1.
2: there are .. types of leprosy infections and depends on the host immune response
2.
4: the ... drugs used in active adult TB infections are
1. isoniazid, 2. Rifampin, 3. Pyrazinamide, and 4. either Ethambutol or an Amingoglycoside
3.
4: for an active TB infection in adults uses ... drugs
4.
6: treatment for an active adult TB infection is with a 4 drug cocktail for ... months
5.
10-20%: all people with latent TB have a .... life time risk of developing active TB, with the greatest risk in the first 2 years after infection, higher risk in children, and higher still in immune compromised folks
6.
30-50%: the BCG vaccine provides about .... efficacy against severe disease in infancy (ie disseminated/miliary or menengitis), but unfortunately this vaccine does not protect against pulmonary or non-infancy disease-- so no herd immunity
7.
48 to 72: the PPD test must be read by health care provider in ... hours, and is also influenced by placement technique
8.
acid fast: ... means that these bacteria have cell walls that are rich in lipids (makes it waxy) and this allows methane dyes such as carbol-fuchsin , crystal violet, auramine/rhodamine, to bind and bind so fast that they are not removed even with ethanol/hydrochloric acid
9.
active: ... tb infections are marked by pulmonary disease, which can be seen on chest x-ray (abnormal), and are contagious, will have positive PPD test
10.
active: ... TB is TB in which patient is clinically ill (ie chest x-ray shows infection), that can be infectious
11.
active: if a person has a positve PPD or IGRA, and any abnormal exam findings, history or chest x-ray, could have an ... case of TB and could be contagious
12.
amoeba: .... in well water could also serve as a reservoir of M. leprae
13.
armadillos: ... are a reservoir for M . leprae in the wild an dmay transmit the infection to humans
14.
B cells: ... are the immune cells that make immunoglobulins
15.
bacilli: ... are bacteria with a rod shape
16.
BCG: or Bacille Calmette Guerin, is a mutant of M. bovis that is attenuated, and is the strain used for the TB vaccine which is the most widely given vaccine in the world (100 million per year worldwide)
17.
BCG: the ... vaccine is given in countries where TB infection is endemic, shortly after birth
18.
BCG: the ... vaccine should not make the PPD positive
19.
carbons: the mycolic acid lipis in mycobacteria cell walls have 70 to 90 ... while our human lipid membranes usually have 16 or so ....
20.
cardiogenic: sometimes TB infection case can present in ... shock due to TB sack around the heart
21.
carotenoids: ,,, are produced by the mycobacteria and are called photochromogens
22.
caseating: the granulomas formed by TB bacteria in the lungs are .... so you see areas of necorsis around the epitheliod cells and lymphocytes
23.
cavitary: ... tuberculosis can be seen in the lung tissue as pockets of bad looking tissue (granulomas), and TB near airway when we cough, spews out
24.
chest x-ray: a ... is a tool often used to help us see if patient has an active TB infection, as well as the physical exam and a through history
25.
classic: ... diagnosis of TB has following symptoms
1. fever (unknown origin)
2. night sweats
3. weight loss
4. cough
5. unexplained persistent pneumonia
6. unresponsive lymphadenitis
26.
cows: ... as well as humans are a reservoir for M. bovis
27.
crook: a TB infection in the spine can cause ... in the back appearance
28.
diagnosis: often a ... of TB is still just based on clinical observation and with no microbiological proof
29.
disease: what tips the balance towards TB ... includes
1. age: very young, teenage years, old
2. immune status: ie immune compromised HIV AIDs, alpha inhibition therapy, immunosuppressants, innate defects
3. heavy exposure
4. genetics
5. certain strains of M. tuberculosis
30.
distant: once tb infection spreads to a ... site may have normal chest x-ray, or may be abnormal, is often contagious, and will have a positive PPD test
31.
diverted: the normal pathway for the exogenous antigen presentation on MHC II of immune cells is ... in M. tb infection, because the phagosome containing TB does not bind to lysosome
32.
DTH: the ... (aka skin response to TB antigen) occurs 2 weeks after infection
33.
exposure: .. to TB occurs when the bacteria are inhaled into respiratory system
34.
extensively: .... drug resistant TB infection are resistant to isoniazid, rifampin, FLQ, and aminogoglycoside
35.
fish tank: M. marinum is known as the ... granuloma, that grows slowly at 37 C, and is present on water and on water animals, and are slowly progressing non-healing papulonodules that are mildly tender
36.
granuloma: the hallmark of M. tb is the caseating ... which can be good (contains infection) but for bacteria
1. site of latency
2. but is only good to a point, because in order to spread to new host, must case pulmonary disease
37.
granuloma: mycobacteria during their infectious process induces .... formation due to lipid content in cell wall
38.
herd: the BCG vaccine does not provide ... immunity, so even when given in mass, does not protect the unvaccinated
39.
HIV: globally see a lot of ... patients also being diagnosed with active TB
40.
human to human: transmission of M. leprae occurs between .... via inhalation of respiratory droplets
41.
humans: ... are the reservoir for M. leprae
42.
humoral: ... aka antibody immunity may not be important
43.
immune system: interplay between TB and ... may change the balance, leading to control of diseas
44.
induration: .... not redness is what is examined to have a postive PPD (measured 48 to 72 hours after intradermal injection)
45.
infected: an ... person with M. tuberculosis, bovis, or africaneum, can be either clincially ill with active TB that is contagious, or can be clinically well with normal chest x-ray but has latent TB that is not contagious
46.
inflammatory and latent: the ... type responses occur simultaneously, until eventually one type becomes dominant
47.
ingest, inoculate, inhale: the route of transmission for NTM and M ulcercans mycobacteria includes ...
48.
interferon gamma release assays: aka IGRAs are assays in the works that should help with TB diagnosis, that would have benefits over PPD in some respects
49.
Koch: ... is scientist that gave us germ theory (postulates)
1. organism present in only infected animals
2. organism can be isolated from such animals
3. isolated organism causes disease in healthy animal
4. organism can be reisolated
50.
latent: 1/3 of the world has a ... TB infection
51.
latent: ... TB occurs in a person that has been infected with tuberculosis type mycobacteria, that can be clinically well (ie clear chest x-ray) and is not contagious to others
52.
latent: .... tb infections are usually contained in the body somewhere, so are not contagious, but PPD test will be positive, and chest xray is normal or see calcifications
53.
latent: if a person has a postive PPD or IGRA, but chest x-ray and clinical exam/history are normal have a ... TB infection, but are not contagious
54.
lepromatous: in ... mycobacterium infections with M. leprae, we see multiple lesions, destructive tissue damage, multibacillary (ie bacteriema), and it is contagious due to a lack of a response by immune system (weak immune system)
55.
leprosy: we see 800,000 cases a year in India, Nepal, Brazil, and Africa of .... we also see about 100 cases of this a year in US
56.
leprosy: ... infections have bee shown to run in families, so may have some genetic predisposition to infection
57.
lipid: acid fast bacteria have stain that sticks to the cell wall so well because the cell walls are ... rich, making them look waxy
58.
lipid synthesis: 30% of mycobacteria genome is devoted to .... or metabolism
59.
lipids: ... in the cell wall of M. tb may facilitate the fact that lysosome of macrophage does not fuse to phagosome, due to selectively fusogenic nature of microbe, which can survive on host lipids
60.
lipids: cell wall ... are instrumental in mycobacteria's virulence, not just structural
1. protects cell
2. influecnes host cell signaing
3. induce granuloma formation
61.
lipids: M. tb exocytoses its ...., and MHC class I to CD8 T cell
62.
lipids: 30% of mycobacteria's weight is due to ....
63.
lymph nodes: next the TB bacteria drain to the regional .... where the infection can then be propagated to more tissue because at this point is tough to contain infection
64.
lymph nodes: swollen ... nodes in the neck, usually caused by non-TB bacteria, that doesn't cause disease in normal people outside of infancy
65.
M. leprae: .. is a type of mycobacteria that is the agent of leprosy
66.
M. leprae: .. is a type of mycobacteria that can be cultivated in mouse footpads, but it takes a long time
67.
M. marinum: ... is a type of mycobacteria that can be found in fish tanks and swimming pools
68.
M. marinum: aka fish tank granuloma is makred by slowly progressive non-healing papulonodules, can will have positive PPD test, and nodules should be biopsied for pathology and culture. And treatment is 2 drugs for 4 to 6 months (ie clarithromycin, rifampin, ciprofloacin-- depnding on what bacteria strain is sensitive to which drugs
69.
M. TB: ... facilitates its uptake by macrophage phagosome, via complement receptors, and then the lysosome will not fuse with the phagosome
70.
M. tuberculosis: the ... complex consists of
1. ....
2. M. bovis
3. M. africanum
(all three cause similar disease that we call tuberculosis)
71.
M. ulcerans: .... mycobacterium are found in water microenvironments such as water insects or amebas, or mosquitos (not 100% sure)
72.
macrophage: in the normal disease pathway when the lysosome containing antigen-microbe fuses with phagosome, see pH fall, due to reactive oxygen species in there, and microbe dies and degrades, and then pieces of it (antigens) are displayed on the MHC II which is presented to CD4 helper T cells
73.
macrophages: ... are phagocytic cells that are usually located in tissue, that participate in cell signaling and cytokine activation, and are the home to M. tb
74.
macrophages and lymphocytes: cellular immunity driven by ... immune system cells, is critical for the control of infection
75.
meningitis: a TB infection causing ... often presents with
1. intermittent fevers
2. malaise
3. progressive vommiting
4. lethargy
5. meningismus (stiff neck
6. CSF with 230 WBC, 70% lymphocytes, 20% monocytes, 10% neutrophils
7. protein count is high in blood, and glucose is low
76.
microbe: in the normal disease pathway the antigen .. is ingested into phagosomal compartment of macrophages
77.
middle: people with ... of the road immune response to infection with M. leprae, seem to contain/resolve the infection without symptoms
78.
multi-drug: ... resistant TB infection are resistant to isoniazid and rifapin, found in increasing number of cases
79.
Mycobacteria: ... are aerobic rod-shaped bacteria that are acid fast
80.
mycobacteria: ... can also be classified on whether or not they are
1. photochromogens (orange with light)
2. scotochromogens (always orange)
3. nonchromogens (stay buff color)
(as well as by temperature growth optimum, and growth times
81.
mycobacteria: .... are non-motile, non-spore forming bacteria
82.
mycobacteria: ... can be distinguished from other forms of bacterial infection based on clinical presentation== due to characteristics expressed by host, or location of the host (can be endemic in some areas)
83.
mycobacteria: ...c an also be distinguished from other forms of bacterial infection using molecular probes ie PCR, or liquid chromatography of the lipids
84.
mycobacteria: ... can be distinguished from other forms of bacterial infection based on growth time, temperature and morphology
1. takes a ton of time to grow
2. color of colonies in light and dark
3. chemical reactions/growth conditions
85.
mycobacteria: ... require special conditions for growth, due to its long replication time 12 to 24 hours
86.
Mycobacteria tuberculosis: in the U.S. .... infects 2 million people, 25,000 will become sick and 2000 will die
87.
Mycobacteria tuberculosis: ... is a leading killer in today's world
1. infects 1/3 of world
2. makes 9 million people sick
3. kills 2-3 million people
88.
necrosis: M tb. inhibits apoptosis in favor of ....
89.
necrosis: ... of the tissue due to caseating granuloma formation could be a good thing or a bad thing because it tries to contain the infection, but then doesn't this contribute to latency
90.
neutrophils: .. are the immune cells that are the phagocytic cell usually in the bloodstream, and sets extracellular DNA traps
91.
nine: for TB treatment in child less than 5, use isoniazid for LTBI and active infection for ... months!
92.
non-TB: ... mycobacteria are usually rapid growers which distinguishes them from the photochromogens, scotochromogens, and nonchromogens
93.
non-tuberculous: M. ulcerans is a type of .... mycobacteriam, that is the agent of buruli ulcer
94.
non-tuberculous: ... mycobacteria aka NTM, are bacteria that are found all over the environment that do not cause leprosy or what we call TB.
95.
nonchromogens: ... are always pigmented (buff color)
96.
nontuberculous: ... mycobacteria infection can occur with the ingestion of contaiminated food or water, inoculation, into wound/surgery, inhalation
97.
nucleic acid tests: ... aka PCR or probes, are used on specimens, only approved for smear positive sputum, and can ID specimens growing in culture
98.
pedicures: ... have been associated with rapidly growing nontuberculous mycobacteria outbreaks (ie using fish in spa treatment!)
99.
photochromogens: ... are pigments produced by the mycobacteria, that when exposed to light will change color due to the production of carotenoids
100.
photochromogens: ... produce carotenoids when exposed to light and will produce a bright orange or yellow color
101.
PPD: repeat .... boost the immune response, they do not create false positives
102.
PPD or IGRA: if you have a positive ... for TB the next step is to determine whether the infection is active or latent through clincial exam, hisotry, and chest radiograph
103.
purified protein derivative: aka PPD test evokes a delayed type hypersensitivity response IF it is a familar antigen, and is injected intradermally
104.
respiratory: the transmission of M. bovis occurs via .... means or by ingestion of nonpasturized diary products
105.
screening: in your general ... when you have a patient with TB ask about
1. known exposure to person with active TB
2. immigration from an endemic area
3. prolonged exposure to immigrants from endemic area
4. travel to endemic area
5. incarceration
6. immunosuppression
7. poverty/drug use/cramped living
106.
sensitive: the PPD test is not ... is just about 20% and is really bad in immunocompromised, very young, and very old
107.
specific: the PPD test is also not ... enough because it cross reacts with other mycobacteria
108.
suspected: when you have a ... case of TB, place PPD on case and close contacts
109.
T cells: ... are immune cells that go through cell signaling and cytokine activation. Are the cells that are depleted by HIV infection
110.
TB: ... can be diagnosed
1. clinical scenario: presentation, x-ray/CT
2. skin test or IGRA of ill person and family
3. chest x-ray-- sometimes positive without clinical presentation
4. acid fast stain (not very sensitive) or culture (also slow to grow
5. nucleic acid based tests (PCR)** most common
111.
TB: the ... mycoplasma bacteria settle in the alveolus, and will eventually get into the macrophage where it can replicate in peace, and will eventually invade the lymph nodes with the aid of the infected macrophage
112.
treatment: some issues related to TB ... include
1. relatively few drugs to treat with
2. emerging antibiotic resistance
3. length of therapy
4. drug delivery
5. difficulty killing latent bacteria
6. macrophage penetration
7. drug interactions-- don't work well with HIV treatments
113.
tuberculoid: in ... mycobacterium infections with M. leprae we see single lesions, nerve and skin damage, paucibacillary, that is not highly contagious, and is due to an overly robust immune system response
114.
tuberculosis complex: the .... causes the disease that we call TB
-M. tuberculosis 37C in 12 to 28 days
- M. bovis 37C in 21 to 40 days
-M. africanum 37 C in 21 to 40 days
115.
vaccine: the .. for TB is the most widely used ... in the entire world, but it is not a great ... because it protects against TB during infancy only, plus it left similar scar to that of smallpox vaccine
116.
vaccine: M. bovis BCG is the .. strain, that is made up of attenuated M. bovis (was allowed to replicate until it lost its virulence)
117.
vaccine: the M. bovis BCG ... is protective against leproxy
118.
warts: bothersome ... can be antoher presentation of TB infection due to M. marinum
119.
water and soil: nontuberculous mycobacterium are found in the ... all around us
120.
wild type: the BCG vaccine is not very effective because the ... disease is not protective, and the infection process is very immunologically complex because the infection hides in the immune system and hijacks immunologic responses
