Repiratory: Tb, Fungal Infection, Pertussis

Front 1

Age-specific risk is higher over age 65 for TB. Why?

Back 1

They are more likely to be exposed when they were young. Not because of decreased immune system.

Front 2

Recent or past transmission of TB?

- infection in children < 5yrs

Back 2

recent transmission

Front 3

Within the following people with positive PPD test, who are most likely develop active TB within 1 year?

Back 3

- HIV
- silicosis

Front 4

Of the following people, who are more likely to have TB?

- jejunoileal bypass
- solid organ transplant
- end stage renal disease
- carcinoma of head and neck
- gastrectomy
- diabetes

Back 4

- jejunoileal bypass
- solid organ transplant

Front 5

Progression of TB is ___ (fast or slow).

Back 5

slow
- except in immunocompromised and children (fast).

Front 6

What is this disease?

Symptoms
- productive cough
- fever
- weight loss
- hemoptysis, chest pain, anorexia, fatigue, night sweats.

CXR
- patchy nodular infiltrate in upper lobe

Back 6

TB

Front 7

What is this disease?

CXR
- nodular infiltrate with cavity, calcified

Back 7

TB (old)

Front 8

What is this disease?

CXR
- numerous small nodules

Back 8

miliary TB

Front 9

What is this called?

- a calcified focus of infection and an associated lymph node

Back 9

Ghon's complex (TB)
- necrosis 2-3 wks after

Front 10

What happens to ghon's complex 2-3 wks after?

Back 10

- necrosis
- heal with calcification on CXR

Front 11

How many specimens should you smear and culture for someone who has TB?

Back 11

3
- one in each consecutive days

Front 12

What is a must do for someone who is diagnosed with TB?

Back 12

HIV serology

Front 13

When is PPD useful?

Back 13

detect latent infection
- asymptomatic
- culture negative
- normal or abnormal CXR

Front 14

What does this mean?

- nonreactive PPD
- reactive during "boostng" test

Back 14

The person had contracted TB a while ago.

Front 15

In what condition is 5mm the cut-off for TB test?

Back 15

- HIV/immunosuppressed
- recent contact to TB
- CXR show apical scarring

Front 16

In what condition is 10mm the cut-off for TB test?

Back 16

- DM
- head and neck malignancies
- IV drug use
- chronic renal disease
- slilicosis
- gasctrectomy or jejunoilieal bypass
- recent converter
- immigrant within past 5 years
- employees from healthcare
- children < 4yrs
- wt loss > 10%

Front 17

In what condition is 15mm the cut-off for TB test?

Back 17

- no risk factors for TB

* not always treated

Front 18

What are some 2nd line drugs for TB? and when are they used?

Back 18

used for drug resistant cases
- quinolones
- amynoglycoside
- clofazimine
- ethionamide
- para-aminosalicylic acid

Front 19

What is the standard therapy for TB?

Back 19

- begin with 4 drugs: INH (4 months), RIF (4 months), PZA (2months), ETH
- discontinue ETH if isolate fully susceptible
- DOT (directly observed therapy)

Front 20

What is the treatment for this TB?

- cavity present and
- culture positive at 2 months

Back 20

- standard treatment for 2 months
- INH/RIF for at least 7 months
- 9 month total treatment

Front 21

What is the treatment for this TB?

- INH resistant

Back 21

- RIF/PZA/ETH for at least 6 months

Front 22

What is the treatment for this TB?

- RIF resistant

Back 22

- INH/PZA/ETH for at least 18 months
- consider aminoglycoside or quinolone

Front 23

Risk factors for MDR-TB.

Back 23

- exposure to patient who has MDR-TB
- in regions with a high prevalence of resistance
- prior treatment with anti-TB drug

Front 24

What is the treatment for this TB?

- MDR-TB

Back 24

4-5 susceptible drugs for 18-24 months
- quinolone
- aminoglycoside

Front 25

What is this TB?

- resistant to INH and RIF
- resistant to fluoroquinolones
- resistant to at least one injectable (aminoglycoside, capreomycin)

Back 25

XDR-TB

Front 26

When is surgery used in treatment for TB?

Back 26

- reduce bacterial burden in patients failing medical treatment

Front 27

What is the treament for latent TB infection?

Back 27

- daily INH for 6-9 months or
- daily RIF for 4 months, intermittent INH (twice weekly DOT)

Front 28

What is the treatment for this TB?

- children < 5 yrs who are close contact to an active case of TB

Back 28

- start INH even if baselien TST is negative
- stop treatment if TST is negative at 3 months

Front 29

What is the relapse rate for TB?

Back 29

0-4%
higher for drug-resistant isolates

Front 30

Although relapse rate for TB is low, if it does occur, when does it usually happens?

Back 30

within 2 yrs

Front 31

What are some complications for TB?

Back 31

- aspergilloma: "cresent sign" on CXR
- hemoptysis
- broncholithiasis
- fibrothorax
- carcinoma

Front 32

What is this disease?

CXR
- round infiltrate with rim of radiolucency

Back 32

"crescent sign"
- aspergiloma (complication of TB)

Front 33

How long should you isolate TB patients?

Back 33

until
- smear converts
- culture converts
- clinically improving

Front 34

What are some pregnancy safe anti-TB drug?

Back 34

- INH
- RIF
- ETH

* preventative treatment may be initiated during pregnancy
* breat feeding can be continued

Front 35

Predisposing position for NTM.

Back 35

- immunocompromised hosts
- chronic lung disease: pneumoconiosis, chronic bronchitis, emphysema, bronchiectasis

Front 36

Common pathogens for NTM.

Back 36

- MAC
- M. kansasii
- M. xenopi

Front 37

What is this disease?

- progressive infiltrate
- thin walled cavities

Back 37

NTM

Front 38

How to diagnose NTM?

Back 38

- must distinguish infection from colonization
- need multiple specimens
- may need bronchoscopy, transthoracic needle biopsy

Front 39

Treatment for MAC.

Back 39

>3 drugs for 12-18 months
- rifabutin
- azithromycin
- quinolones
- ETH
- streptomycin

Front 40

Treatment for M. Kansasii.

Back 40

- RIF, INH, ETH for 12-24 months

* this species usually resistant to RIF and PZA

Front 41

Treatment for M. Xenopi.

Back 41

no standard regimen
- clarithromycin
- RIF
- ETH
- quinolones
- rifabutin
- azithromycin
- linezolid

Front 42

What is this organism?

- most prevalent in ohio river valley.
- spores or mycelial fragments inhaled
- cause diffuse pneumonitis, usually self limited
- can disseminate hematogenousely

Back 42

histoplasmosis

Front 43

What is this disease?

- fever, chills, headache, myalgia, anorexia, cough, chest pain
- CXR: hilar/mediastinal lymph nodes, patchy infiltrates
- erythema nodosum

Back 43

acute pulmonary histoplasmosis
- mediastinal granuloma

Front 44

What is this disease?

- productive cough, dyspnea, chest pain
- CXR: cavitating apical infiltrates

Back 44

chronic histoplasmosis: may mimic TB

Front 45

What is this disease?

- calcification of nodular cavities
- patient may have hemoptysis

Back 45

broncholithiasis caused by chronic histoplasmosis

Front 46

How is histoplasmosis diagnosed?

Back 46

- antigen test
- serology: most sensitive

Front 47

Treatment for histoplasmosis.

Back 47

needed in chronic, disseminated
- amphotericin B
- itraconazole

for acute infection (with hypoxia) and granulomatous mediastinitis
- corticosteroids

Front 48

What is this organism?

- affect mainly bone and skin (ulcers)
- broad based budding yeast

Back 48

blastomycosis

Front 49

What is this organism?

- thick capsule
- southwest U.S.
- mainly affect CNS
- pulmonary nodules

Back 49

coccidioides

Front 50

What is this organism?

- ubiquitous in environment
- inhalation of airborn spores
- neutrophils and macrophages are important for defense
- form fungal balls

Back 50

aspergillus

Front 51

What is this disease?

- hymoptysis
- CXR: asymptomatic nodule
- CT: rim of air around mass

Back 51

aspergillus

Front 52

Treatment for aspergillosis.

Back 52

- resection
- itraconazole

Front 53

Treatment for invasive aspergillosis.

Back 53

- amphotericin
- itraconazole

Front 54

What is this disease?

- prolonged profound neutropenia
- tissue invasion
- cavity, hemoptysis, pneumothorax

Back 54

invasive aspergillosis

Front 55

Is there marrow recovery in invasive aspergillosis?

Back 55

No. (disseminated)

Front 56

What is this organism?

- transmitted via aerosol
- human is the only reservoir
- incubation: 1-3 wks
- cause whooping cough in kids

Back 56

pertussis (bordatella pertussis)

Front 57

Who are most commonly infected with pertussis?

Back 57

- children <1 y/o
- young adults: due to wanning immunity of vaccine

Front 58

What are the three phases of pertussis?

Back 58

- catarral (1-2wks): URI, lymphocytosis, leukocytosis
- paroxysmal (1-6wks): coughing, productive
- convalescence (2-3wks): decreased coughing

Front 59

Which phase of pertussis?

- URI symptoms
- leukocytosis: >50000 cells/mm3

Back 59

catarral

Front 60

Which phase of pertussis?

- productive cough

Back 60

paroxysmal

Front 61

Which phase of pertussis?

- decreased cough

Back 61

convalescence

Front 62

Adults or children who have pertussis?

- no wooping cough
- longer clinical course
- less ill

Back 62

adults

Front 63

Complication of pertussis in infants.

Back 63

- apnea
- pneumonia
- seizures
- death

Front 64

Complication of pertussis in adults.

Back 64

- fractured ribs
- pneumothorax
- syncope
- sunconjunctival hemorrhage
- subdural hematoma

Front 65

How to diagnose pertussis?

Back 65

gold standard: culture from nasopharynx

Front 66

Treatment for pertussis.

Back 66

supportive
- humidified air
- avoid antitussives
- steroids

antimicrobial
- macrolides
- alternatives: TMP-SMX, quinolones (adults only)

Front 67

How is pertussis vaccine administered?

Back 67

- DTaP at 2,4,6 months
- booster at 15-18 months ad 4-6 yrs
- TdaP at 11-12 yrs (up to age 64)

Front 68

What are some antimicrobial prophylaxis for pertussis?

Back 68

- erythromycin
- azithromycin