Pulmonary Infections Flashcards
Which of these antibiotics does not impair NTM growth?
A) Aminoglycosides
B) Co-trimoxazole
C) Linozelid
D) Penicillin
E) Tetracycline
D) Penicillin
aminoglycosides, macrolides,
tetracyclines, cotrimoxazole, and linezolid may impair NTM growth
How long should you be off antibiotics that impair NTM growth before testing for NTM?
A) 7 days
B) 10 days
C) 14 days
D) 21 days
E) 30 days
C) 14 days
If individuals undergoing diagnostic evaluation for NTM infection are taking antibiotics that may impair
NTM growth (such as aminoglycosides, macrolides, tetracyclines, cotrimoxazole, linezolid), consider discontinuing these antibiotics 2weeks prior to collecting samples.
What staining should be used for NTM in the micro lab?
A) Auramine-phenol
B) Carbol fushin
C) Kinyoun Stain
D) Methyl Violet
E) Rhodamine B
A) Auramine-phenol
All respiratory samples should be stained using auramine-phenol after liquefaction and concentration
and then examined by microscopy (grade B).
For Mycobacterium avium complex which drug susceptibility should be checked from the list below?
A) Amikacin
B) Clarithromycin
C) Cefoxitin
D) Doxycycline
E) Rifampicin
A) Amikacin
&
B) Clarithromycin
For Mycobacterium avium complex (MAC), clarithromycin and amikacin susceptibility testing should be performed on an isolate taken prior to initiation of treatment and on subsequent isolates if the patient fails to respond to treatment or recultures MAC after culture conversion (grade C).
For Mycobacterium kansasii which drug susceptibility should be checked from the list below?
A) Amikacin
B) Clarithromycin
C) Cefoxitin
D) Doxycycline
E) Rifampicin
E) Rifampicin
For Mycobacterium kansasii, rifampicin susceptibility testing should be performed on an isolate prior to initiation of treatment and on subsequent isolates if the patient fails to respond to treatment or recultures M. kansasii after culture conversion (grade D).
For Mycobacterium abscessus which drug susceptibility should be checked from the list below?
A) Amikacin
B) Clarithromycin
C) Cefoxitin
D) Doxycycline
E) Rifampicin
A) Amikacin
B) Clarithromycin
C) Cefoxitin
& preferably Doxycycline
Susceptibility testing for M. abscessus should include at least clarithromycin, cefoxitin and amikacin (and preferably also tigecycline, imipenem, minocycline,
doxycycline, moxifloxacin, linezolid, cotrimoxazole and clofazimine if a validated method is available) to
guide, but not dictate, treatment regimens (grade D).
In NTM MAC non severe disease, which is the appropriate treatment from the list below?
A) Rifampicin 600mg 3×per week, Ethambutol 25mg/kg 3×per week, and Azithromycin 500mg 3×per week
B)Rifampicin 600mg daily and Ethambutol 15mg/kg daily and Clarithromycin 500mg twice daily and intravenous amikacin for up to 3months
C) Rifampicin 600mg daily and Ethambutol 15mg/kg daily and Isoniazid 300mg (+pyridoxine 10mg) daily and Consider intravenous amikacin for up to 3months
D) Rifampicin 600mg daily
and Ethambutol 15mg/kg daily
and moxifloxacin 400mg daily
and Consider intravenous amikacin for up to 3months
E) Rifampicin 600mg daily and Ethambutol 15mg/kg daily and Isoniazid 300mg (with pyridoxine 10mg) daily
A) Rifampicin 600mg 3×per week, Ethambutol 25mg/kg 3×per week, and Azithromycin 500mg 3×per week
Non-severe MAC-pulmonary disease
(ie, AFB smear negative respiratory
tract samples, no radiological evidence of lung cavitation or severe infection, mild-to-moderate symptoms, no signs of systemic illness)
NON SEVERE MAC CAN BE 3X per week treatment - the rest of NTM are daily!
Rifampicin 600mg 3×per week and
Ethambutol 25mg/kg 3×per week and
Azithromycin 500mg 3×per week or Clarithromycin 1g in two divided doses 3 x per week
What is the treatment for Rifampicin sensitive M. Kasasii?
Rifampicin 600mg daily and Ethambutol 15mg/kg daily and
Isoniazid 300mg (with pyridoxine 10mg) daily or azithromycin 250mg daily or clarithromycin 500mg twice daily.
Rifampicin-sensitive M. kansasii-PD should be treated with rifampicin, ethambutol and isoniazid or a macrolide (clarithromycin or azithromycin) using a daily oral regimen
You have a patient with pulmonary cryptococcosis (Cryptococcal antigen positive from BAL). The patient is immunocompetent and is thought to have Mild Disease.vWhat is the first line treatment?
A) IV amphotericin (liposomal)
B) IV amphotericin and oral Flucytosine
C) Oral Fluconazole
D) Oral itraconazole
E) Oral Voriconazole
C) Oral Fluconazole
https://pmc.ncbi.nlm.nih.gov/articles/PMC9696922/
What is first line treatment for pulmonary candidiasis?
A) IV amphotericin B
B) Oral itraconazole
C) Oral Voriconazole
D) IV caspofungin
E) No treatment
A) IV amphotericin B
Intravenous amphotericin B or oral or intravenous fluconazole.
A 67-year-old man with bronchiectasis is being reviewed in a respiratory outpatient clinic. His bronchiectasis has been well-controlled historically, however, over the last 6 months he has suffered frequent low-volume haemoptysis mixed with clear phlegm. The symptoms have persisted despite 3 protracted courses of oral antibiotics. CT chest with contrast reveals bilateral airway nodularity with some cavitation predominantly in the upper lobes.
Aspergillus serologies return as follows:
Investigation Result
Aspergillus IgE 11.4 kUA/L (0 - 0.34 kUA/L)
Aspergillus precipitins (IgG) 165 (0 - 40)
Total IgE 957 kU/L (0 - 81 kU/L)
Eosinophils 0.8 x 109/L (0 - 0.4 x 109/L)
What is the most appropriate management for this patient?
A) Admit to hospital for intravenous amphotericin
B) Oral co-amoxiclav
C) Oral fluconazole
D) Oral prednisolone
E) Oral voriconazole
E) Oral voriconazole
Oral prednisolone can be used in allergic bronchopulmonary aspergillosis (ABPA), however, the radiological changes and haemoptysis are more in keeping with chronic infection rather than airway sensitisation. The total and aspergillus-specific IgE can be elevated in CCPA as well.
The pattern described on the CT is suggestive of chronic cavitary pulmonary aspergillosis (CCPA). The diagnosis is supported by the serological response, notably a markedly elevated aspergillus precipitins assay. Oral voriconazole or itraconazole are the usual treatments and prolonged courses, often as long as 6 months, are needed.
What is the treatment for pulmonary babesiosis?
A) Atovaquone and azithromycin
B) Atovaquone and clindamycin
C) Clarithromycin and doxycycline
D) Co-amoxiclav and clarithromycin
E) Co-trimoxazole and pentamidine
A) Atovaquone and azithromycin
Diagnosed on a peripheral blood smear which shows a tetrad or ring pattern in the RBCs and indicates babesiosis. The treatment consists of a combination of atovaquone and clarithromycin/azithromycin or a combination of clindamycin and quinine.
What is the most common bacterial coinfection in flu of less than 6 days onset?
Streptococcus Pneumoniae
What is the most common bacterial coinfection in flu of greater than 6 days onset?
Staphylococcus Aureus
Which of the following may result in false positive tuberculin skin test?
A) Nocardia infection
B) Previous BCG vaccine
C) Rheumatoid arthritis
D) Sarcoidosis
E) Steroid therapy
B) Previous BCG vaccine
Other false positive - NTM, incorrect method
False negative - sarcoidosis
What is the treatment of TB for a person who has had TB treatment interruption (off TB meds for 2 weeks) and from a low to medium risk country?
Rifampicin (R), Isoniazid (H), Ethambutol (E), Pyrazinamide (Z), Moxifloxacin (M), Streptomycin (S)
A) 2HRZE/4HR
B) 2HRZE/10HR
C) 2HRZE/ 7HR
D) 2HRZES/1HRZE/5HRE
E) 6BPaLM
D) 2HRZES/1HRZE/5HRE
You review a patient on the hematology ward who had a allogeneic stem cell transplant 2 weeks ago. He is breathless. CT shows multiple nodules surrounded by ground glass area.
What is the single most likely diagnosis?
A) Bronchiolitis obliterans
B) CMV Pneumonitis
C) Engraftment syndrome
D) Invasive pulmonary aspergillosis
E) Nocardia
D) Invasive pulmonary aspergillosis
CT of invasive aspergillosis - solitary OR multiple nodules which may have a halo of haemorrhage (GGO) due to invasion into vessels
Post transplant complications:
Phase 1 (pre-engraftment) - <30 days
Phase 2 (post-engraftment) - 30-100 days
Phase 3 (late phase) - >100 days
What is the main host defence problems in the pre-engraftment phase?
Neutropenia, mucositis, acute GvHD, and peri-engraftment disease
Which phase does bronchiolitis obliterans develop?
A) Pre-engraftment
B) Post engraftment
C) Late engraftment
D) none of the above
C) Late engraftment
Late engraftment phase is at risk of Chronic GvHD
CT of bronchiolitis obliterans shows air trapping, small airway thickening, or bronchiectasis
What is the first line treatment for PCP infection?
A) Co-trimoxazole for 7 days
B) Co-trimoxazole for 21 days
C) Dapsone for 14 days
D) Pentamidine for 21 days
E) Atovaquone for 28 days
B) Co-trimoxazole for 21 days
First-line regimens for treatment of PCP
* We recommend trimethoprim-sulfamethoxazole as the first-line treatment of choice for PCP of any severity (Grade 1A).
- We suggest that people who develop PCP despite taking trimethoprim-sulfamethoxazole as prophylaxis can be treated with standard high-dose trimethoprim-sulfamethoxazole (Grade 2C).
- We recommend that treatment should be continued in people living with HIV for 21 days (Grade 1B).
You review a patient with severe PCP on the ward. after 4 days of treatment you have decided this is treatment failure.
What is the next appropriate step
A) Add Prednisolone
B) Increase Co-trimoxazole
C) Switch to oral primaquine combined with intravenous or oral clindamycin
D) Add Dapsone
E) Add nebulised pentamidine
C) Switch to oral primaquine combined with intravenous or oral clindamycin
Management of treatment failure
* We suggest waiting at least 4 days before switching therapy in the absence of clinical improvement (Grade 2C).
- We suggest switching therapy for individuals who develop toxicity related to trimethoprim-sulfamethoxazole. Those with moderate-to-severe and mild-to moderate PCP can be given oral primaquine combined with intravenous or oral clindamycin;
- those with mild disease can be given atovaquone (Grade 2B).
