Mycobacterial Flashcards
(32 cards)
Which species of mycobacterium are associated with lymphadenitis in immunocompetent children?
Mycobacterium avium complex (MAC), and Mycobacterium scrofulaceum
What are mycobacterial diseminated infections usually associated with?
HIV infection
What value is associated with disseminated MAC disease?
Low CD4+ lymphocyte count
What is Lady Windermere syndrome?
voluntary cough suppression that results in stagnation of secretions which is great for the growth of organisms.
What is the most common presentation of atypical mycobacteria in immunocompetent pediatric host.
Suppurative cervical or sumbandibular lymphadenoptahy.
What is the most common presentation of atypical mycobacteria in children with HIV?
Recurrent and persistent fever and chronic anemia
Presentation of Atypical Mycobacteria?
Chronic pulmonary dz resembling TB (adults)
Cervical adenopathy/lymphadenitis in children
Tenosynovitis, bursae, bone and joint infections
Osteomyelitis of the sternum
Disseminated dz in immunocompromised
What is the unique MAC syndrome with AIDS?
in the first 1-2 mos. post HAART-Fever and focal MAC Lymphadenitis.
–the immune systems starts to recover the then responds to previously acquired opportunistic infection w/ overwhelming inflam. response
W/U for atypical mycobacteria?
Culture-blood or BX, bone marrow on routine media. Better on selective mycobacterial media.
Nucleic acid hybrid probes
PCR
CXR-immunocompetent pt’s mimic TB
CT lung-Bronchiectasis
CT abd-Large retroperitoneal and mesenteric lymph nodes
FNA-confirms
What is the best diagnostic tool to use when diagnosing disseminated MAC?
culture of blood and bone marrow or other normally sterile tissues or bf.
Surgical Tx. for atypical mycobacteria?
excision of infected nodes recommended for immunocompetent children
I+D of fluctuant abscesses often lead to drinage sinus lasting mos. or years
*“that won’t look pretty on a date”
Medical tx. for atypical mycobacteria?
Send to ID
tx includes at least 2 drugs
1st line-Clarithromycin, or Azithromycin
2nd drug Ethambutol preferred
TB Pathology?
Mycobacterium tuberculosis
What is MDR-TB defined as?
Multi-drug resistant TB-resistance to the 2 most effective first line meds: Isoniazid and rifampin
What is definition of XDR-TB
Extensive drug resistant TB is resistant to Isoniazid, rifampin, and second line drugs as well.
How is M TB usually contracted?
aerosol exposure through the lungs or mucous membranes
What response in the body allows M TB reactivation?
decreased immune response
Disease results from direct bacterial effects and inappropriate host immune response to tubercular antigens
Presentation for TB?
Pulm complaints
Infected end organs (kidney, bone, meninges,)
TB lesions-are epithelioid granuloma w/ central caseation necrosis
R/f for TB:
HIV Hx of + PPD prior TB tx. Travel Homlessness
Features of active TB:
Cough Wt. loss/ anorexia Fever Night sweats Hemoptysis Chest pain extrapulmonary involvement
Presentation of tuberculous meningitis?
Intermittent/persistent HA for 2-3 weeks
Subtle mental status changes may progress to acme
Fever minimal or absent
Skeletal TB presentation
Spine MC site (Pott dz) back pain/stiffness; lower ext. paralysis up to 50% w/ undiagnosed Pott dz.
TB arthritis involves on 1 joint
Rad. changes may not be present for weeks/months
Genetourinary TB presentation
Symptoms include flank pain, dysuria and frequency
In men, epidymitis or a scrotal mass
In women - PID, infertility
GI TB presentation?
Nonhealing ulcers in mouth or anus Diffuclty swallowing Abd pain mimicking pep ulcer dz malabsorption pain, diarrhea, hematochezia
