Flashcards in Lecture 11 Tb Deck (23)
Tb patients slowly waste away, hence the name ______
tb has a thick ____ covering that prevents staining by usual gram stains. some time it stains weakly gram ___
why is Tb more resistant to antibiotics?
divides very slowly, most Abs kill dividing bacteria
____ was the first Ab discovered to kill Tb because it affects ribosomes.
____ acts on the Tb cell wall and induces nitric oxide that kills bacteria
____ lesions are more infectious than just smear positive infections
infection is most likely to produce disease in _____ and the ____
(also 15-25 year olds)
most common presentation of primary infection? What part of the lung is it seen in?
typically lower lung (ie lower part of the middle lobe)
what is usually the only evidence of a primary Tb infection?
bacteremic tb is called _____. do most patients after primary infection progress to more symptoms, or do most become asymptomatic?
most become asymptomatic-latent Tb
In 5-10% of patients with latent Tb, it will become active again. this is called ____ tb.
where does reactivation tb typically present in the lung? Why? what are the usual symptoms?
upper lobes, due to higher O2 tension;
fever, night sweats, hemoptysis, weight loss (classic Tb symptoms)
____ lesions on CXR are common in patients with reactivation Tb
extra-pulmonary tb in the cervical lymph nodes is called _____. Tb in the spine is called ____.
scrofula; pott's disease
The PPD is due to a _____ ____ immune response. It is measured based on ___ of the indurated skin
false positive PPDs may be seen in patients with _____ or other mycobacterial infection. False negatives may occur in those with advanced ____, immunosuppresive therapy, or those with ____ ____
previous BCG vaccination;
HIV; active disease
2 other tests for latent infection:
do those with previous BCG vaccination react ?
T-spot; Quantiferon TB (measures release of IFN gamma);
what is the gold standard for diagnosis of active disease?
culture; it takes 3-6 weeks
how many sputum smears for Acid Fast Bacteria are needed to diagnose or rule out Tb?
3 smears, over 8 hours apart
treatment of latent Tb:
Isoniazid (INH) for 9 months
toxicity of INH?
what to include to prevent side effects?
include vitamin B6 to prevent neuropathy
Standard care of treatment for active disease:
_____ for 2 months, check _____. then 4 months of _____
rifampin, isoniazid, pyrazinamide, ethambutol (RIPE);