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22 Cards in this Set

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Latent TB
Symptoms
infectious?
X-ray
No symptoms, granulomas
Not infectious, not coughing, contained
:Pleural scarring, apical calcifications, fibrosis, retraction. Granuloma
Gohn Complex
Calcified pulmonary parenchymal lesion near hilar node.
: Lobes retracted.
Active TB
:Clinical
:x-ray
:dissemination (where)
: cough, fever, wt. loss, sweats, hemoptysis
:Focal or widespread pneumonia. Many lobe involvement, pleural involvement. Cavities and retracted lobes
scrofula
TB spreading to cervical or other lymphnodes
:not inflammed, tender with fever. Seen in neck
TB diagnosis
1) Chest X-ray
2) PPd
3) QauntiFERON WBC mix w/TB Ag, see if make IFN gamma
4) Clinical specimen AFB stain and culture
Factors affecting skin test
BCG vaccine (ignore after 5 yrs)
:Anergy--overwheliming infection, young, IC, live virus vaccine
: booster phenomenon, test 2x
Treatment Drugs
First line: RIPES--rifampin, isoniazid, pyrazinamide (PZA), ethambutol. Streptomycin. RI have hepatotoxicity

Second: PAS, ethionamide, cyclocerine
Principles of TB treatment
Active: Multiple drugs, decrease # of drugs as bacteria decrease, isolate, don't add one drug to failing regimen, failure usually from non-adherence
Prophylactic TB treatment
Latent, + PPD, reduce reactivaton, better for new infection, Isoniazid alone (hepatotoxicity)
BCG vaccine
Live attenuated, limited efficacy. Prevent CNS disease in children.
M. Avium (MAC, M.avium complex)
: Where
: Colonize?
Disease
AIDS disease
: Water, plants, soil
: Transient colonization
: Pulmonary MAC ICompo, lymphadenitis in children
: AIDS disseminated no HAART, fever, sweats, wt loss, bone marrow probs
Where HAART: focal lymphadenopathy
M. Marinum
: Where
: Disease
Where: Non-chlorinated H2O
: Papule or nodule. can ulcerate. Fever, local lymphadenopathy. Incubate 2-3 wks
m. marinum sporotrichoid
Bacteria spread from site of inititial infection nodules along lymphatic drainage
Leprosy (m. leprae)
skin testing
Fernandez reaction: 48 hrs
Mitsuda: 3 wks. Granuloma. + in tuberculoid, - in lepromatous
Lepromatous leprosy
skin lesions
bacilli
Ab fight
Tuberculoid Leprosy
Cell mediated immunity
Nerve damage
Tuberculoid Leprosy
Cell mediated immunity
: no AFB in swabs
: elevated plaques w/decreased sensitivity & hypopigmentation
:organized granulomas on histo
Signs of Leprosy
Eyebrow alopecia, enlarged earlobes, swelling fingers, enlarged earlobes, hypopigmentation
Symptoms/signs lepromatous
Desseminated nodules, infiltraion and thickening of skin.
:disorganized granulomas, foamy macros *few lymphos
leprosy management
Chemo: rifampin, dapsone, clofazamine (in combos)
Anti-inflammatories
epidemiology
:most people don't get it
:HLA genetic predisposition
:need long exposure, hard to get
Cytokines to transform t-cells
TH1: IL-12 & IFN gamma--need Vitamin D to activate macros
TH2: IL-4