Tuberculosis and Fungal Pulmonary Disease Flashcards
Commonalities
Most are subclinical or asymptomatic
Often granulomatous (CMI)
Less acute and striiking than bacterial
Protracted with out tx
Might have consitutuonal but might not
Chest exam is unremarkable oftne
Tb hx, exam,
Cough, weight loss, fever and nightsweat (not in elderly)
Evidence of chronic illness, lungs clear, findings of pleural effusion
Adnopathy?
How to read PPD
Normal - 15
High risk - 10
HIV, close contact - 5
Miliary vs other
Lung biopsy best for miliary
Gastric aspiration if unccoperative and producing sputum
If bronchial, then can collect sputum
Sputum stidues
Negative smears are more common without cavities (HIV)
POsitive smear needs high volume of bacilli
MAC
Mycobacterium avium-intracellulare
Non-communicbe
Wait for result
Non-smoker
Classic - older men with COPD…sputum and chornic fibrocavitary opaciticis…smear is positive (mimics usual TB)
Lady Windermemes - more in women, non smokers, chronic dry cough…nodules and bronchiectasis favoring right middle lobe and mser often negative
Caseating granulomas
Seen in TB and histo very often…GPA can also cause
Othere endemic fungi and atypical TB produce NON-caseating granulomas…along with sarcoidosis, berylliosis, and HS penumonitis
Histo
Hilar and mediastinal lymphadenopathy (different than blasto)
Similarto primary TB in this case
Pulomnary blastomycosis
Extrapulmonary dz result of dissemination
Air-space opacities, cavities, mass-like and milirary opacitis WITHOUT adenopathy
Granuloma with prom neutrophils
Tx with itraconazloe
PJP
Drug of choice is bactrim in immunocompromised
Pneumothorax
Hyphae
Look for the crescent sign (indicates tissue infarction)
Neutropenia
Blasto vs. candida
Pneumo
Path
Blasto is stronger than candida…both have true yeast forms
Pneumo - disc-shaped cyst with intracystic bodies
Coccidiomycosis unique
Eosinophila
SW US
Valley Fever
