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Pulmonary > Tuberculosis > Flashcards

Tuberculosis Flashcards

1
Q

What is a latent TB infection?

A

person that is infected with TB but does not have active dz

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2
Q

What is the number 1 or 2 killer by infectious dz in the world?

A

TB

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3
Q

what percentage of the population was affected by TB in the 1800’s?

A

20%

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4
Q

Why was TB declining at a constant rate in the 1900’s and then in 1984-1994 there a stop in decline? (5)

A
  1. HIV
  2. Decreased public health infrastructure
  3. Increased immigrants
  4. Nosocomial outbreak
  5. DRTB
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5
Q

What happens in stage 1 of TB pathogenesis? What are the different outcomes during this stage?

A

ingestion of TB by resident alveolar macrophage

  • phagosome-lysosome ingestion (MTB killed)
  • apoptotic death (MTB killed)
  • Multiplication of MTB leading to necrotic death of macrophage and MTB survive
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6
Q

what happens in stage 2 of TB pathogenesis?

A

symbiotic stage

- MTB multiplies within macrophages and incoming monocytes are reservoir

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7
Q

What happens in stage 3 of TB pathogenesis?

A

migration of T cells to site of infection leading to granuloma formation which prevents MTB from replicating

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8
Q

What happens in stage 4a of TB pathogenesis?

A

Latent TB infection (LTBI)

- MTB infection contained in granuloma and any that escape are eaten by macrophages

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9
Q

What happens in stage 4b of TB pathogenesis?

A

decline in immunity leading to reactivation of TB
- HIV or other immunocompromised individuals leads to liquifying necrosis resulting in rupture of granuloma leading to infection

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10
Q

what type of necrosis results in granuloma rupture?

A

liquifying necrosis

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11
Q

What are the 2 radiographic features of a latent TB infection?

A

Ranke complex
- Ghon complex + calcified regional hilar and/or mediastinal lymph nodes
Ghon complex
- calcified lung nodule at the site of initial infection

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12
Q

What will the CXR of an active TB infection show?

A

cavitation

diffuse infiltrates

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13
Q

What will sputum smears and cultures in LTBI show compared to active TB?

A

LTBI cultures will be negative and active will be positive

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14
Q

True or False: latent TB infection is asymptomatic

A

True

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15
Q

what types of symptoms do patient’s with active TB infection demonstrate?

A

cough
fever
night sweats
weight loss

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16
Q

Which type of TB is considered infectious?

A

active TB before treatment

17
Q

Which form of TB infection will show a positive PPD?

A

both active and LTBI are positive

18
Q

Which types of patients are considered to have a positive TB skin test with >5mm induration?

A
  • recent close contact with active TB case
  • HIV +
  • organ transplant
19
Q

Which types of patients are considered to have a positive TB skin test with > 10 mm induration?

A

immigrants from increased prevalence of TB infections

20
Q

Which types of patients are considered to have a positive TB skin test with >15mm induration?

A
  • all others even if they are at low risk for contracting
21
Q

What are reasons for a false-positive on a PPD?

A

pt with BCG vaccine

individuals infected with environmental mycobacter

22
Q

What are reasons for a false-negative on PPD?

A

T-cell depleted individuals
AIDS
organ transplant

23
Q

What are the characteristics of a BCG vaccine and how is it different from small pox vaccine?

A

raised area on the deltoid. Small pox vaccine is wide and flat

24
Q

What are the 2 types of IFNy release assays?

A

Qunatiferon

T-spot TD

25
Q

Which IFNy release assay is more sensitive in immunocompromised patients and why?

A

T-spot more sensitive than quantiferon in immunocompromised patients because can detect single cells

26
Q

True or False: The more positive a TB skin test, the more likely you are to develop a LTBI

A

True

27
Q

Which types of patients are most at risk for reactivation of LTBI?

A

smokers

advanced HIV

28
Q

What type of infection is responsible for 1/3 of all deaths in HIV patients?

A

TB

29
Q

When do most TB infections happen in immigrants and why?

A

5 years after immigration
this is because in native land they have a lot of sun and therefore a lot of vitamin D. They mostly move to darker areas and VITAMIN D IS SHOWN TO SUPPRESS TB

30
Q

What is the proposed mechanism of why vitamin D suppresses TB?

A

vitamin D induces production of catheliocidin which is an anti-microbial peptide that kills TB

31
Q

What is the standard treatment for LTBI?

A

9 months of isoniazid (INH)

32
Q

What is a common alternative to isoniazid and for how long?

A

Rifampin daily for 4 months

33
Q

What is the major risk factor for INH?

A

hepatitis

34
Q

What is 3 HP and what are the the advantages and disadvantages?

A

INH + Rifapentene ONCE WEEKLY for 3 months
advantages are that its a shorter course
disadvantages are that if you miss one dose, it has more drastic detrimental effect

35
Q

how do you treat a patient with an active infection?

A

treat with multiple drugs so that it doesn’t become resistant

Pulmonary (32 decks)

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