tuberculosis Flashcards
(66 cards)
1
Q
- condition caused by mycobacterium tuberculosis
- slow growing bacteria
- can present as pulmonary illness
A
tuberculosis
2
Q
- TB is inhaled and moves down bronchi into middle/lower lobes of lungs
- initial immune reaction releases macrophages, T lymphocytes, IL-1, IL-6, and TNF alpha
- granuloma develops and encases TB
- caseous necrosis develops in center of granuloma leading to ghon focus
- usually asymptomatic
A
primary TB
3
Q
hallmark of primary TB
A
ghon complex
4
Q
- if pt with latent TB becomes immunocompromised, they may no longer be able to contain the infection
- infection multiplies and spreads
- moves to apices of lungs
- cavitary lesions in apices and necrosis of lung parenchyma
- symptomatic and contagious
A
reactivation TB
4
Q
- ghon complex starts to have fibrocalcifications form around it
- keeps TB dormant and not spread
- Ranke complex
- not contagious and can remain dormant for years
A
latent TB
5
Q
high risk populations for TB reactivation
A
HIV, DM, CKD, organ transplant pts, silicosis, immune suppressing drugs, illicit drug use
6
Q
early symptoms of active TB
A
malaise, fever, weight loss, severe night sweats, productive cough/hemoptysis
7
Q
complications of pulmonary TB
A
pneumothorax
bronchopneumonia
pleural effusion
hemoptysis
8
Q
PE findings of pulmonary TB
A
crackles from inspiration or after short cough
look chronically ill, malnourished
9
Q
- when TB enters the blood stream and spreads to extra pulmonary sites (outside of the lungs)
- disseminated hematogenous spread occurs and the formation of multiple millet seed-sized tuberculosis foci can develop in the lungs
A
extra pulmonary/miliary TB
10
Q
TB in pleura
A
tuberculous pleurisy
11
Q
central nervous system TB
A
tuberculous meningitis
12
Q
pericardium TB
A
leads to constrictive pericarditis
13
Q
liver TB
A
can cause acute hepatitis
14
Q
adrenal glands TB
A
leads to inability to produce cortisol –> Addison’s disease
15
Q
lymphatic system TB
A
in scrofula of neck
16
Q
genitourinary system TB
A
urogenital tuberculosis
17
Q
bones and joints TB
A
post’s disease of the spine
tuberculosis arthritis
osteomyelitis in long bones
18
Q
abscess through skin TB
A
tuberculous ulcer
19
Q
extra pulmonary TB PE findings
A
- subacute–> failure to thrive, FUO, dysfunction of one or more organ systems, night sweats
- acute miliary TB–> multi organ system failure, syndrome of septic shock, acute respiratory distress syndrome (ARDS).
20
Q
how to diagnose TB
A
TB skin test
PPD test
Mantoux test
21
Q
limitations of TB test
A
- can not distinguish active from latent TB
- read at 48-72 hours
- can’t use with BCG vaccine (bacillus calmette-guerin)***
22
Q
positive TB test based on what
A
Less than 5 mm: The result is negative.
5 mm or more: The result is positive for people with certain risk factors, such as HIV, recent contact with someone with TB, or immunosuppression.
10 mm or more: The result is positive for people with additional risk factors, such as recent immigration from a high-TB country, living in a high-risk environment, or working in a high-risk setting.
23
Q
how to get TB results within 24 hours
A
interferon gamma release assay
- QuantiFERON TB Gold
- Tspot
24
what is part of the initial approach to a diagnostic eval of a patient with suspected TB
chest x ray
chest CT
25
reactivation pulmonary TB classically presents with focal infiltration of the upper lobe:
- apical CASEATING granulomas
- nodular infiltrates
- hilar/paratracheal lymph node enlargement
- ghon and or ranke complexes may be found after healed primary
26
different ways to get pulmonary TB diagnosis
- 3 consecutive morning sputum specimens
- sputum culture with acid fast stain
- biopsy of caveating granulomas
- DNA/RNA amplification
27
how to diagnose extra pulmonary TB
biopsy-- acid fast smear and culture of tissue, fluid, or drainage
28
treatment for active TB
6 month regimen
begins with 4 medications x2 months
- isoniazid (INH)
- Rifampin (RIF)
- Ethambutol (EMB)
- pyrazinamide (PZA)
continue treating with INH and RIF for additional 4 months
must treat for at least 3 months beyond negative cultures
29
treatment for latent TB
isoniazid x 9 months
or
rifampin x 4 months
or
isoniazid and rifapentine weekly x 3 months
or
isoniazid and rifampin daily x 3 months
30
rifampin side effects
red orange secretions
P450 inducer
31
isoniazid side effects
peripheral neuritis
32
pyrazinamide side effects
increased Uric acid
33
ethambutol
red green discrimination
34
streptomycin
ototoxic
35
- regular physician visits, who monitor medication intake and look for signs of medication side effects
- will check sputum smears
- ensures people follow medicine instructions due to long treatment course for TB
directly observed therapy (DOT)
36
resistant to one first line antituberculous drug, either isoniazid or rifampin
drug-resistant
37
resistant to isoniazid AND rifampin
multidrug resistant TB
38
resistant to isoniazid, rifampin, fluoroquinolone, and aminoglycosides and/or capreomycin
extensively drug resistant tuberculosis
39
options for abbreviated empiric treatment for drug resistant disease
bedaquiline
pretomanid
linezolid plus moxifloxacin
40
- among the most common opportunistic infections in advanced HIV disease
- occur ubiquitously in the environment (soil and water) (contracted by the bacteria being aerosolized)
- not communicable from person to person
nontuberculous mycobacterial infections
41
- Most common*
- slow growth
- infects lungs and lymph nodes
1. avium complex
42
- slow growth
- infects lungs, and can lead to disseminated disease
2. M. Kansasii
43
- slow growth
- infects skin and soft tissues
3. M. Marinum
44
- rapid growth
- infects lungs, skin and soft tissues
4. M. Abscessus
45
- rapid growth
- infects skin and soft tissues
5. M. chelonae
46
- rapid growth
- infects skin, soft tissues, and lung
6. M. Fortuitum
47
- disseminated infection
- late stages of HIV
- CD4 count < 50/mcl
- persistent fever and weight loss
NTM outside of lungs
48
how to treat NTM outside of lungs
clarithromycin or azithromycin + ethambutol +/- rifabutin
49
2 major phenotypes of NTM lung disease
- nodular/brochiectactic (NB)
- Fibrocavitary (FC)
50
- typically seen in postmenopausal non smoking white women
- also known as lady windermere syndrome
- pts usually experience many years of progressive respiratory symptoms and recurrent respiratory infections due to unrecognized underlying bronchiectasis
- prolonged cough, fatigue, weight loss
- 50% will not progress
nodular/brochiectatic (NB)
51
nodular/brochiectatic (NB) CT findings
- bronchiectasis with nodules
- often "tree in bud" appearance
- classically RML and lingual
52
-typically male pt, over 50
- typically has some form of underlying chronic lung condition
- COPD, silicosis, pulmonary fibrosis
- progressive
- systemic symptoms (fever, fatigue, weight loss, night sweats)
- worse outcome and prognosis than NB type
fibrocavitary (FC)
53
fibrocavitary (FC) CT findings
fibrocavitary lesions
often upper lobe involvement
54
diagnosis of pulmonary infection clinical
pulmonary or systemic symptoms
55
diagnosis of pulmonary infection radiology
nodular or cavitary opacities on CXR,
CT shows bronchiectasis with multiple small nodules
56
diagnosis of pulmonary infection microbiology
A. positive cx from 2 sputum samples, or
B. positive cx from 1 BAL sample, or
C. lung biopsy with typical histology plus positive cx of tissue biopsy, BAL, or sputum
57
pulmonary infection treatment
- over half of pts who meet DX criteria progress within 3-5 years
- so start treatment asap
58
pulmonary (MAC) treatment
3 drug therapy, treated for at least 12 months:
- clarithromycin or azithromycin +
- rifampin or rifabutin +
- ethambutol
59
pulmonary (M kansasii) treatment
18 months:
- isoniazid
- ethambutol
- rifampin
60
how to diagnose skin and soft tissue
biopsy and positive culture
61
skin and soft tissue treatment
surgical debridement with at least two abx for 3 months
- azithromycin
- clarithromycin
- amikacin
- imipenem
- linezolid
- fluoroquinolones
62
how is lymphadenitis diagnosed
biopsy and culture
63
lymphadenitis treatment
- surgically with our anti tuberculous therapy
if surgery contraindicated:
- azithromycin + rifampin + ethambutol
64
macrolide resistance can occur if
macrolide mono therapy is given
65
macrolide resistance treatment
daily ethambutol, rifampin, and clofazimine, augmented by two to six months of IV amikacin
