Mhr Topic 23: Mycobacteria And Actinomycetes

Front 1

Mycobacteria characteristics (acid fast, O2, spores, motility)

Back 1

Do stain acid fast because of cell wall
aerobic
non spore forming
non motile

Front 2

2 types of bacteria which cause tuberculosis

Back 2

Mycobacterium tuberculosis and mycobacterium bovis

Front 3

Mycobacterium tuberculosis (Grow speed, nitrate reduction, resovoir)

Back 3

Grows slowly (3-6 weeks)
Nitrate reduction +
Human reservoir only

Front 4

Mycobacterium bovis (Grow speed, nitrate reduction, resovoir)

Back 4

Grows slowly (3-6 weeks)
Nitrate reduction -
Bovine reservoir as well as human

Front 5

What does PPD test do and not do

Back 5

+ test used to diagnose Latent TB infection.
Cannot diagnose Active TB disease (but can be a clue), does not predict protective immunity.

Front 6

Factors leading to recent US TB epidemic

Back 6

1) HIV epidemic
2) Immigration
3) Congregate settings (prison, nursing homes)
4) Less TB funding

Front 7

Directly Observed Therapy (DOT)

Back 7

Watch people swallow every pill. Oral therapy is for at least 6 years so this is important to make sure they take all their meds.

Front 8

What drugs is Multi Drug Resistant TB resistant to and what is the current prevelance?

Back 8

Resistant to Isoniazid (INH) and Rifampin (RIF). 5% prevalence.

Front 9

How is TB transmitted?

Back 9

Respiratory droplets

Front 10

What is the annual disease risk in people co-infected with HIV and TB?

Back 10

10% annually

Front 11

Active TB v.s. Latent Tb treatment

Back 11

1 drug for latent TB. Is not infectious and has far fewer organisms.
Multiple drugs for active disease.

Front 12

X ray of immunosuppressed person with TB v.s. immunocompetent

Back 12

Immunocompetnet is far more obvious than immunosupressed

Front 13

Symptoms of pulmonary TB

Back 13

1) Productive cough for long period of time.
2) Chest pain
3) Hemoptysis (coughing up blood)

Front 14

Symptoms of systemic TB

Back 14

Fever
Chills
Night sweats
Easily fatigued
loss of appetite
weight loss

Front 15

Symptoms of chronic Basilar meningitis

Back 15

Headaches
Change in mentation
Cranial nerve findings
Hemiparesis
cerebellar signs
stupor/coma

Front 16

Vertebral osteomyelitis

Back 16

(Pott's disease)
Anterior thoracolumbar vertebrae
Involving disk space between vertebrae
paraspinal absess formation common

Front 17

Peripheral skeletal osteomyelitis

Back 17

Painful extremity
Adjacent monoarthritis
Weight bearing joints

Front 18

Genitourinary TB

Back 18

Low grade, chronic renal/prostatic infection
Dysuria, gross hematuria, and flank pain
Sterile pyuria - Lots of white cells but no bacteria in urine.
Destruction of urinary collecting system

Front 19

Miliary TB

Back 19

Extensive hematogenous disease
Pathologic lesions resembling millet seeds.
Increased frequency in immunosurpressed
Most patients are anergic; will have a - TB test

Front 20

Booster Effect

Back 20

Effect which occurs during a TB skin test. Someone goes from - to + within a matter of months. There is a chance that the person was latently + from awhile ago, and the first test triggered the + in the second.

Front 21

CSF culture characteristics in someone with TB

Back 21

Mononuclear pleocytes (as opposed to neutrophils found in other types of meningitis).
Low Glucose
High Protein
Smear will likely be negative
Need 3-4 samples for 80% sensitivity

Front 22

Diagnosis of TB in HIV patients

Back 22

1) PPD test + if =/>5mm
2) Tissue diagnosis
3) Bacteremia present in 25-50%

Front 23

Priority guidelines for TB control

Back 23

1) Identify Cases
2) Isolate "
3) Treat "
4) Evaluate contacts
5) Chemoprophylaxis

Front 24

When can you discontinue isolation of a TB patient?

Back 24

1) Clinical Improvement
2) 3 Negative AFB smears
3) If MDR-TB must be culture (-)

Front 25

For how long do you treat people who are HIV for TB?

Back 25

At least 6 months after last + culture

Front 26

For how long do you treat people who have bone, miliary or CNS TB?

Back 26

12 Months

Front 27

Preventitive TB therapy

Back 27

Daily INH for 6-9 months. Longer for HIV children, pregnancy is not an exclusion.

Front 28

Mycobacterium avium-intracellulare complex (Who, treatment)

Back 28

MOTT (microbacterium other than TB)
Seen in advanced aids patients and chronic pulmonary disease in elderly with COPD.
Relatively drug resistant, treat with 3-5 drugs.
Treat AIDS patients with CD4<50 prophylactically.

Front 29

Tuberculoid Leprosy v.s. Lepromatous leprosy.

Back 29

Lepromatous leprosy is more immunosuppressed. Have many acid fast bacilli, high antibody titers, and little cell mediated immunity but have low nerve damage b/c of lack of TH response. Opposite for Tuberculoid.