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33 Cards in this Set
- Front
- Back
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True or False:
An xray showing widening of the mediastinum is indicative of TB. |
FALSE.
Widened mediastinum is indicative of Bacillus anthracis infection! |
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Mycobacterium tuberculosos is:
A. spore forming or non-spore forming? B. what shape? C. has what distinctive growth cording pattern? D. stains how? |
A. non-spore forming
B. rods C. has what distinctive growth cording pattern = serpentine D. stains how = acid-fast |
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True or False:
Mycobacterium tuberculosis's quick growth accounts for the damage it can cause. |
FALSE.
M.tb grows super slow! The damage is actually cause by the host's immune response (Reactivation disease causes massive tissue destruction because of recall immunity mediated by T cells and macrophages. Macrophages release cytokines and proteolytic enzymes into tissue, creating damage!) |
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What accounts for M.tb's damage if not the organism itself?
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The damage is actually cause by the host's immune response Reactivation disease causes massive tissue destruction because of recall immunity mediated by T cells and macrophages. Macrophages release cytokines and proteolytic enzymes into tissue, creating damage!
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How is M.tb spread?
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People with cavitary lung disease are the big spreaders and when they cough, droplet nuclei spread out into the environment. If you as a passerby happen to inhale those in good enough inocculum quantity, then you become infected!
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What are the most important determinants of the spread of TB? (2)
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cough frequency, inoculum size
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What immune system component effectively and unwittingly spreads M.tb throughout the body for potential seeding?
A. PMNs B. Macrophages C. CD8 T cells |
B. Macrophages
the macrophages that are infected carry the organism to lymphatics to hilar nodes and the blood to peripheral organs where they survive becoming walled of in granulomas. This is usually asymptomatic! Years later, the granulomas can break off and cause reinfection. |
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For pulmonary TB, initial presentation is anorexia, weight loss and cough (could be cancer too). Chest X-ray shows [ mid-lung / upper lobe ] cavities for reactivation disease and [ mid-lung / upper lobe ] infiltrates for primary disease.
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Chest X-ray shows upper lobe cavities for reactivation disease and midlung infiltrates for primary disease.
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Widely disseminated TB is called miliary TB because small foci that seed the lung look like millet seeds. The most common sites for extrapulmonary TB are what three sites?
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bones (vertebra = Pott’s disease), meninges (tuberculous meningitis) and kidneys (genitourinary TB)
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What is the standard treatment for TB?
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2 months of Rifampin, Ethambutol, Purazinomide, Isoniazid +
4 months of Rifampin and Isoniazid |
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What is the criteria for MDR-TB (multi drug resistant tb) and XDR-TB (extremely? drug resistant tb)?
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MDR-TB: Multi-drug resistant TB. Resistant to at least INH + Rifampin
XDR-TB: Extensively drug-resistant TB. Resistant to INH + Rifampin + fluoroquinolones + second-line injectable (kanamycin, amikacin or capreomycin) |
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There is a TB vaccine. So why don't we use it here in the US?
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there IS a vaccination but it only prevents aggressive and disseminated disease, NOT infection, so it (BCG) is not currently recommended in the US. Vaccine interferes with PPD test too.
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Other mycobacteria are non-tuberculous. These fall under non-cultivatable and culturable. Which falls under each category?
M. avium complex M. leprae M. kansasii M. marinum M. scrofulaceum |
All are culturable EXCEPT for M. leprae
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Mycobacteria leprae has a tuberculoid form and lepromatous form. Differentiate between the two with regards to:
1) what you see from acid-fast stains from lesion samples 2) lymphocyte and granuloma abundance or lack thereof 3) T cell and APS response 4) Lepromin rxn + or - 5) clinical presentation of asymmetric or bilateral nerve damage 6) if skin lesions are hypoesthetic |
Tuberculoid form:
1) few bacteria seen in acid-fast stain of lesion sample 2) abundant lymphocoytes and well-formed granulomas 3) Brisk response 4) Lepromin rxn + 5) localized asymmetric peripheral sensory nerve damage with hypoesthetic lesions. Lepromatous type is the opposite/other for each. A sulfomamide + rifampin for 3 to 10 years |
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Match the conditions to their therapies:
M.tb, M.leprae, M.kansasii, M.avium complex A. 6 months on antibiotics: 2 on RIPE and 4 on RI. B. Sulfonamide + rifampin for 3-10 years. C. macrolide + ethambutol + rifampin derivative |
A. 6 months on antibiotics: 2 on RIPE and 4 on RI. = M.tb, M.kansasii
B. Sulfonamide + rifampin for 3-10 years. = M.leprae C. macrolide + ethambutol + rifampin derivative = M. avium complex |
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What is the treatment for Mycobacteria leprae?
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For both forms of M. leprae (both tuberculoid and lepromatous), treatment is Sulfonamide + rifampin for 3-10 years.
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Which culturable mycobacteria does this describe:
*yields pulmonary disease most resembling M.tb (moreso than any other cultivatable). *found in midwest mostly *seen in AIDS patients from endemic area A. M. kansasii B. M. marinum C. M. scrofulaceum D. M.avium complex E. M.ulcerans F. M. fortuitum G. M. chelonei |
A. M. kansasii
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Which culturable mycobacteria does this describe:
*"swimming pool granuloma" *seen in watermen and tropic fish fanciers. A. M. kansasii B. M. marinum C. M. scrofulaceum D. M.avium complex E. M.ulcerans F. M. fortuitum G. M. chelonei |
B. M. marinum
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Which culturable mycobacteria does this describe:
*rare cause of disease *usually cervical adenopathy in children A. M. kansasii B. M. marinum C. M. scrofulaceum D. M.avium complex E. M.ulcerans F. M. fortuitum G. M. chelonei |
C. M. scrofulaceum
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Which culturable mycobacteria does this describe:
*one of the most common causes of systemic infections in AIDS patients with very low CD4 cell counts A. M. kansasii B. M. marinum C. M. scrofulaceum D. M.avium complex E. M.ulcerans F. M. fortuitum G. M. chelonei |
D. M.avium complex
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Which culturable mycobacteria does this describe:
* cause of very common and debilitating skin ulcers in the tropics (Buruli ulcer) A. M. kansasii B. M. marinum C. M. scrofulaceum D. M.avium complex E. M.ulcerans F. M. fortuitum G. M. chelonei |
E. M.ulcerans
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Culturable mycobacteria are divided up into several groups (photochromogen, scotochromogen, non-pigmented and rapid growers). Describe each group and name the respective mycobacteria that belong to the group.
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Photochromogens - produce yellow carotenoid pigments after exposure to light and are slow growers - M. kansasii, M.marinum
Scotochromogens - produce yellow pigment in light AND dark and are slow growers - M. scrofulaceum Non-pigmented - no color, slow growers - M. avium complex Rapidly-growing - M. fortuitum, M. abscessus |
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Which of the following are FALSE:
A. Cultivatable non-tuberculosis mycobacteria are usually NOT transferred person to person B. isolation from a clinical specimen is not necessarily associated with a disease process C. can colonize healthy individuals as well as immunocompromised individuals D. all the above are true |
D. all the above are true
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True or False:
Clofazimine is used in patients with sulfa allergy or dapsone (sulfone) resistance when it comes to M. leprae treatment. |
True.
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With regards to M.leprae, what is a reversal reaction and what is erythema nodosum leprosum?
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Reversal reaction adn ENL can occur during the course of therapy as cell-mediated immunity improves and dying bacilli release antigens. They manifest as a WORSENING of the skin and nerve lesions (reversal reactions) and subcutaneous nodules, arthritis and fever.
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Nocardia and actinomyces are gram [ + / - ] organisms that are [cocci, bacilli, spiral] shaped.
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Gram + bacilli shaped things
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Which of these are filamentous branching bead morphology that cause pulmonary infection and systemic abscesses in immunocompromised patients?
A. Nocardia asteroides B. Actinomyces israelii C. Thermophilic actinomycetes D. Rhodococcus equi |
A. Nocardia asteroides,
treated wtih sulfonamides or sulfa/trimethoprim |
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Which of these are filamentous branching rod morphology that is associated with destructive abscess of the jaw, lung and viscera?
A. Nocardia asteroides B. Actinomyces israelii C. Thermophilic actinomycetes D. Rhodococcus equi |
B. Actinomyces israelii
treated with penicillin |
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Which of the following causes "farmer's lung"?
A. Nocardia asteroides B. Actinomyces israelii C. Thermophilic actinomycetes D. Rhodococcus equi |
C. Thermophilic actinomycetes
Grow on moist hay in warm, closed environments (barns). Causes hypersensitivity pneumonitis (Farmer's lung). Symptoms: fever, cough, wheezing, shortness of breath. |
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Which of the following are associated with farm animals and cause pulmonary infections and pulmonary abscess in HIV infected patients?
A. Nocardia asteroides B. Actinomyces israelii C. Thermophilic actinomycetes D. Rhodococcus equi |
D. Rhodococcus equi
treat with macrolides, vancomycin and rifampin |
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Match each organism to its treatment: Nocardia asteroides, Actinomyces israelii, Thermophilic actinomycetes, Rhodococcus equi.
1. penicillin 2. macrolides, vancomycin and rifampin 3. sulfonamides or sulfa/trimethoprim 4. steroids and stay out of the barn! |
1. penicillin - Actinomyces israelli
2. macrolides, vancomycin and rifampin - Rhodococcus equi 3. sulfonamides or sulfa/trimethoprim - Nocardia asteroides 4. steroids and stay out of the barn! - Thermophilic actinomycetes |
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What is the second line of therapy for M.tuberculosis?
A. Macrolides B. Lincosamides C. Aminoglycosides D. Fluoroquinolones |
D. Fluoroquinolones
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Sever idiosyncratic hepatotoxicity can occur with which M.tb regimen drug?
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Isoniazid
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