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infectious disease > tuberculosis > Flashcards

tuberculosis Flashcards

1
Q
  • condition caused by mycobacterium tuberculosis
  • slow growing bacteria
  • can present as pulmonary illness
A

tuberculosis

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2
Q
  • TB is inhaled and moves down bronchi into middle/lower lobes of lungs
  • initial immune reaction releases macrophages, T lymphocytes, IL-1, IL-6, and TNF alpha
  • granuloma develops and encases TB
  • caseous necrosis develops in center of granuloma leading to ghon focus
  • usually asymptomatic
A

primary TB

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3
Q

hallmark of primary TB

A

ghon complex

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4
Q
  • if pt with latent TB becomes immunocompromised, they may no longer be able to contain the infection
  • infection multiplies and spreads
  • moves to apices of lungs
  • cavitary lesions in apices and necrosis of lung parenchyma
  • symptomatic and contagious
A

reactivation TB

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4
Q
  • ghon complex starts to have fibrocalcifications form around it
  • keeps TB dormant and not spread
  • Ranke complex
  • not contagious and can remain dormant for years
A

latent TB

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5
Q

high risk populations for TB reactivation

A

HIV, DM, CKD, organ transplant pts, silicosis, immune suppressing drugs, illicit drug use

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6
Q

early symptoms of active TB

A

malaise, fever, weight loss, severe night sweats, productive cough/hemoptysis

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7
Q

complications of pulmonary TB

A

pneumothorax
bronchopneumonia
pleural effusion
hemoptysis

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8
Q

PE findings of pulmonary TB

A

crackles from inspiration or after short cough
look chronically ill, malnourished

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9
Q
  • when TB enters the blood stream and spreads to extra pulmonary sites (outside of the lungs)
  • disseminated hematogenous spread occurs and the formation of multiple millet seed-sized tuberculosis foci can develop in the lungs
A

extra pulmonary/miliary TB

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10
Q

TB in pleura

A

tuberculous pleurisy

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11
Q

central nervous system TB

A

tuberculous meningitis

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12
Q

pericardium TB

A

leads to constrictive pericarditis

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13
Q

liver TB

A

can cause acute hepatitis

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14
Q

adrenal glands TB

A

leads to inability to produce cortisol –> Addison’s disease

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15
Q

lymphatic system TB

A

in scrofula of neck

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16
Q

genitourinary system TB

A

urogenital tuberculosis

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17
Q

bones and joints TB

A

post’s disease of the spine
tuberculosis arthritis
osteomyelitis in long bones

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18
Q

abscess through skin TB

A

tuberculous ulcer

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19
Q

extra pulmonary TB PE findings

A
  • subacute–> failure to thrive, FUO, dysfunction of one or more organ systems, night sweats
  • acute miliary TB–> multi organ system failure, syndrome of septic shock, acute respiratory distress syndrome (ARDS).
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20
Q

how to diagnose TB

A

TB skin test
PPD test
Mantoux test

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21
Q

limitations of TB test

A
  • can not distinguish active from latent TB
  • read at 48-72 hours
  • can’t use with BCG vaccine (bacillus calmette-guerin)***
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22
Q

positive TB test based on what

A

Less than 5 mm: The result is negative.

5 mm or more: The result is positive for people with certain risk factors, such as HIV, recent contact with someone with TB, or immunosuppression.

10 mm or more: The result is positive for people with additional risk factors, such as recent immigration from a high-TB country, living in a high-risk environment, or working in a high-risk setting.

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23
Q

how to get TB results within 24 hours

A

interferon gamma release assay
- QuantiFERON TB Gold
- Tspot

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24
Q

what is part of the initial approach to a diagnostic eval of a patient with suspected TB

A

chest x ray
chest CT

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25
Q

reactivation pulmonary TB classically presents with focal infiltration of the upper lobe:

A
  • apical CASEATING granulomas
  • nodular infiltrates
  • hilar/paratracheal lymph node enlargement
  • ghon and or ranke complexes may be found after healed primary
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26
Q

different ways to get pulmonary TB diagnosis

A
  • 3 consecutive morning sputum specimens
  • sputum culture with acid fast stain
  • biopsy of caveating granulomas
  • DNA/RNA amplification
27
Q

how to diagnose extra pulmonary TB

A

biopsy– acid fast smear and culture of tissue, fluid, or drainage

28
Q

treatment for active TB

A

6 month regimen

begins with 4 medications x2 months
- isoniazid (INH)
- Rifampin (RIF)
- Ethambutol (EMB)
- pyrazinamide (PZA)

continue treating with INH and RIF for additional 4 months

must treat for at least 3 months beyond negative cultures

29
Q

treatment for latent TB

A

isoniazid x 9 months
or
rifampin x 4 months
or
isoniazid and rifapentine weekly x 3 months
or
isoniazid and rifampin daily x 3 months

30
Q

rifampin side effects

A

red orange secretions
P450 inducer

31
Q

isoniazid side effects

A

peripheral neuritis

32
Q

pyrazinamide side effects

A

increased Uric acid

33
Q

ethambutol

A

red green discrimination

34
Q

streptomycin

A

ototoxic

35
Q
  • regular physician visits, who monitor medication intake and look for signs of medication side effects
  • will check sputum smears
  • ensures people follow medicine instructions due to long treatment course for TB
A

directly observed therapy (DOT)

36
Q

resistant to one first line antituberculous drug, either isoniazid or rifampin

A

drug-resistant

37
Q

resistant to isoniazid AND rifampin

A

multidrug resistant TB

38
Q

resistant to isoniazid, rifampin, fluoroquinolone, and aminoglycosides and/or capreomycin

A

extensively drug resistant tuberculosis

39
Q

options for abbreviated empiric treatment for drug resistant disease

A

bedaquiline
pretomanid
linezolid plus moxifloxacin

40
Q
  • among the most common opportunistic infections in advanced HIV disease
  • occur ubiquitously in the environment (soil and water) (contracted by the bacteria being aerosolized)
  • not communicable from person to person
A

nontuberculous mycobacterial infections

41
Q
  • Most common*
  • slow growth
  • infects lungs and lymph nodes
A
  1. avium complex
42
Q
  • slow growth
  • infects lungs, and can lead to disseminated disease
A
  1. M. Kansasii
43
Q
  • slow growth
  • infects skin and soft tissues
A
  1. M. Marinum
44
Q
  • rapid growth
  • infects lungs, skin and soft tissues
A
  1. M. Abscessus
45
Q
  • rapid growth
  • infects skin and soft tissues
A
  1. M. chelonae
46
Q
  • rapid growth
  • infects skin, soft tissues, and lung
A
  1. M. Fortuitum
47
Q
  • disseminated infection
  • late stages of HIV
  • CD4 count < 50/mcl
  • persistent fever and weight loss
A

NTM outside of lungs

48
Q

how to treat NTM outside of lungs

A

clarithromycin or azithromycin + ethambutol +/- rifabutin

49
Q

2 major phenotypes of NTM lung disease

A
  • nodular/brochiectactic (NB)
  • Fibrocavitary (FC)
50
Q
  • typically seen in postmenopausal non smoking white women
  • also known as lady windermere syndrome
  • pts usually experience many years of progressive respiratory symptoms and recurrent respiratory infections due to unrecognized underlying bronchiectasis
  • prolonged cough, fatigue, weight loss
  • 50% will not progress
A

nodular/brochiectatic (NB)

51
Q

nodular/brochiectatic (NB) CT findings

A
  • bronchiectasis with nodules
  • often “tree in bud” appearance
  • classically RML and lingual
52
Q

-typically male pt, over 50
- typically has some form of underlying chronic lung condition
- COPD, silicosis, pulmonary fibrosis
- progressive
- systemic symptoms (fever, fatigue, weight loss, night sweats)
- worse outcome and prognosis than NB type

A

fibrocavitary (FC)

53
Q

fibrocavitary (FC) CT findings

A

fibrocavitary lesions
often upper lobe involvement

54
Q

diagnosis of pulmonary infection clinical

A

pulmonary or systemic symptoms

55
Q

diagnosis of pulmonary infection radiology

A

nodular or cavitary opacities on CXR,
CT shows bronchiectasis with multiple small nodules

56
Q

diagnosis of pulmonary infection microbiology

A

A. positive cx from 2 sputum samples, or
B. positive cx from 1 BAL sample, or
C. lung biopsy with typical histology plus positive cx of tissue biopsy, BAL, or sputum

57
Q

pulmonary infection treatment

A
  • over half of pts who meet DX criteria progress within 3-5 years
  • so start treatment asap
58
Q

pulmonary (MAC) treatment

A

3 drug therapy, treated for at least 12 months:
- clarithromycin or azithromycin +
- rifampin or rifabutin +
- ethambutol

59
Q

pulmonary (M kansasii) treatment

A

18 months:
- isoniazid
- ethambutol
- rifampin

60
Q

how to diagnose skin and soft tissue

A

biopsy and positive culture

61
Q

skin and soft tissue treatment

A

surgical debridement with at least two abx for 3 months
- azithromycin
- clarithromycin
- amikacin
- imipenem
- linezolid
- fluoroquinolones

62
Q

how is lymphadenitis diagnosed

A

biopsy and culture

63
Q

lymphadenitis treatment

A
  • surgically with our anti tuberculous therapy
    if surgery contraindicated:
  • azithromycin + rifampin + ethambutol
64
Q

macrolide resistance can occur if

A

macrolide mono therapy is given

65
Q

macrolide resistance treatment

A

daily ethambutol, rifampin, and clofazimine, augmented by two to six months of IV amikacin

infectious disease (12 decks)

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