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Pulmonology Board Review > Tuberculosis and Non-mycobacterial Lung Infections > Flashcards

Tuberculosis and Non-mycobacterial Lung Infections Flashcards

1
Q

Imaging findings in NTM infections

A

CXR with nodules/cavities OR

HRCT with multifocal bronchiectasis and multiple small nodules

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2
Q

Micro requirements for NTM infection

A

Positive sputum cultures (not smear) x 2

or

Positive bronchail was culture

or

Histopath +/- “expert consultation”

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3
Q

3 situations where routine susceptibility testing for NTM is recommended

A
  1. MAC isolates - clarithromycin only
  2. M. kansasii - rifampin only
  3. Rapid growing mycobacterium
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4
Q

Rapid growing mycobacterium

A

M. fortuitum

M. abscessus

M. chelonae

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5
Q

How to prevent health care related NTM infections

A

NO wound, injection site, or IV catheter be exposed to tap water or tap water derived fluids

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6
Q

NTM pathogens considered contaminants

A

M. Gordonae

M. terrae complex

M. mucogenicum

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7
Q

5 NTM species known to be present in tap water

A

M. abscessus

M. kansasii

M. lentiflavum

M. simiae

M. xenopi

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8
Q

Gene responsible for macrolide resistance in NTM infections

A

erythromycin methylase (ERM)

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9
Q

Who gets prophylaxis agains disseminated MAC and what regimen

A

AIDS patients with CD4 count < 50

Azithromycin 1,200 mg/week

or

Clarithromycin 1,000 mg/day

or

Rifabutin 300 mg/day

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10
Q

Treatment regimen for pulmonary limited MAC

A
  1. 3 times per week dosing with
    1. Clarithromycin 1,000 mg or Azithromycin 500 mg
    2. Ethambutol 25 mg/kg
    3. Rifampin 600 mg
  2. DAILY dosing if
    1. Severe disease
    2. Cavitary lesions
    3. Previously treated disease
  3. DURATION = culture negative x 1 year
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11
Q

Treatment for disseminated MAC

A
  1. Daily treatment with
    1. Clarithromycin 1,000 mg or Azithromycin 250 mg
    2. Ethambutol 15 mg/kg
    3. Rifabutin 150 - 350 mg
  2. DURATION
    1. symptoms resolve AND cell mediated immune function returns
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12
Q

Treatment of pulmonary limited M. Kansasii

A

Daily treatment with

  1. Isoniazid 300 mg
  2. Rifampin 600 mg
  3. Ethambutol 15 mg/kg

DURATION = culture negative x 1 year

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13
Q

Treatment of pulmonary limited M. abscessus

A

No clinically reliable treatment, perhaps surgery

Macrolide may or may not work depending on ERM gene

  1. Amikacin 10-15 mg/kg 3-5x/week OR
  2. Tigecycline 25-50 mg/day OR
  3. Zyvox 300 - 600 mg/day
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14
Q

Should household contacts of patients with confirmed pulmonary TB be tested and treated for latent TB

A

Yes

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15
Q

Populations without HIV who should be tested for latent TB

A

Dialysis patients

Patients about to receive transplant

Patients with silicosis

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16
Q

Populations who should not be screened for latent TB

A

Diabetics

ETOH abuse

Smokers

Underweight individuals

17
Q

People who may be considered for screening for latent TB but not mandated

A

Prisoners

Health care workers

Immigrants from countries with high TB burden

Homeless

Drug users

18
Q

People whom 5 mm is cut off for positive PPD

A

HIV patients

Recent TB contacts

Prior hx of TB

Organ transplant recipients

Immunosuppressed

19
Q

People for whom 10 mm is the cut off for positive PPD

A

Recent immigrants

IV drug users

High risk employees/residents

Silicosis

ESRD

DM

Heme malignancies

Gastrectomy or ileal bypass

Kids < 5 years old

20
Q

Will quantiferon or TSPOT tests show false positive with BCG vaccine history

A

No, but a simple PPD will

21
Q

Treatment regimens for TB in low incidence countries

A
  1. INH x 6 months
  2. Rifapentine + INH weekly for 3 months if HIV +
  3. Rifampicin + INH for 3-4 months
  4. Rifampicine alone for 3-4 months
22
Q

TB treatment options if from high incidence country

A
  1. INH monotherapy for 6 months
  2. Rifapentine + INH weeks for 3 months
  3. Rifampicin + INH for 3 months if < 15 years of age
  4. INH for 36+ months if HIV+
23
Q

Side effects from INH

A

LIver disease, CNS symtpoms, and peripheral neuropathy if B6 deficient

24
Q

Side effects from rifamycins

A

Turns body fluids orange, liver toxicity

25
Q

3 signs of active pulmonary TB

A

Lymphadenopathy/Ghon complex

Pleural effusions

Obstructive atelectasis

26
Q

Secondary symptoms of active pulmonary TB

A

Upper lobe predominance

No “RULE OUT” patterns

CT usually not needed

27
Q

Respiratory sample requirements for TB diagnosis

A
  1. Need 3 ml or more
  2. Early morning
  3. Induced sputum is as good as bronch/BAL
    1. Don’t bronch unless some urgent need
28
Q

Phases and treatments for active TB

A
  • Intensive phase
    • 7d/week x 8 weeks or 5d/week x 8 weeks
    • 4 drug regimen (Rif, INH, EMB, PZA)
  • Continuation phase
    • 7d/week x 18 weeks or 5d/week x 18 weeks
    • INH and Rifampin
29
Q

Timing of IRIS after ART therapy with TB and HIV

A

2-6 weeks

Pulmonology Board Review (32 decks)

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