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Clin Med II- Exam 2 > TB/Histo/Cocci > Flashcards

TB/Histo/Cocci Flashcards

(95 cards)

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1
Q

Where else besides the lungs can TB spread?

A

lymph nodes
kidneys
spine
brain

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2
Q

Etiology of TB

A

droplet nuclei inhaled and reach alveoli; exposure usually requires PROLONGED exposure

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3
Q

Progression of TB

A

transmission –> skin test conversion in 6-8 weeks –> primary TB –> spontaneous healing in 6 mo (latent)–> progression w/i 2 yrs, progression after 2 yrs, progression w/ concurrent HIV infection (reactivation )

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4
Q

Latent TB

A

bacteria in body w/o Sx
macrophages ingest TB bacilli creating a barrier (GRANULOMA)
unable to transmit
LTBI may activate if pt becomes immunocompromised and granulomas break down

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5
Q

TB disease

A

Sx w/i weeks or years later when immune system compromised (HIV @ high risk)
Pt CONTAGIOUS!

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6
Q

Risk in normal human w/ no risk factors

A

10% in a lifetime

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7
Q

Risk for TB in DM

A

30% in a lifetime

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8
Q

Risk for TB in HIV individuals

A

7-10% PER YEAR

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9
Q

Testing in TB

A
  1. TST or IGRA
  2. CXR: done if + for skint est; r/o other things
  3. Bacteriological examination: dx microbiology needed with + infection testing
  4. Drug Susceptibility Testing (DST)
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10
Q

Risk factors for RB

A 
HIV
<5 YO
DM
Silicosis
Malnutrition
Substance abuse
immunosuppressive therapy
Immigrant
Injection drug users
close living quarters
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11
Q

Sx of TB

A
  1. Fever
  2. Cough (+/- productive or hemoptysis)
  3. CP (pleuritic or retrosternal)
  • others: weakness, weight loss, anorexia, chills, night sweats, dyspnea
  • extrapulmonary TB depends on location
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12
Q

PE for TB

A

POSTTUSSIVE CRACKLES
dullness/dec fremitus
LAD
Clubbing

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13
Q

Dx for TB

A

Mantoux tuberculin skin test (TST): intradermal in forecarm - create wheal w/ 0.1 ml Purified protein derivative (PPD)

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14
Q

How soon do you read TST?

A

48-72 hours; induration measured

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15
Q

When will TST be positive after exposure?

A

2-8 weeks following exposure

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16
Q

Reading TST

A

> 5 mm: high risk group: HIV, contact w/ TB active indiv, evidence of TB on CXR, immunosuppressed, organ transplant

> 10 mm: immigrant from country w/ high rates, HIV neg injection drug users, mycobacteria lab personnel, high congregate setting, med conditions, children <4, children and adol exposed to high risk adult

> 15mm: + in anyone w/o risk factors

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17
Q

2 Step TB test

A

1st negative, repeat in 1-3 weeks

2nd postive, TB present

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18
Q

How does 2 step work

A

creates boosted response and is likely due to past exposure

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19
Q

What creates false + in 2 step test?

A

BCG (bacillus Calmette-Guerin) vaccine

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20
Q

IGRA

A

quintiferon-TB GOld & T-spot TB

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21
Q

What is IGRA

A

measures immune response in blood to TB; blood incubated w/ TB antigen and response measured (IFN-g concentration)

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22
Q

Limitation of IGRA

A

can’t distinguish between active and latent TB infection;

more expensive than TST

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23
Q

Benefit of IGRA

A

pt. does not have to return for reading

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24
Q

TB CXR primary active

A

Hilar lymphadenopathy*
may progress w/ effusions or infiltrates
cavities seen w/ progressive pulm. TV
miliary pattern!

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25
Latent TB CXR
dense nodules or lesions w/ possible calcification
26
Reactivation of latent TB
cavities, infiltrates, and possible adenopathy
27
Where are TB abnormalities normally found
apical/posterior upper lobes*** or superior areas of lower lobes
28
HIV CXR
may have atypical presentation
29
2nd line imaging
CT- more sensitive
30
Ranke Complex (healed primary pulm TB)
1. Ghon Lesion: calcified parenchymal granuloma (tuberuloma) | 2. Ipsilateral calcified hilar lymph node
31
Ghon lesion
calcified parenchymal granuloma
32
Bacteriological exam (Sputum)
3 specimens (8-24 h apart) - @ least 1 in the morning
33
What do you do once you have sputum samples?
1. Smear: AFB - supports dx 2. Cytology: nucleic acid ampfliciation test (NAA) - supports dx 3. Culture *: gold standar - confirms dx but takes 2- 6wks
34
Final dx of TB based on bacteriological exam
+ AFB and NAA: TB presumed, start tx immediately culture +: TB present, do DST Culture - and TB still suspected: treat and monitor response to tx Bx if needed
35
Bx of TB
Necrotizing (caseating) granuloma***
36
What has necrotizing granulomas?
Bx of TB | GPA (granulomatosis w/ polyangiitis)
37
Xpert MTB/RIF assay
automated NAA test using disposable cartridges
38
What does Xpert MTB/RIB detect?
M. tuberculosis DNA and rifampin resistance
39
Benefits of Xpert MTB
Takes only 2 hours | minimal training needed
40
disadvantages for Xpert MTB
cost | does not replace AFB smear or culture
41
Tx for active TB
1. isolation, negative pressure 2. Rifampin, INH, Pyrazinamide, Ethambutol 3. DOT - direct observed tx
42
SE of rifampin
orange secretions | skin sensitivity
43
SE of INH
hepatotoxicity (monitor LFT) peripheral neuropathy Fatal hepatitis (prego women)
44
How to help peripheral neuropathy associated w/ INH
give Vit B6
45
PZA SE
hepatotoxicity | Hyperuricemia
46
EMB SE
optic neuritis: test visual acuity and color vision
47
Criteria to not be considered infectious
1. 2 weeks of tx 2. 3 negative sputum smears 3. sx improve
48
Going home while infectious
- strict follow up - no children <5 or immunocompromised living in home - unable to travel except to health care visits
49
Active TB doses
initial phase for 8 weeks: 56 doses continuation phase for 18 weeks: 126 doses (daily) or 36 doses (2x weekly)
50
Latent TB tx
1. ) INH: 9 mo (6 mo minimum): 300 mg daily or 900 mg 2x/week; preferred in pregnant and children 2-11 2. ) INH + Rifapentine (RPT): 12 weekly doses; unable to use in pregnancy; recommended for otherwise healthy patients w/ HIV; preferred adults and children >12 YO 3. ) Rifampin: 4 mo: 120 doses; given if can't tolerate INH
51
Preferred Latent TB tx for pregnant women and kids 2-11
INH
52
Preferred Tx for adults and children >12
INH + RPT
53
Given to those that can't tolerate INH
Rifampin
54
MDR TB does not respond to
at least INH and Rif
55
Causes of MDR-TB
inadequate med or dosing premature tx interruption spontaneous mutation
56
XDR-TB
responds to even less drugs, including fluoroquinolones surgery to remove necrotic tissue important but not always available
57
Bacillus Calmette-Guerin (BCG) Vaccine
intradermal live vaccine decrease risk of severe consequences due to TB disease; does not prevent primary infection of activation of LTBI; protects against meningitis and disseminated RB in children
58
Recommendation of BCG vaccine
single dose at birth in developing countries (WHO) children w/ negative TST and continual exposure (CDC) - not recommend giving to HIV positive childre; health care workers if high risk of MDR-TB
59
Contraindications of BCG Vaccine
immunosuppressed | pregnancy
60
Testing w/ BCG vaccine
blood test less likely to produce false-positive | TST not contraindicated (may have false +)
61
Fungal Pneumonias
Histoplasmosis Coccidiomycosis Others: Aspergillus, candida, cryptococcus, blastomycosis, pneumocystis jiroveci
62
Etiology of histoplasmosis
soil contaminated w/ bird or bat droppings (inhalation of fungal spores, body temp converts spores to yeast, proliferates in lungs and spreads to lymph or other organs) Highest rates: midwest: OH and Mississippi River Valleys *** HIV/AIDS or other immunocompromised indiv.
63
Activity associated w/ histoplasmosis
``` SPELUNKING construction demolition mining roofing farming gardening AC unit installation ```
64
Sx of Histoplasmosis
90% asymptomatic mild flu-like sx most sx resolve in weeks-a month unless severe
65
Asymptomatic histoplasmosis
most common in healthy | CXR: may show residual granuloma
66
Acute symptomatic pulmonary histoplasmosis
fever, marked fatigue, few resp. sx sx: 1 week - 6 mo Mild sx usually self-limited
67
Progressive disseminated histo
pt immunocompromised fever, fatigue, cough, dyspnea, weigh loss multiple organ involvement fatal w/i 6 weeks!
68
Chronic pulmonary histoplasmosis
older COPD pts | progressive lung changes: apical cavities
69
Dx for Histo
Antibody tests: Immunodiffusion (ID) and complement fixation (CF) Antigen detection: enzyme immunoassay (EIA) Bx Culture: chronic or severe disease; 6 weeks to become + CXR
70
Immunodiffusion (ID) test
tests for acute and chronic infection
71
Complement fixation (CF)
may take up to 6 weeks | more sensitive, less specific than ID
72
Enzyme immunoassay (EIA)
urine** or serum testing
73
When to do culture for histo
chronic or severe disease
74
CXR in histo
hilar adenopathy | patchy or nodular infiltrates in lower lobes
75
Cause hilar adenopathy
Sarcoidosis TB Histo Cocci
76
Tx for histo
``` acute mild-mod: no tx mod-severe: ampho or azole progressive: ampho or azole chronic: azole HIV/AIDS: ampho + azole ```
77
When to suspect histo
``` pneumo w/ mediastinal or hilar LAD mediastinal or hilar mass pulm nodule cavitary lung disease pulm sx w/ arthritis/arthralgia + erythema nodosum dysphagia w/ esophageal narrowing ```
78
Valley fever
coccidiomycosis
79
Etiology of cocci
contaminated soil; lower deserts of wester hemisphere outbreaks after dust storm and earthquakes
80
Presentation of cocci
lives/recently traveled to endemic area excavation, construction, gardening, digging 60% asymptomatic severe in immunocomp, prego, DM, African and filipino
81
Sx of cocci
asymptomatic: residual granuloma on CXR symptomatic: mild resp sx, self-limited, weeks to months may progress w/ chronic pulm disease or disseminated disease (high risk pts)
82
Primary cocci infection sx
CAP 7-21 days after exposure: fever cough, pleuritic CP, fatigue, HA, athralgia (desert rheumaticism) rash: erythema multiform, erythema nodosum***
83
Disseminated cocci disease
immunocompromised lung findings: abscess bone lesions lymphadenitis, meningitis
84
Dx of cocci
EIA ID (more specific: used after EIA; detects IgM antibodies) CF (detects IgG; assess disease severity) Labs Sputum culture Skin test CXR
85
detects disease severity
CF
86
detects IgM
ID
87
Labs for cocci
Eosinophilia w/ slight leukocytosis
88
Sputum culture for cocci
hard to obtain w/ dry cough
89
Skin test for cocci
coccidiodin or spherulin - reactivity is life not; not diagnostic
90
CXR for cocci
hilar adenopathy patchy, nodular pulm infiltrates miliary infiltrates thin wall cavities
91
Chronic pulmonary disease w/ cocci CXR
residual lung nodules w/ thin walled cavities (disappear w/i 2 years) chronic cavitary lesions w/ infiltrates (may mimic TB)
92
Tx for cocci
not typically required; only required in high risk/severe sx therapy: -azole; ampho if severe or pregnant
93
teratogenic
azoles
94
f/u for cocci
every 2-4 weeks (regardless of tx provided) sx resolve in weeks to months: continue to follow every 3-6 mo no med: f/u for 1 year meds: f/u annually for 2+ years for potential recurrence
95
think cocci
pulm complaints AND: - erythema nodosum - erythema multiforme - eosinophilia

Clin Med II- Exam 2 (7 decks)

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