Opportunistic Lung Infections and Tuberculosis
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| 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
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| Top countries that have TB ? | * Mexico, Philippines, India
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| Top races that are infected in the US ? | * Hispanics, African-Americans, and Asians
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| 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
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| TB survivability ? | * Highly resistant to drying out and can live in spit for a very long time.... * need UV light (sun) to kill it
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| TB growth ? | *slow growth bc nutrients are hard to transport across waxy membrane..... *incubation time is 8 wks
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| Gram staining ? | * Acid Fast - resistant to staining due to waxy coat by Mycolic Acid
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| How TB is spread ? | * inhalation of droplet nuclei
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| 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
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| 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
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| 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
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| Primary TB ? | * get TB that causes lung scars and lymph node caseation and can go to liver and spleen to cause miliary TB
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| Secondary TB ? | * after the primary infection lays latent or get reinfected and cause caseating granulomas of the lungs and can get miliary TB again
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| Some Laboratory Diagnosis of TB ? | * Sputum in morning or urine ..... * Acid Fast stains such as Ziehl-Neelson or Auramine-rhodamine
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| Common board culture used ? | * Lowenstein-Jensen (egg based medium)
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| 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
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| PPD Test = ? | * Positive: 10mm or more erythema and induration after 48 hr
..... * + does not mean active disease
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| TB Prevention ? | * BCG Vaccine (PPD test ineffective after) and Vit D
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| 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
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| 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
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| Pneumocystis jiroveci ? | * an inhaled fungus that is usu in ppl that are T-Cell Deficient
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| Pneumocystis jiroveci presentation ? | *: Alveoli are found filled with organism, desquamated alveolar cells, and foamy proteinaceous material; radiographs show bilateral diffuse infiltrates.
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| Pneumocystis jiroveci tmt ? | *Trimethoprim-sulfamethoxazole
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| Board Buzz words for TB ? | *Acid Fast
-Cord Factor
-Droplet nucleii
-Caseous necrosis
-Lowenstein Jensen media
-BCG vaccine
-PPD
-Ghon focus
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