TB/Fungal Pneumo Flashcards
TB etiology?
Spread?
myco tuberculosis
Spread: PROLONGED airborn exposure to droplets from ACTIVE infection
droplets contain tubercle bacilli
Normal immune response to TB?
Abn response to TB?
macrophages wall off bacteria in lungs (LTBI)
macrophages form granulomas -> TB multiply inside gran -> necrotizing granulomas -> break and bacteria spill into lungs
2º TB is?
reactivation of LTBI
TB epidemiology?
immuno-compromised
non-whites
TB presentation?
Pneumonia-like
post-tussove rales
TB lab findings?
(U) normal
hypoN+ (SIADH)
↑ CRP
TB CXR findings?
determine active/latent
Active:
focal infilt up lobes, hilar adeno, effusions, cavitation
Ghon-Ranke Complex:
calcified primary focus and hilar lymph node
TB sputum findings?
Nucleic Acid Amp test
Cx for tx (3 consecutive a.m. specimens)
Smear = acid-fast bacilli (not definitive for TB)
TB bx findings?
necrotizing granulomas!
TB blood test?
interferon gamma release assay
Active TB tx?
isolation RIPE drugs x 6 mo: Rifampin (RIF) Isoniazid (INH) Pyrazinamide (PZA) Ethambutol (EMB)
LTBI tx?
prophylaxis:
Isoniazid x 9 mo
monitor LFT
Drug toxicities:
RIF?
INH?
PZA?
EMB?
RIF = orange excretions
INH = hepatitis, peripheral neuropathy
PZA = hepatitis, hyperuricemia
EMB = optic neuritis
Fungal pneumo: common types?
histoplasmosis
coccidioidomycosis
Histoplasmosis etiology?
Epidemiology?
h. capsulatum
(bird/bat poop)
midwest, spore inhalation
Histoplasmosis presentation?
Progressive?
Chronic?
(U) asymp
fever, ↑↑ fatigue, few respiratory sxs
1 wk- 6 mo
+ cough, dysp, wgt loss
multi organ, fatal
(U) older COPD
progressive lung Δs
Histoplasmosis CXR findings?
hilar adeno
patchy/nodular infilt, low lobes
Histoplasmosis labs?
antigens (lung fluid, blood, urine)
Bx
Cx for chronic
Histoplasmosis tx?
Asymp?
Acute?
Severe?
Chronic?
AIDS?
Φ for asymp
Acute: Φ or conazoles
Severe: amphotericin B IV
Chronic: amphotericin B or itraconazoles
AIDS: amphotericin B PLUS itraconazoles maintenance
Coccidioidomycosis (valley fever) etiology?
c. immitis or c. posadasii (molds)
south US and mexico desert
spore inhalation
Coccidioidomycosis sxs?
(U) pneumonia, ↑↑ fatigue, HA, arthralgias
ERYTHEMA NODOSUM (on shins)
Erythema multiforme
Coccidioidomycosis disseminated epidemiology?
Sxs?
immuno-comp
blacks, asians, 3rd tri preggos
↑ pulmo sxs
Lymphadenitis
Meningitis
Bone lesions at prominences
Coccidioidomycosis CXR findings?
hilar adeno,
patchy/nodular infiltrates,
miliary infilt w/ disseminated dz,
thin-walled cavities
Coccidioidomycosis lab findings?
EOSINOPHILLA
serum antibodies
Coccidioidomycosis tx?
NO steroids
progressive dz: fluconazole, ampho B
thoracic srugery
Conazoles to treat fungus interactions?
metabolized by CYP450 so ↑↑ interactions
monitor liver fxn for toxicity
