TB & Fungal Pneumonias Flashcards
TB spread by
airborne by active TB during PROLONGED exposure
latent TB (LTBI)
bacterial walled off, no symptoms, no active infection, not infectious, may reactivated in future
primarily necrotizing (caseating) granulomas
TB
risk for developing reactivation TB is greater during
first 2 years after infection
secondary TB
reactivation of TB form LTBI
TB risk factors
immune compromise (HIV), crowded living, exposure (healthcare work), nationality (africa, asia and latin america)
active TB symptoms
fever, chill, night sweats, cough
pulmonary aspergillosis is a complication of
TB
lab findings of TB
hyponatremia (SIADH) and elevated CRP
interferon gamma release assays a/w
TB testing
TB CXR ?
shows active or inactive
CXR findings of active TB
CLASSIC: focal infiltration in upper lobes
Ghon/Ranke complex
TB: calcified primary focus and hilar lymph node, residual evidence of healed primary TB
gold standard for Dx of TB
sputum culture
sputum culture
3 consecutive morning
TB histologic hallmark of biopsy
necrotizing (ceseating) granulomas
TB skin testing
Mantoux test PPD
Mantoux test PPD measures
induration not erythema read in 48-72 hrs
if skin testing positive for TB then ?
CXR to r/o active dz
if 2nd tb skin test positive
indicates TB infection in distant past-boosted response
reaction size on tb skin test
HIV >5 mm, immigrants/healthcare related >10, nl people >15
interferon gamma release assays benefits
not affected by BCG
tx of active TB
RIPE x 2 months then RIF and INH x 4 months [DOT-directly observed]
tx of latent TB
INH and B6 x 9 months
what to monitor when treating TB
LFT
complication of TB
drug resistant, miliary TB, uncontrolled hematogenous TB, multiorgan
RIF
red orange tears, sweats, urine, stool
INH
hepatitis, peripheral neuropathy (given w/ B6)
PZA
hepatic toxicity, hyperuricemia (gout)
EMB
optic neuritis
histoplasmosis
caused by histoplasma capsulatum-isolated from soil contaminated w/bird or bat droppings
asymptomatic primary histoplasmosis
may see residual granuloma (scar) on CXR
acute symptomatic pulmonary histoplasmosis
due to prolonged exposure, fever, fatigue, few resp. symp. lasts 1 week-6 month
progressive disseminated histoplasmosis
rare, fever , fatigue, cough, dyspnea, wt loss, multiple organ involvement, fatal w/in 6 weeks
chronic pulmonary histoplasmosis
in COPD pts, apical cavities in lung
lab for histoplasmosis
antigen detection in bronchoalveolar lavage fluid, urine, blood
histoplasmosis cxr
hilar adenopathy
tx for sever histoplasmosis
amphotericin B IV
tx for chronic histoplasmosis
amphotericin B or itraconazole
tx for histoplasmosis in AIDs pts
amphotericin B + itraconazole
coccidioidomycosis (valley fever)
FEVER, cough, chest pain, ha, fatigue, arthralgias, rash (ERYTHEMA MULTIFORME), ERYTHEMA NODOSUM
erythema nodosum in coccidioidomycosis (valley fever) vs sarcoidosis
valley fever has FEVER
disseminated coccidioidomycosis
lung abscess, lymphadenitis, meningitis, BONE LESIONS at boney prominences
cxr findings of coccidioidomycosis
hilar LAD, patchy nodular infiltrates, miliary infiltrates, THIN WALLED CAVITIES
eosinophilia
coccidioidomycosis w/ slight leukocytosis
tx of sever coccidioidomycosis
fluconazole, amp B IV
coccidioidomycosis in pregnancy
if disseminated dz, mortality risk in both mother and fetus is high
common SE of ..azoles
hepatotoxicity –>monitor liver function
coccidioidomycosis 3 Es
- erythema nodosum 2. erythema multiforme 3. eosinophilia
most common opportunistic infection a/w AIDS
pneumocytostis jiroveci pneumonia
