TB and non TB Mycobacteria
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24 terms
Terms | Definitions |
|---|---|
 How is TB transmitted? | Airborne--Aerosolized in droplets 1-5 microns |
| In what groups is a PPD over 5 mm POSITIVE? | Immunosuppressed--HIV, transplant High risk/suspicion--Child, close contact, abnormal CXR |
| In what groups is a PPD over 10 mm POSITIVE? | "Population risk" "Medical risk" factor for accelerated progression |
| In what groups is a PPD over 15 mm positive? | EVERYONE |
| When should quanterferon be used to detect TB? | Settings where positive skin test may be due to cross-reacting mycobacteria other than TB--recipient of BCG vaccine, Infection with mycobacteria kansasii, marinmum, background exposure to environmental mycobacteria (M. Avium in south) |
| How does the quantaferon assay work? | -Whole Blood Assay -TB Antigens from M. TB cell wall very specific to TB-- ESAT6 and CFP-10 -Interferon release implies previous infection with TB |
| What are the medical risk factors for progression to disease in TB? | Immunocompromised host--HIV, Transplantation Co-Morbid conditions--DM, Malnutrition, End stage Renal Disease, Pneumoconiosis, Sarcoidosis, Steroids, malignancy |
| What is the effect of HIV on TB? | Diminished immune response--Ineffective macrophage killing, Less likely to have positive skin test Those with prior latent TB have 7-8% risk of disease reactivateion PER YEAR Rapid progression from infection to disease (WEEKS instead of years) Atypical clinical manifestations=dx difficult Recovery does not lead to future immunity |
| Sx of active TB? | Cough greater than 2 weeks duration Hemoptysis Unexplained weight loss Constitutional Sx--fatigue, fever, drenching night sweats |
| What is primary TB? | Recent exposure and infection to another case of active TB that has progressed to active disease (usually within 3-6 months) |
| What is Reactivation TB? | Infection with TB in distant past that has now become active usually due to weakened immune system (months to years) |
| What is Relapsed TB? | Previously treated TB that is recurring |
| What is Reinfection TB? | Treated for TB previously and now infected with a new strain (ALMOST UNIQUE TO HIV) |
| Clinical aspects of TB in HIV vs. General Population? | TST--More likely non-reactive in HIV, more likely to be positive in general population Site of Disease--75% involve lymphatic disease and/or pleural effusions in HIV, 75-90% Pulmonary only in general population Pulmonary disease--Lower lobe and non-cavitary in HIV, more likely upper lobe and cavitary in general population |
| Traditional and Fluorescent smears and PCR done in TB? | Traditional smears--ZIEHL-NIELSEN, Kinyoun Fluorescent smears--AURAMINE-RHODAMINE PCR--Amplify IS-6110, M. TB vs. MOTT |
| Factors that make you more likely to be contagious? | Ability to aerosolize (Laryngeal TB most contagious) Smear positive Extensive Disease Poor ventilation of shared space |
| "Rule of thumb" for taking meds for TB? | "4 times 2, then 2 times 4" 6 months total Isoniazid (H), Rifampin (R), Ethambutol (E), Pyrazinamide (Z) 2 months HREZ, then 4 months HR |
| What is clinically suggestive of M. Avium Complex disease in children? | CERVICAL ADENITIS |
| What are the possible clinical manifestations of M.Avium Complex (pulmonary) | Classical (Emphysema-associated) Focal infiltrate Solitary nodule (mass) RML--Lingula Syndrome--suddenly became more prominent (which was a switch from Emphysema disease) Primary Complex--RAREST; massive sub-chorinal lymph nodes |
| Where does MIC effect in disseminated Non-HIV? | Lung, Bone, Liver, Lymphatic, Skin |
| When should prophylaxis be given for disseminated MIC in HIV? | Absolute CD4 count <50 Give azithro 1200 mg once weekly |
| Therapy for MIC disseminated in HIV? | Clarithromycin 500 mg 2x daily Ethambutol 15 mg/kg daily Consideration for Rifabutin 300 mg daily |
| When should M. Kansasii be considered? | Sandblasting (Associated with Silica) Coal Miner's Pneumoconiosis |
| When should M. Marinum be considered? | "Fish tank" granuloma |
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