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Lung Infections & TB

Opportunistic Lung Infections and Tuberculosis

Epidemiology of TB ? * 1/3 of the world is infected... *highest rates in blacks and Native Americans bc low Vit D.... * Almost all are foreign-persons.... * prevalent in warm and cold limates
Top countries that have TB ? * Mexico, Philippines, India
Top races that are infected in the US ? * Hispanics, African-Americans, and Asians
Some contributing Factors for acquiring TB ? * having HIV..... *contact with TB in a foreign person .... * HLA-Bev15 gene on chromosome 17 mutations..... * anyone working closely with someone with TB
TB survivability ? * Highly resistant to drying out and can live in spit for a very long time.... * need UV light (sun) to kill it
TB growth ? *slow growth bc nutrients are hard to transport across waxy membrane..... *incubation time is 8 wks
Gram staining ? * Acid Fast - resistant to staining due to waxy coat by Mycolic Acid
How TB is spread ? * inhalation of droplet nuclei
Cx Sx ? * Early - asymptomatic or get flu like Sx and remain carriers .... *Later - Chronic cough with mucopurulent expectorant, often containing blood, chest pain, sob, malaise, fatigue, fever, and lots of weight loss
Primary TB patho in weeks 0-3 ? * TB uses its mannose cap to attach to the macrophages mannose receptor and proliferate within the macrophage and spread
Primary TB patho after week 3 ? *macros present TB via MHC-II and IL-12 to T cells -----> Th1 cells----> IFN-gamma---> activates the macrophages and activates and TNF to cause caseating granulomas
Primary TB ? * get TB that causes lung scars and lymph node caseation and can go to liver and spleen to cause miliary TB
Secondary TB ? * after the primary infection lays latent or get reinfected and cause caseating granulomas of the lungs and can get miliary TB again
Some Laboratory Diagnosis of TB ? * Sputum in morning or urine ..... * Acid Fast stains such as Ziehl-Neelson or Auramine-rhodamine
Common board culture used ? * Lowenstein-Jensen (egg based medium)
New test used ? * Interferon Gamma Release Assays --- mixes bd with TB antigen and measure the amount of IFN-gamma after 24-48 hrs.... *if infected with TB, IFN-gamma should be high
PPD Test = ? * Positive: 10mm or more erythema and induration after 48 hr ..... * + does not mean active disease
TB Prevention ? * BCG Vaccine (PPD test ineffective after) and Vit D
Mycobacterium avium-intracellulare (MAC or MAI) ? * MAI found in the environment, associated with birds, with no person to person transmission.... * mimicks TB and smoking/alcohol can predispose
HIV and TB/Mycobacterium ? * M. tuberculosis manifest early in the course of AIDS; atypical mycobacteria are seen late in the course of HIV disease..... so can have both at the same time
Pneumocystis jiroveci ? * an inhaled fungus that is usu in ppl that are T-Cell Deficient
Pneumocystis jiroveci presentation ? *: Alveoli are found filled with organism, desquamated alveolar cells, and foamy proteinaceous material; radiographs show bilateral diffuse infiltrates.
Pneumocystis jiroveci tmt ? *Trimethoprim-sulfamethoxazole
Board Buzz words for TB ? *Acid Fast -Cord Factor -Droplet nucleii -Caseous necrosis -Lowenstein Jensen media -BCG vaccine -PPD -Ghon focus
Created by: thamrick800