Week 12 - Topic 2: Pneumonia and Tuberculosis Flashcards
What does a chest x-ray show for pneumonia?
Infiltrate, consolidation or cavitation that persists for >48h
What are symptoms of pneumonia?
- Rales or bronchial breath sounds (crackles)
- New onset or worsening cough
- SOB or incr. in respiratory rate
- Worsening gas exchange
Why does positive end-expiratory pressure (PEEP) increase in pneumonia?
You need more pressure to push the air into your lungs that are now full with fluid –> need for intubation
How is pneumonia classified (3)?
1) By region: lobar vs bronchial pneumonia
2) By organism: bacterial, viral or mycoplasma pneumonia
3) Aspiration pneumonia (fluid, fungus found in dust)
You find consolidation in the chest x-ray of a pneumonia patient. What could be filling up the airways/alveoli (4)?
1) Pus
2) Fluid
3) Blood
4) Cancer cells
When listening to the lungs of a pneumonia patient, where won’t you hear breathing/airway movement?
Where there is consolidation
When looking at the chest x-ray of a pneumonia patient, what might you see?
- Consolidation
- Nodules
- Masses
- Atelectasis (lung collapse)
- Interstitial opacities (viral cause)
What are common (3) bacterial pathogens for LRTI?
1) Strep pneumoniae
2) Haemophilus influenzae type B (Hib)
3) Any bacterial pathogen aspired into the lungs
Who’s at risk for developing strep pneumonia?
Elderly > 65 y.o.
Kids <2 y.o.
Smokers
People with heart or lung diseases
Who is at risk for developing an infection from Hib?
Unvaccinated children
How can you find out if a patient has TB?
You do an acid fast bacillus culture to see if they have Mycobacterium tuberculosis
What must you (the nurse) do when a physician request an acid fast bacilli culture?
Put the patient on isolation and airborne precautions
Why MUST TB be reported and treated (4 reasons)?
- High risk of transmission
- Airborne transmission
- Lethal
- Treatment available and effective
What are the symptoms of TB?
Fever, weight loss
Cough, night sweats, chills
Sometimes coughing blood (if cavitation in lungs)
True or False: A chest x-ray can specifically show someone has TB.
False, unless it shows cavitation
When is cavitation common?
In adults with reactivated TB
True or false: Cavitation is uncommon in children with TB.
True
True or False: Only pulmonary TB is contagious.
True, because that is when the patients are spewing out aerosols/secretions.
What mode of transmission is TB?
airborne
True or false: Liver TB is contagious and patient should be placed on airborne precautions.
False
When is extra-pulmonary TB contagious?
In the OR when you are doing a biopsy and aerosols may be produced
Who is at risk for TB?
- Immigrants from areas of high TB rates
- Being in close contact with someone of active TB
- Homeless, IV drug users, HIV (high rates of TB transmission)
- Kids <5 y.o. with a positive TB test
What vaccine is there against TB? Why is it not very used anymore?
BCG (bacille Calmette-Guérin) vaccine
It is not effective in prevention (only offers protection to some people)
True or false: We screen all healthcare workers for TB.
False, only those at high risk
Why don’t we really use blood test (IGRA) for TB exposure?
It is not very sensitive
How do we test for TB exposure?
TST: tuberculin skin test
Can TB exposure testing be used for diagnosis?
No, but can be an indicator in children
When can BCG vaccine create a false positive for TST?
around 40% of cases if vaccine was done after 12 months-6 years of age (persistent false + after 10 years)
How do we diagnose TB?
- Sputum culture (confirmation)
- Smear microscopy for AFB
- PCR-NAAT (only presumptive)
How do you know if the physician is suspecting TB?
They will request 3 AFB sputums:
1) Collect them in the morning when the patient coughs the most
2) Bronchial washings/induced (PT is given a product that makes them cough, sputum collected 1h apart)
3) Gastric aspirates (usually children who cough+swallow a lot)
How many people develop latent TB?
95% of people
How many people will develop reactivated TB?
5% of people with latent TB
Who can develop extra-pulmonary TB?
Those who have reactivated TB
What is a latent TB infection?
Presence of M tuberculosis (tubercle bacilli) without:
- Signs and sx
- Culture is negative
How does one with latent TB reduce the risk of getting it reactivated?
By getting treatment
What is common between latent and active TB?
They give positive skin tests
True or False: Latent TB is a reportable disease.
False, but active TB is
True or False: A pt with latent TB does not need to be put in isolation/additional precautions.
True
How long is active vs. latent TB treament?
Active: 6+ months
Latent: 4-6 months (no obligation to get treated)
What is DOT?
Direct observation therapy
Nurse must observe patients take their obligatory TB treatment (usually for non-compliant patients)
Who is at risk of developing reactivated TB (after previously having latent TB)?
- HIV
- Untreated TB + fibrotic lesions
- Children < 5
- Substance abusers
- Receiving TNF-a antagonists for treatment of rheumatoid arthritis or Crohn’s disease
When is TST done?
Pre-exposure to TB
How is TST done?
Administer 0.1 mL of tuberculin intradermal and read 48-72h later
Must be done in two steps (1-4 weeks apart) to eliminate false +
What makes a negative TST?
<10 mm induration
What makes a positive TST?
> = 10 mm induration
True or False: You do not do a second TST on those who were tested + the first time.
True, to avoid getting an even worse reaction the 2nd time
Who is given a 2 step TST?
- HCW
- Prison workers
- Residents of nursing homes
- People who have travelled to TB endemic countries for a long time
What does the contagiousness of TB depend on?
1) the level of bacilli in the sputum (can be AFB - or AFB 3+)
2) If the pt had sx
An asymptomatic pt with AFB 3+ is less contagious than a symptomatic pt with AFB 2+
True or False: You can get TB from simply sharing the same airspace as a TB person.
Yes, because it is airborne
When is TST post-exposure done?
Once, at least 8 weeks post exposition
A person has done a TST with a result of 0-4 mm. When would we give him treatmen?
If he is under 5 y.o. and was in contact with an infected person
(Give treatment until we do another TST test 8 weeks after exposure)
What is the best protection against TB?
Early diagnosis and treatment
Where must you place in a TB PT in a hospital?
Negative-pressure room under airborne precautions
What must the HCW do before entering the TB PT’s room?
Need a fit check for the N95 respirator
What is atypical/walking pneumonia?
Mild version of typical pneumonia (moderate to no sputum, absence of leukocytosis)
How does atypical pneumonia progress?
Starts as mild URTI and develops into dry cough and dyspnea
What bacteria cause atypical pneumonia?
Bacteria that does not gram stain:
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Chlamydia psittaci
- Legionella spp**
What viruses cause atypical pneumonia?
Influenza
RSV
Parainfluenza
What fungus (2) cause atypical pneumonia?
Histoplasma
Pneumocystis
Which microorganism generally causes atypical pneumonia?
Viruses
What type of pneumonia is especially spread through contaminated water?
Legionella pneumophila that causes Legionnaire’s disease/Legionellosis
What is the mode of transmission of legionella infection?
Droplet
How do you diagnose Legionnaire’s diseae (3)?
1) Urine antigen test
2) Sputum culture
3) Blood serology (increase in IgG)
What is pneumocystis pneumonia (PCP)?
Fungi pneumonia that greatly affects HIV or immunosuppressed patients
What is characteristic of PCP?
Presence of cysts from the fungi
What is aspergillosis?
Infection of the lungs caused by aspergillus (a mold)
Who is at risk of aspergillosis?
Immunocompromised people (oncology especially)
How do we diagnose aspergillosis?
Serology test that looks for galactomannan, a component of the cell wall of Aspergillus
