TB & NTMI Flashcards
What does the ERM gene do?
Present in NTM, gives macrolide resistance.
ERM = Erythromycin Methylase
Treatment for MAC?
Clarithromycin 1g -or- Azithromycin 500mg
Ethambutol 25mg/kg
Rifampin 600mg
-3/wk. Daily if cavitary, severe, or recurrent
Duration of therapy for MAC?
Culture negative + 1 year.
Treatment for M Kansasii?
Isoniazid 300mg
Ethambutol 25mg/kg
Rifampin 600mg
-Same as Tx for MAC, but INH replaces macrolide
Treatment for M Abscessus?
No medically proven regimen. Consider resection. If ERM (-), consider macrolide, amikazin, Tigecycline, Linezolid.
Which HIV positive patients should receive treatment for LTBI?
Anyone with a positive or unknown PPD.
Regardless of age, pregnancy, CD4 count, etc
What are six appropriate triggers to test HIV negative patients for LTBI (e.g., PPD)?
- Starting HD
- Starting TNF alpha inhibitors
- Pre transplant
- Healthcare workers
- Prisoners
- Immigrants from TB-endemic areas
PPD screening test:
>=5mm positive?
>=10mm positive?
>=15mm positive?
- 5: HIV, recent contact, prior TB, allograft recepient, immunosuppressed.
- 10: immigrant, IVDU, “high risk employee/resident”, silicosis, ESRD, DM, hematologic malignancy, gastrectomy, ileal bypass, <5yo
- 15: everyone else
Treatment for LTBI?
Options:
- INH monotherapy for 6 months
- Rifapentine + INH for 3 months
- Rifampicin + INH for 3 months
Side effects of INH?
Liver, CNS, peripheral neuropathy due to B6 defect.
Side effects of Rifamycins?
Induces Cyp450s, LFTs, orange bodily fluids
What does the rpoB gene do?
In TB, codes for rifampin resistance
Treatment of TB?
- Intensive phase: 8 weeks of Rifampin, INH, Pyrazanamide, Ethambutol
- Continuation phase: 18 weeks of Rifampin, INH
Name 7 infections requiring droplet precautions.
Pertussis Influenza Mumps Ruella RSV Coxsackie N. Meningitides
Name 7 infections requiring airborne precautions.
TB Avian flu Herpex Zoster Varicella Measles SARS MERS
