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F2 E3 Shea > TB, Cocci, Histo, PCP > Flashcards

TB, Cocci, Histo, PCP Flashcards

1
Q

Affects 1/4 of world’s population. Global pandemic with HIV

A

TB

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2
Q

Causative agent of TB

A

Mycobacterium tuberculosis

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3
Q

How does TB spread

A

by airborne droplets from Active TB patients

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4
Q

Is TB chronic or acute

A

Chronic

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5
Q

After inhaling TB, there are 4 possible outcomes. What are they?

A

1) clear bacteria
2) Active TB case
3) Latent infection (wall off)
4) Re-activation TB (necrosis breaks through walled off are)

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6
Q

Popcorn: caseous necrosis

A

TB

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7
Q

Non-necrotising necrosis

A

Sarcoidosis

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8
Q

How long dose it take for macrophages to wall off TB?

A

2-8 weeks

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9
Q

Is latent TB infectious?

A

No

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10
Q

Is Re-activated TB infectious?

A

Yep

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11
Q

Why do latent TB patients take prophylaxis?

A

to not develop reactivated TB

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12
Q

What are TB risk factors (CHARMS)?

A

Children <5, HIV, Alcohol, Radiation (immunetherapy), malnutrition, SUD,

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13
Q

What nationalities have high TB? Triple As

A

Africans, Asians, Latin Americans

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14
Q

Will a skin test (PPD) for TB be positive for Latent TB?

A

Yes, Next step is a CXR

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15
Q

SXS of active TB? Classic TB

A

Fevers, Chills, night sweats, chest pain, anorexia, weakness, fatigue, weight loss.

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16
Q

What does TB look like (another infection)?

A

Like Pneumonia, post-tussive rales = classic

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17
Q

What does TB look like with a CXR?

A

Hilar adenopathy at MIDDLE lobe

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18
Q

What does reactivated TB look like with a CXR?

A

Apical/ Upper lobe infiltrates and cavitations

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19
Q

How do you Diagnose TB

A 
Sputum cytology - NAT
Sputum culture = GOLD STND
need 3 consecutive in the morning
3 AFB sputum smears = not diagnosable
Biopsy = necrotizing caseating granuloma
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20
Q

What do you measure on a TB test?

A

induration not erythema

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21
Q

what is the 2 step TB test?

A

Do the first PPD and read it 2-3 days after it is placed. Then repeat the PPD1-3 weeks later if the first one came back negative.

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22
Q

If a patient has a BCG vaccine, will they be positive on the skin test?

A

yes

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23
Q

What factors causes a patient to have a positive PPD of 5mm?

A

HIV, Recent contacts, TB on CXR, immune comp

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24
Q

Are the blood draws for TB?

A

Yes, the IGRA and the T Spot

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25
Q

What are some advantages to an IGRA blood draw for TB?

A

Done in one visit, results in 24 hours, no booster needed, no reader bias, isnt affected by BCG Vax

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26
Q

What are some disadvantages to an IGRA blood draw for TB?

A

expensive, blood sample needs to be processed w/n 12 hours, and prone to blood draw errors.

27
Q

Is TB reportable?

A

Yes within 24 hours by phone

28
Q

How do you treat a patient with active TB?

A

Isolate in a negative pressure room (patient gets a mask, pcp gets a respirator). Give RIPE with Directly observed Therapy.

29
Q

How do you treat LTBI (Latent)

A

Prophylaxis with INH and Vit B6 for 9 months

30
Q

What are 2 complications to TB infection?

A

Miliary spread and Multi-drug-resistant

31
Q

What are some side effects to RIPE?

A

R - red/orange tears, sweat, urine, stool
I - hepatic toxicity
P - hepatic toxicity
E - Optic neuritis

32
Q

Who gets TB target testing?

A

patients at high risk of developing disease once infected - annual skin test, and offer phrophylaxis

33
Q

Latent TB signs and sxs include..

A

None, patient feels normal and is not contagious, but will be positive on the skin test or IGRA

34
Q

What is the most common Non TB mycobacteria?

A

MAC - mycobacterium avium complex.

35
Q

Where is MAC found?

A

in the soil and water

36
Q

Chronic lung infections account for __% of NTM infections.

37
Q

What are other TB bacterias?

A

M. africanum

38
Q

What signs will a MAC patient have?

A

SF lymphadenitis and Cervical lymphadenitis in kids

39
Q

Wheres does MAC Like to infect?

A

skin and soft tissue - direct innoculation

40
Q

what are the 2 MAC presentations?

A

1) cavitary - COPD smoking Men.

2) Nodular bronchiectatic disease in non-smoking women >50

41
Q

How do you Diagnose MAC

A

Sputum or bronchial wash with an AFB culture.

42
Q

First line MAC tx is…

A

Macrolides, ethambutal and RIF for 12 months.

43
Q

Where is Histo and Cocci from?

A

Histo - Ohio river valley and bat/bird stool

Cocci - SW US

44
Q

What is the most common form of Histo infection?

A

Asymptomatic with granumola (scars) on CXR

45
Q

Active diffused pulmonary disease with Histo sxs are…

A

fever, Marked Fatigue lasting for 1 week to 6 months but is almost never fatal.

46
Q

Acute localized pulm disease with Histo presents as…

A

pneunomia with LOCAL infiltrates.

47
Q

Histo in older COPD patients with Apical cavities is …..

A

Chronic cavitary pulm Hostoplasmosis

48
Q

Rarely occurs in immunecompentent patietns, but sxs include fever, Marked Fatigue, cough, dynspea, and wt. loss

A

Disseminated Histoplasmosis - often fatal

49
Q

How can you diagnosis Histo

A 
Differentiate from Sarcoidosis or TB
No. 1 = Cultures for chronic cases.
CXR - Hilar adenopathy, patchy, nodular infiltrates in LOWER lung fields.
Lab - Antigen in bronchoalveolar lavage.
Serology - weeks to detect antibodies
50
Q

Where is Histo found on a CXR

A

Hilar adenopathy

51
Q

How can you treat Histo?

A 
no tx for Asxs patients (sxs control)
Symptomatic patients dont need tx but can receive Itraconazole.
Severe = Amphotericin B IV
Chronic = Amphotericin B or Itraconazole
AIDS = Amphotericin B and Itraconazole
52
Q

What is cocci’ s incubation time?

53
Q

what percent of cocci patients have sxs?

A

40% but only 1/2 of them seek treatment

54
Q

what are Cocci infection sxs?

what do you see on a CXR

A

fever, cough, pleuritic pain, Headache, arthralgia, Marked Fatigue, rash (3Es)
CXR - scar granuloma

55
Q

What are the 3 Es and in what disease are they present?

A

Eosinophilia, Erythema nodosum, erythema multiforme

56
Q

what patient demographics gets complications for Disseminated Cocci?

A

Africans, Asian, and women in 3rd trimester at greater risk for disseminated cocci

57
Q

What does cocci look like if the infection is serious?

A

Lymphadenitis, Meningities, Bone lesions at bony prominances

58
Q

What makes a patient immunecompromised?

A
  • solid organ transplant
  • high dose steriod
  • chemo
  • immunosuppressed meds
  • pre-existing cardiopulm conditions
  • frail and old
59
Q

how can you diagnose cocci?

A

CRX- hilar adenopathy, patchy nodular infiltrates, miliary, THIN WALLED CAVITIES

60
Q

What are some lab findings for Cocci?

A

High Eosinophils, IgM, and IgG.

Phoenix = 10-50% positive for skin test

61
Q

How can you treat cocci?

A

NO Steroids

Immunsuppressed- Fluconazole 3-6 months + Amphotericin B IV (if 1st trimester of pregnancy)

62
Q

What the the prognosis for Cocci?

A

very good, unless its disseminated or meningeal (50% mortality rate)

63
Q

Why are Azoles a crappy medication?

A

interact with CYP 450, GI, HEPATOTOXIC

64
Q

Most common infection in AIDS patients?

A

jiroveci pneumonia > 200 cd4 t cells = hypoxia

F2 E3 Shea (16 decks)

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