TB, MAC, Aspergillosis, Candida, Cryptococcal Infection, Endemic Mycoses Flashcards
TST >5mm is positive in
HIV
recent contact with TB + person
Fibrotic changes on Xray
Organ transplants or immunosuppressed
TST >10 is positive in
Recent arrivals from high risk countries
IV Drug users
Residents or employees of prisons, jails, nursing homes, hospitals, homeless shelters
Micro lab personnel, kids <4
TST >15 is positive in
everyone with no risk factors for TB
Used to exclude TB in patients with false positive sputum results or confirm disease in patients with false negative smears
Nucleic acid amplification test of sputum
Infiltrates in the apical-posterior segments of upper lung and superior segments of lower lobe in TB
TB reactivation
Hilar LAD or infiltrates in any part of the lung in TB
Primary progressive TB
Uniform reticulonodular infiltrate
Miliary TB
Treatment for latent TB
Daily Isoniazid for 6 months or daily rifampin for 4 months
Pt with HIV- Daily Isoniazid for 9 months
Treatment for Active TB
8 weeks of Rifampin , Isoniazid, Ethambutol, Pyrazinamide
Then 4 or 7 months of Isoniazid and Rifampin
Criteria to establish a patient as no longer infectious
Adequate TB treatment
Improvement in symptoms
three consecutive negative sputum smears
Labs to check when using ethambutol or pyrazinomide
Uric acid for pyrazinomide.
visual acuity, color vision for ethambutol
Healthy white woman with right middle lobe or left lingular lobe lung infiltrate. She has scoliosis, pectus excavatum or MVP suggesting underlying connective tissue defect
MAC
Disseminated MAC occurs in HIV patients with CD4 cell count less than
50
Treatment for MAC
Azithromycin or Clarithromycin
with ethambutol and either rifampin or rifabutin
Mycobacterium abscessus, Mycobacterium fortuitum and Mycobacterium chelonae are causes of
localized skin and soft tissue infections
Allergic bronchopulmonary aspergillosis occurs in patients with
Asthma or CT
Lab findings for ABPA
elevated IgE, eosinophilia
ABPA presents as
difficult to control asthma and recurrent pulmonary infiltrates
CT findings in invasive aspergillosis
Halo sign- a target lesion with surrounding ground-glass attenuation (hemorrhage)
Testing for aspergillus
culture from deep body specimen, serum galactomannan
Treatment for aspergillosis
Voriconazole for invasive aspergillosis, surgical resection for aspergilloma
Treatment for ABPA
Glucocorticoids
Aspergilloma treatment in asymptomatic patient with stable Xray
None
Disseminated crypto can present as
Fungemia and meningitis
Cryptococcal meningitis occurs in AIDS patients with CD4 count less than
100
Treatment for Crypto
Ampho B with flucytosine
Then fluconazole until CD 4 cound is >100 for 3 months
Blasto and Histo occur in
Mid west and MS and Ohio river valleys
Skin findings in coccidiomycosis
erythema nodosum or erythema multiforme
