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24 Cards in this Set
- Front
- Back
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3 species of mycobacteria of importance in humans:
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M. tuberculosis- TB
M. leprae- leprosy M. intracellulare- disseminated disease in immune suppressed |
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Where do mycobateria replicate in a lung?
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alveolar macrophages
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Immune response to mycbacteria in the lungs
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granulomas
Granulomas become calcified nodules (Gohn complex) |
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Bacteria within granulomas are unable to replicate but remain viable for how long?
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years-decades
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Mycobacteria are Acid-fast, aerobic ____
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rods
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______ tuberculosis (TB) is the widespread dissemination of Mycobacterium tuberculosis from hematogenous spread
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Miliary
(1-3% of all TB cases) |
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6% of Primary tuberculosis is "_______" TB
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clinical
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90% of primary TB is "_____" TB.
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latent
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What causes Secondary (reactivated) tuberculosis?
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Immune suppression allows latent TB to reactivate
Granulomas break down releasing organisms Clinical TB results |
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Manifestations of Reactivated Pulmonary TB
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Insidious onset of fever, night sweats, weight loss, anorexia, malaise, weakness
Cough often productive of blood-streaked sputum Apical and posterior segments of upper lobes most often affected May see cavitary lesions on CXR |
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extrapulmonary tuberculosis that affects the spine
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Pott disease
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Infected macrophages can take TB hematogenously throughout body if _____ law is broken
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Jason's
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TB:
_____ stain of sputum |
Acid fast
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TB:
Culture in broth takes up to ___ days |
14
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agar used to culture TB (takes a month)
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Lowenstein-Jensen agar
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PPD test:
Within 48 hours, a positive lesion is erythematous and _____ |
indurated
15mm induration is positive in persons with latent TB |
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10mm post-PPD induration is positive for:
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Recent arrivals from high-prevalence countries ****
Injection drug users Residents and employees of high-risk congregate settings Mycobacteriology laboratory personnel Persons with clinical conditions that place them at high risk Children <4 years of age, or children and adolescents exposed to adults in high-risk categories |
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5mm post-PPD induration is positive for:
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Immunosuppressed patients (HIV/AIDS, cancer, etc.)****
Persons with fibrotic changes on chest radiograph consistent with old healed TB |
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First line treatment of TB
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Requires 4 drug cocktail
First line drugs Isoniazid (INH) Rifampin Ethambutol Pyrazinamide |
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Second line drugs for TB
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Streptomycin
Para-aminosalicylic acid Cycloserine Ethionamide Amikacin Levofloxacin Capreomycin |
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Treatment of active TB with 4 drug cocktail lasts for 2 months. Then the pt has CXR and AFB smear. If CXR and smear are NEGATIVE, continue isonaiazid and rifampin for how long?
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4 more months
(7 more months if AIDS pt) |
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Multi-drug resistant TB (MDR-TB)
Resistant to what? |
INH and Rif
Can still be treated by substituting second-line drugs |
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Extensively drug-resistant TB (XDR-TB)
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INH, Rif, any fluoroquinolone
and at least one of three injectable second-line drugs (capreomycin, kanamycin, and amikacin) |
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For latent tuberculosis, the standard treatment is six to nine months of
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isoniazid alone.
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