
  • inadequate cleaning of reusable medical equipment
111
Q

How to prevent TB: agent

A

-Detection of cases
-early and complete treatment based on susceptibility testing

112
Q

How to prevent TB: room

A

negative pressure room

113
Q

How to prevent TB: PPE

A

airborne isolation
N95 respirator

114
Q

How to prevent TB: portal of exit

A

Resp etiquette

115
Q

How many negative sputum specimens should you have before ending isolation?

A

culture for AFB daily x3 in 8-24 hour intervals

116
Q

How to rule out TB

A

Negative chest Xray and 3 negative sputum specimens at least 8 hours apart

117
Q

TB that is resistant to isoniazid and rifampin

A

MDR-TB

118
Q

TB manifestation in CSF

A

Lymphocytic pleocytosis

119
Q

How does the TST test work?

A

Inject PPD, wait 48-72 hours, then measure the area of induration

120
Q

Will people always have a positive TST if they have active TB?

A

No

121
Q

Treatment for TB

A

INH (Isoniazid)
RIF (Rifampin)
+ 2 other drugs

After 3 months - INF+RIF

122
Q

How often should active TB cases receive sputum cultures?

A

monthly

123
Q

What baseline testing is needed for TB before treatment?

A

Ocular and Liver*

124
Q

Treatment of latent TB

A

INH- 9 months or rifampin for 4 months

Monitor for active TB

125
Q

Risk levels for TB

A

Low risk - no TB patients in the area or facility
Medium Risk - exposed to TB pts or samples
Ongoing transmission - person-person transmission within the year

126
Q

Examples of TB Prevention: Administrative

A
  • assign responsibility for TB control
  • Conduct TB risk assessment
  • control plan: detect, AIIR, treatment
  • testing availability and reporting
  • practices for managing suspected and confirmed cases
  • cleaning and disinfection
    -staff education and pt education
  • employee screening
  • post signs about infection control
127
Q

Prevention of TB ENV/ PPE

A

-Resp protection program
- Employee and family/ visitor education (resp hygiene)
- negative pressure ventilation rooms

128
Q

How many air exchanges are needed per hour for an AIIR for a TB patient

A

6-12 air exchanges per hour

129
Q

When to end AIIR for TB patient

A

-after 2 weeks of therapy with good clinical response and 3 negative AFB smears

130
Q

Routine employee testing- how often

A

TST or IGRA for new hires
Medium risk - annual
ongoing transmission- every 8-10 weeks

131
Q

Does non-pulmonary TB require AIIR?

A

No

132
Q

When should you TST test an exposed employee to TB

A

ASAP within 2 weeks and again in 8-10 weeks (time for seroconversion)

133
Q

What is the most common non-TB mycobacterium

A

Mycobacterium Avium Complex

134
Q

What is the most common pathology of non-TB mycobacteria (NTM)?

A

Pulmonary

135
Q

Most symptoms are the same for NTM and TB, but what is one symptom that differs?

A
  • hypersensitivity to hot H2O
136
Q

Who is most likely to get disseminated disease from MAC?

A

AIDS patients

137
Q

These organisms, MAC, M. Kansasii, M. Abcessus, and M. fortuitum cause ______ disease

A

pulmonary

138
Q

M. fortuitum, M. marinum, M. chelonae, M. abcesses, and M. ulcer can cause _________ disease

A

skin and soft tissue disease

Think- damaged skin from fresh H2O

139
Q

How does MAC manifest in young children?

A

Lymphadenitis

140
Q

What are the rapid growing NTMs?

A

M. Chelonae, M. Abcesses, and M. fortuitum

141
Q

What NTM is a concern for SSI, Dialysis, and cath ass infections related to tap water

A

M. chelonae

142
Q

What are the precautions for NTM?

A

Standard, not spread person to person

143
Q

Who is at the highest risk for influenza?

A

65+
Under 2
Pregnant
Chronic conditions

144
Q

How long does influenza virus shed?

A

7-10 days, but most contagious 5 days after

145
Q

How long is someone contagious with flu?

A

24 hours before onset- 5 days after

146
Q

How long is the incubation period for flu?

A

2 days

147
Q

How is flu transmitted?

A

Droplet

148
Q

What are the symptoms of flu?

A
  • Fever
    -Cough
    -Headache
    -Sore throat
    -muscle aches
    OR Asymptomatic
149
Q

What is one characteristic about the onset of flu

A

Rapid onset

150
Q

What is the season for the flu in the U.S.

A

October- March

151
Q

What are common secondary bacterial infections after flu?

A

1) strep pneump
2) H. influenzae
3) staph aureus

152
Q

How long after the flu do secondary infections typically happen?

A

4-14 days after improvement

153
Q

Dx for flu

A

PCR
Rapid
Viral culture

154
Q

Treatment for flu

A

Supportive
Antivirals within 48 hours

155
Q

Viral treatment for flu

A

Ostelamivir

156
Q

Naming convention for influenza strains

A

Virus type (A,B,C), Place, Strain #, year, virus serotype

157
Q

Two pairs of influenza serotype

A

Hemaglutinin
neuraminidase

158
Q

What types of flu cause human disease

A

A and B

159
Q

Small changes to the flu virus

A

Antigenic drift

160
Q

Major changes to flu strains

A

Antigenic shift

161
Q

What are nonhuman reservoirs of flu?

A

Avian, Swine

162
Q

Pandemic Phase: No flu in animals that can infect humans

A

Phase 1

163
Q

Pandemic Phase: Virus circulating in animals, known to infect humans

A

Phase 2

164
Q

Pandemic phase: animal to human transmission, small clusters, but no human to human transmission

A

Phase 3

165
Q

Pandemic phase: Human to human transmission

A

Phase 4

166
Q

Pandemic phase: Human to human and outbreaks in 2 or more countries in a single region

A

Phase 5

167
Q

Pandemic phase: outbreaks in >1 region

A

Phase 6

168
Q

Pandemic phase: Flu levels decrease from peak levels

A

Post-peak

169
Q

Pandemic phase: returned to seasonal rates

A

Post pandemic

170
Q

Pandemic planning phases 1-3 (animal- human, no human - human)

A

education: flu symptoms and iso
- vax
- facility plans for surge
- exp mgmt plans
- plan just in time training
- comms plan

171
Q

Pandemic planning phase 4 (human to human)

A
  • Est # HCP needed
  • Start to increase iso
  • review exp mgmt plans
  • plan to sustain ops
  • visitor screening plan
  • staffing guidance for cases
172
Q

Phase 5 pandemic planning for flu OB in 2+ countries in same region

A
  • enhanced screening and surveillance
  • just in time training (NOW)
  • sched staff comms
    -Incident command
173
Q

Phase 6 pandemic planning (outbreaks in multiple regions)

A
  • surge strategy: staff, supplies, space
  • cxl elective procedures
  • implement employee exp management plan
174
Q

When to get routine flu vaccine

A

6 months and older
annually

175
Q

What is the contraindication to the flu vax?

A

GBS within 6 weeks of prev flu vax
egg based vax

176
Q

What should the IPC have plans in place for flu?

A
  • early ID nad iso of pts
  • annual education
  • vax to pts and HCP
    = Restrict ill pts and hcp
177
Q

ICP influenza- how to prevent transmission

A
  • flu vax
    -resp hygiene and cough ett
    -manage ill HCP
178
Q

What precautions should be used for flu

A

Standard precautions
Droplet precautions

179
Q

How long should the influenza patient be on droplet precautions?

A

7 days + fever free for 24 hours

180
Q

What are the droplet precaution recommendations for flu?

A
  • private room
  • surgical mask if leaving room
  • surgical mask to enter room
    -N95 for aerosol generating procedures
181
Q

How long should a mom with flu be separated from her baby post-partum

A

until afebrile for 24 hours and resp symptoms under control

182
Q

Who should feed the baby when the mother has influenza?

A

Health caregiver

183
Q

Can the mom’s breast milk be used when she has influenza?

A

Yes, but healthy caregiver should feed

184
Q

If the mom with flu and the baby need to colocate, what controls should be in place?

A
  • engineering controls (curtain or room sep)
  • 6 ft distance
  • healthy caregiver
  • mom dons mask
185
Q

How long should a post-partum mom with influenza be on droplet precautions?

A

7 days

186
Q

Best practice- HCP with ILI

A

Don’t report to work, don’t return until 24 hours no fever

187
Q

What is PEP for influenza

A

vax unvaccinated people + dose of antivirals

188
Q

Outbreak control of flu

A

1 case- enhanced surveillance
Test symptomatic cases
Droplet precautions suspected/ confirmed
cohort pts and residents with vax
consider PEP
stop non-urgent medical procedures

189
Q

Leading cause of death from infection in a hospitalized patient

A

Pneumonia

190
Q

Pneumonia in patient admitted to the hospital from the community

A

community acquired pneumonia

191
Q

Pneumonia in a patient:
1)in an acute care hospital for 2+ days within 90 days of infection
2) resided in a nursing home
3) received IV antibiotics, chemo, or wound care within 30 days
- attended hosp or hemodialysis clinic

A

Healthcare associated pneumonia (HCAP)

192
Q

Pneumonia that develops within >=48 hours after admission to a hospital

A

Healthcare acquired pneumo

193
Q

Pneumonia in someone intubated with mechanical ventilation for at least 48 hours

A

ventilator associated pneumo

194
Q

Most common organisms to cause CAP

A

S. pneumo
H. influenza
S. aureus
Moracella catarhallis

195
Q

Organisms that most often cause atypical pneumo

A

Legionella
Chlamydia
Mycoplasma
Enterobacter

196
Q

What puts someone at higher risk for pneumo from P. aeuruginosa?

A
  • Structural lung disease
  • chronic steroid use
  • prior antibiotics
197
Q

What puts someone at a higher risk for s. aureus pneumo?

A

-endstage renal disease
- IV drugs
- Prior flu
- Prior antibiotic (fluroquinolones)

198
Q

What are the clinical signs of MRSA pneumo?

A

Severe
neutropenia
Abnormal chest Xray
hemoptysis

199
Q

risks for HAP/ HCAP

A
  • antimicrobials in the last 90 days
  • hospitalized for 5+ days
  • high freq MDROs in community
  • immunosuppressive state
200
Q

Risks for VAP

A

-Emergency intubation
- nasotracheal intubation
- etomediate use
- head not elevated
- subpar oral care

201
Q

CAP quality measures: when blood culture should be collected

A

within 24 hours and before antibiotics

202
Q

CAP quality measures: antibiotics

A

antibiotic timing
antibiotic selection

203
Q

CAP quality measures: vaccination

A
  • pneumo vax when appropriate
  • influenza vax
    -smoking cessation
204
Q

Preventing CAP

A

Vax with flu and pneumo
Smoking cesation

205
Q

Prevention of HAP, HCAP, and VAP: vax

A
  • Flu and pneumo vax
206
Q

Prevention of HAP, HCAP, and VAP: precautions

A

HH
gloves
isolate pts with resistant organisms

207
Q

Prevention of HAP, HCAP, and VAP: resp equipment

A

Proper resp equip maintenance

208
Q

Prevention of HAP, HCAP, and VAP: intubation and tubes

A

Avoid endo-tracheal intubation when possible
-reduce nasogastric tubes

209
Q

Prevention of HAP, HCAP, and VAP: maintaining oral and oropharyngeal hygiene

A

Oral decontamination
Subglottic secretion drainage

210
Q

How long should you wait for enteral feeding after intubation?

A

24-48 hours

211
Q

How to prevent aspiration

A
  • avoid endotracheal tube when possible
  • use orotracheal intubation (not naso)
  • Raise head 30-35 degrees
  • oral cleaning with aseptic
212
Q

What is the ventilator bundle?

A
  • Elevate the head
  • move the body
  • Peptic ulcer PEP
  • DVT PEP
  • Daily oral care
213
Q

If there is a case of VAE, what does the IP need to do?

A

Assess why- fishbone
Correct

214
Q

What complication of C. Diff has a high mortality rate?

A

Ileus

215
Q

Is C. Diff part of the normal intestinal flora?

A

Yes, can be colonized with non-toxigenic C. Diff which is protective

216
Q

First action when Dx’d with C. Diff

A

Discontinue current antibiotics

217
Q

How often does C. Diff reoccur?

A

15-25%

218
Q

How to interrupt transmission of C. diff

A

Hand washing
gloves
isolation
cohorting
environmental cleaning and disinfection

219
Q

How long should isolation last for C. Diff?

A

unknown- debated if a few days after diarrhea stops or entire hospital stay

220
Q

Environmental cleaning and disinfection for C. diff

A

1:10 dilution sodium hypochlorite solution where CDI rates are high

Consider UV-C device- need to terminally clean room

Ash's Certification Study (22 decks)

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