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ID Boards > TB/NTM > Flashcards

TB/NTM Flashcards

1
Q

NTM recovered almost exclusively from municipal water sources

A

M kansasii

M xenopi

M simiae

**NTM are generally resistant to chlorination

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2
Q

Risk factors for disseminated NTM

A
  • cell-mediated immunodeficiency (HIV, steroid use)
  • IFNg or IL2 defects
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3
Q

Rapid-Growing NTM

A
  • M abscessus
  • M chelonae
  • M fortuitum complex
  • M immunogenum
  • M mucogenicum
  • M smegmatis
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4
Q

Slow-Growing NTM

A
  • Photogromogens (demonstrate pigment only in presence of light)
    • M kansasii
    • M marinum
  • Scotochromogens (pigment with or without presence of light)
    • M gordonae
    • M scrofulaceum
  • Nonchromogens (no pigment)
    • MAC
    • M haemophilum
    • M malmoense
    • M simiae
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5
Q

NTM a/w metalworking fluid

A

M immunogenum

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6
Q

NTM a/w lasik

A

M chelonae

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7
Q

Complications of leprosy

A
  • reversal reaction
    • increased warmth, erythema, edema of preexisting lesions
    • d/t development of exuberant local T-cell mediated immune response to living or dead bacilli
    • permanent nerve damage if left untreated
    • can’t occur in tuberculoid form
  • erythema nodosum leprosum
    • acute new SQ nodules - painful, red, tender
    • extensor surfaces of legs and the face
    • d/t complement activation following immune complex deposition
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8
Q

disseminated NTM infection in AIDS patient suspected but cultures negative

A

M genavense

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9
Q

has been implicated in pseudo-outbreaks a/w contaminated scopes

A

M immunogenum

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10
Q

NTM in equitorial Africa

A

M ulcerans

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11
Q

Leprosy tx

A
  • PB - dapsone + rifampin x6mos
  • MB - dapsone + clofazimine daily x12mos
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12
Q

+ hypoanesthesia

A

leprosy (this is lepromatous classification - will be punch bx AFB+)

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13
Q

Classification of leprosy

A
  • Paucibacillary - most common. Bacillary load <1mil, skin bx = AFB negative. <5 skin lesions
  • Multibacillary - “lepromatous”, massive bacillary load, skin bx = AFB floridly positive. >5 skin lesions
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14
Q

disseminated fortuitum tx

A

3rx (including 1 IV) x4-6mos

  • macrolides, quinolones, bactrim, doxy (50%)
  • IV: aminoglycosides, imipenem, cefoxitin, tigecycline
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15
Q

disseminated chelonae tx

A

3rx (including 1 IV) x4-6mos

  • macrolides, fluoroquinolone, linezolid
  • IV: aminoglycosides, imipenem, cefoxitin, tigecycline

***tobra = best for chelonae

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16
Q

NTM a/w tattoos

A

M chelonae

2-3mos PO therapy - 1-2rx based on susc, but typically always includes macrolide

17
Q

nail salon furunculosis

and tx

A

a/w outbreaks and/or sporadic

rapid growers most common (fortuitum)

PO abx - 4mos quinolones and/or doxy

18
Q

likes to tunnel and involve the tendons

A

M marinum (fishtank granuloma)

tx: multiple rxs = 2 agents x3-4mos typical + debridement if possible

19
Q

NTM post-plastic surgery (and typical tx)

A

chelonae

remove foreign bodies

tx as per susc

typical 4-6mos

20
Q

Tx for pulm abscessus

A

3-4 drugs x18-24mos (though cure = rare)

4-6mos induction, followed by suppressive

  • PO options: clofazimine, linezolid, moxifloxacin
  • Parenteral options: tigecycline, cefoxitin, imipenem, amikacin
21
Q

M abscessus subspp

A

boletti, massiliense, abscessus

subspp abscessus almost always have inducible macrolide resistance - erm(41) gene

22
Q

Pulm kansasii therapy

A

clinically more like TB = curable

thin-walled cavities, involving upper lobes

Tx = INH, RIF (= key rx), EMB

actually high success rate (90+%)

23
Q

Typical option for MAC treatment

A

macrolide, rifampin, ethambutol - typically daily, though TIW is optional if non-cavitary

if cavitary dz: amikacin 1-2mos

ultimately require minimum 18-24mos (need 12 mo culture negative)

24
Q

Pulm NTM common in Europe: and in northern US/Canada:

A
  • Canada/northern US: xenopi
  • Europe: malmoense
25
Q

NTM a/w saltwater fish and fishtanks

A

M marinum

26
Q

NTM a/w with lung disease after aspiration

A

fortuitum

27
Q

NTM that demonstrate cross-reactivity with IGRAs

A

szulgai, kansasii, marinum

28
Q

The only NTM that is communicable

A

M massilense (in CF patients)

29
Q

NTM that is often contaminant

A

M gordonae

30
Q

NTM a/w tropical setting

A

M ulcerans (buruli ulcer) - wading in water = RF

31
Q

line-associated NTM

A

M mucogenicum

32
Q

NTM a/w healthcare/hygiene outbreaks

A

chelonae, fortuitum, abscessus

33
Q

NTM corneal disease

A

M chelonae

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