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31 Cards in this Set
- Front
- Back
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What species of mycobacteria are rapid growers? |
CAN ADVANCE FAST!!! CAF!!!
m. chelonae, m. abscessus, m. fortuitum |
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Leprosy is divided into three main categories:
1. Lepromatous Leprosy
2. Borderline Leprosy (borderline tuberculoid, borderline, borderline lepromatous)
3. Tuberculoid Leprosy
Which has the highest amount of bacilli in the skin? |
Lepromatous Leprosy- primarily a Th2 response --> humoral, not cellular |
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Leprosy is divided into three main categories:
1. Lepromatous Leprosy
2. Borderline Leprosy (borderline tuberculoid, borderline, borderline lepromatous)
3. Tuberculoid Leprosy
Which type has the greatest cellular immunity? |
Tuberculoid leprosy- primarily a Th1 response -->cellular immunity |
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Leprosy is divided into three main categories:
1. Lepromatous Leprosy
2. Borderline Leprosy (borderline tuberculoid, borderline, borderline lepromatous)
3. Tuberculoid Leprosy
Most symmetric lesions? |
Lepromatous leprosy- primarily a Th2 reponse, which is wimpy and humoral, so tons of lesions (symmetric) |
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Leprosy is divided into three main categories:
1. Lepromatous Leprosy
2. Borderline Leprosy (borderline tuberculoid, borderline, borderline lepromatous)
3. Tuberculoid Leprosy
Which has the most sensory affliction? |
Tuberculoid leprosy |
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Toll like receptor thought to play a role in leprosy? |
TLR-2 polymorphism increases susceptibility |
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Leprosy is endemic in southeast Texas... why? |
ARMADILLOS!!! |
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Cytokine milieu of Turberculoid Leprosy vs Lepromatous Leprosy? |
Tuberculoid leprosy- Th1 response primarily IL-2, INFy (cellular)
Lepromatous leprosy- Th2 response primarily IL-4, IL-10 (antibody/humoral) |
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Classic cutaneous symptoms of Tuberculoid leprosy? (ie number of lesions, type of lesions, sensation) |
Tuberculoid leprosy (Th1, cellular)- thin, hypopigmented plaques, very few or single, localized and asymmetric, absent sensation |
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diagnosis? |
Tuberculoid leprosy!!! Greater auricular nerve is the most common of the peripheral nerves to enlarge |
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Most common peripheral nerve to enlarge with Tuberculoid leprosy? Why? |
Greater auricular nerve (this is a dead giveaway!!!)
PGL-1(phenolic glycolipid 1) of bacteria binds to laminin-2 of Schwann cells |
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10 year old female, indiginous to Brazil, single lesion, biopsy and no organisms seen, just large granulomas... |
TUBERCULOID LEPROSY
classic lesion is a single hypopigmented or erythematous macule/plaque with atrophic center, can be anesthetic
No to few organisms because this is a Th1 response with good cellular response |
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Lepromatous leprosy
Th2 response, humoral response, wimpy |
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Medication? |
Clofazamine!!!
Lepromatous leprosy--- notice blue discoloration |
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sequelae of leprosy? (mc lepromatous leprosy) |
Leonine facies Madarosis (eyebrow loss) Huge ear lobes Corneal anesthesia/keratitis/blindness Saddle nose Gynecomastia (2/2 orchitis) Ulnar nerve involvment (papal hand) Median and ulnar nerve involvement (claw hand) Digit bone resorption Acquired icthyosis Neuropathic ulcers Orchitis |
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Enlarged nerves are characteristic of which type of leprosy? |
Tuberculoid!!! NOT lepromatous!!! (but lepromatous still has anesthesias) |
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Multidrug Therapy for single lesion? Multibacillary? |
Single: rifampin 600mg x 1, ofloxacin 600mg x 1, minocycline 100 mg x 1
Multi: dapsone 100mg daily, clofazimine 50mg daily, rifampin 600mg monthly, clofazimine 300mg monthly |
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What is Lucio's phenomenon? |
Lucio's phenomenon is an unusual reaction seen almost exclusively in patients from the Caribbean and Mexico with diffuse, lepromatous leprosy (Th2, humoral). It is characterised by recurrent crops of large, sharply demarcated, ulcerative lesions, affecting mainly the lower extremities, but may generalise and become fatal as a result of secondary bacterial infection and sepsis.
This is due to deposition of bacilli and immune complexes in dermis and endothelial cells --> cutaneous infarction
Note, this is NOT diffuse Leprosy of Lucio (unique form localized to western Mexico and Latin America, strikingly diffuse infiltration of skin giving a shiny appearance to skin 'La Bonita') |
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What is Diffuse Leprosy of Lucio? |
Not Lucios phenomenon!
DLL is a striking diffuse infiltration of the skin producing a varnished and shiny appearance, MC in western Mexico and Latin America
'La Bonita' |
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What is a Type I reactional state? |
Type I: Reversal Reaction
Occurs in Borderline Tuberculosis, Borderline Lepromatous (more common) after treatment --> immune response 'upgrades' (enhances cell mediated immunity via Th1) to cause increased inflammation of pre existing lesions and increase in bacilli in dermis
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What is a Type II reactional state? |
Type II: Erythema Nodosum Leprosum
Occurs in Borderline Lepromatous and Lepromatous Leprosy
Excessive humoral immunity with a Th2 pattern and formation of immune complexes that deposit extravascularly --> small teder, erythematous subcutaneous nodules, fever, arthralgia, neuritis, vasculitis, adenopathy, orchitis, dactylitis |
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Multiple clinical presentation of cutaneous tuberculosis include:
Tuberculous chancre Tuberculosis verrucosa cutis Scrofuloderma Lupus vulgaris Acute miliary TB Tuberculosis gumma Tuberculosis cellulitis Erythema Induratum
How do these categorize? (ie inoculation, endogenous, hematogenous, tuberculids?)
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Inoculation: tuberculous chancre, tuberculosis verrucosa cutis
Endogenous: scrofuloderma, tuberculosis cutis oroficialis
Hematogenous: lupus vulgaris, miliary TB, gumma, cellulitis
Tuberculids: Erythema Induratum |
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What is the difference between a tuberculosis chancre and tuberculosis verrucosa cutis? |
A chancre develops at the site of inoculation in a tuberculosis free individual, versus tuberculosis verrucosa cutis that develops at an inoculation site of a previously sensitized individual |
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DX? |
Scrofuloderma- direct extension from underlying tuberculosis lymphadenitis- MC in anterior cervical lymph nodes
d/t direct extension (endogenous) |
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Difference between tuberculosis cutis oroficialis and lupus vulgaris? |
Tuberculosis cutis oroficialis occurs at sites meeting mucosal and cutaneous borders --> from autoinoculation from visceral tuberculosis ( patient with advanced HIV coughing up blood, gets huge granulomas on lips)
Lupus vulgaris is destructive, mutilating, hematogenous spread of TB wtih red-brown papules/plaques with 'apple jelly', 90% on H + N, cultures only positive in 50% |
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What is miliary TB? Treatment? |
Uncontrolled infection, frequently in childre or AIDS patients
RIPE: rifampin, isoniazid, pyraziamide, ethambutol |
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Tuberculid reaction: Erythema induratum
typically occurs where? in what patient? |
Usually in patients with a stong immunity to tuberculosis-- positive PPD
usually in women of middle age on lower posterior calf as a tender, erythematous 1-2cm subcutaneous nodule, see lobular panniculitis |
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Most common mycobacterial infection in AIDS? |
mycobacteria avium intracellulare |
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Swimming pool granuloma:
Causative agent? Source? |
M. Marinum
3 weeks after exposure to aquarium, swimming pool, lagoon, or lake |
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Mycobacteria most common in nail salon whirlpool baths? |
M. fortuitum |
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Which mycobacteria requires ferric ions to grow in culture? |
mycobacterium hemophilum |
