44. Leprosy & Non-TB mycobacteria Flashcards Preview

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Flashcards in 44. Leprosy & Non-TB mycobacteria Deck (13):
1

M. leprae epi?

250,000 new cases/year

Armadillos

2

M. leprae transmission?

- via nasal droplets
- humans = principal reservoir
RFs:
- type of leprosy (lepromatous > tuberculoid)
- bacterial burden (multibacillar > Paucibacillar)
- close contact
- age
- immunosuppression
- genetics (NOD2 mutation, HLA)

3

M. leprae microbiology?

- slow multiplier and obligate intracellular org
- can’t be grown on artificial media
- grows best in cooler areas of body
- infects macrophages and schwann cells

4

M. leprae pathogenesis?

- pagocytosed by macrophages via complement receptors
- type of cell-mediated response dictates clinical presentation: mycobacterial presentation of different stress proteins could inf immune response or specific HLA-DR alleles
- Th1 = tuberculoid (low infectivity, single area)
- Th2 = lepromatous (high infectivity, disseminated, hypergammaglobulinemia)

5

M. leprae disease?

Hansen’s disease
Anesthetic skin lesion(s) + thickened peripheral nerve(s)
Tuberculoid: (Th1)
- few hypopigmented, discrete lesions
- single but progressive nerve involvement
Lepromatous (Th2, immune complex deposition)
- many symmetrical skin lesions, diffuse margins, thickened skin, nodules
- several nerves but slow progression
- loss of eyebrows, saddle nose deformity, ear lobe nodules

6

M. leprae dx?

- physical exam: skin and nerves
- slit-skin smear (AFB smear)
- biopsy: gold standard

7

M. leprae tx?

Multi-drug:
- paucibacillary disease (PB) blister pack
- multibacillary disease (MB) blister pack
- dapsone
- rifampicin
- clofazimine

Prevention:
- rifampin single dose may prevent disease in close contacts
- BCG 26% efficacy

8

NTBMtb microbiology?

- Rapid growers: visible colonies in 1 week
- Slow growers: 2-4 weeks
- photochromagen (yellow-orange colonies when exposed to light)
- scotochromagen (yellow-orange colonies in dark or light)
- normochromagens (no pigment)

9

MAC pulm disease RF, dx, tx?

- RF for MAC pulm disease? COPD, CF, lung disease, immunocompromised – solitary nodule, cavitary disease, nodular bronchiectasis, hypersensitivity pneumonitis

- MAC Pulm: sxs & radiographic & exlusion of other causes; 2 positive sputum cx or single BAL positive for MAC

MAC Pulm: nodulat/bronchiectatic: rifampin, ethambutol, azithromycin/ clarithromycin 3x q week

Fibrocavitary or severe ^^: ^^ qd

10

MAC disseminated disesae, dx, tx?

- Disseminated MAC: fevers, wt loss, night sweats, abd pain, diarrhea

Disseminated MAC
- elevated LDH
cytopenias
- AFB blood cx,
Bone marrow aspirate

Disseminated: macrolide + etham + rifamycin

11

M. ulcerans Buruli ulcer disease, dx, tx?

Buruli ulcer produces potent cytotoxin (mycolactone)

- Buruli ulcer: painless papule to ulcer

Buruli ulcer:
- rifampin + streptomycin
- or + clarithromycin

12

M. marinum disease, dx, tx?

- marinum painless/painful papules or nodules w/indolent course

Marinum:
- rifamp + clarithro +
Ethambutol (severe)

13

rapid grower NTBMtb disease, dx, tx?


- rapid growers skin if indolent skin lesion not
responsive to standard Abx

- Cipro or doxy or Bactrim or clarithro
(cutaneous disease)