Final Exam Study Guide.docx - Final Exam Respiratory Infections 3 Tuberculosis(TB Mycobacterium tuberculosis C acid fast bacillus mycolic acid Use

Final Exam Study Guide.docx - Final Exam Respiratory...

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Final Exam Respiratory Infections 3: 11/11/13 Tuberculosis (TB) Mycobacterium tuberculosis C: acid fast bacillus , mycolic acid Use special stain, gram stain doesn’t work. Known as “consumption” in the 1800’s because you lost so much weight like the disease was consuming you. S: bloody sputum: chronic pneumonia in 85% of patients who are symptomatic , cough, chest pain, fatigue, fever, anorexia, chills, cough up bright red blood, night sweats, can loose a lot of weight; symptoms occurs until treated and if untreated will die within 1-2 years ; 15% of symptomatic patients extrapulmonary (meningitis). Can go a lifetime without having symptoms or knowing you have TB. Slow growing organism. Symptoms come on acutely. Starts in the lungs but can spread to any body system or organ. P: intracellular breath it in granulomas (tubercles) formed by T cells calcification seen on X-ray D: culture AFB; x-ray; PCR-gene probe; tuberculin skin test with PPD (purified protein derivative) delayed hypersensitivity (10mm induration in 48-72 hours) T: isoniazid (INH) +3 other antibiotics: communicability stopped, treats infection, reduces reactivation by 75%, but 30% in NYC are resistant to therapy. Vaccine is BCG, it is live attenuated and is used in Europe. E: Communicable in coughing/sneezing. Any respiratory droplets. E: 1980’s saw increase in US; peak in ’92,1/3 of whole world, 3M/year mortality, high incidence groups are AIDS, <3 y.o., addicts, aged, prisoners In flu enza (viral Pneumonia) Influenza Virus A (B,C) C: ssRNA (-) (8 segments), enveloped S: URT and LRT symptoms, fever, malaise, muscle soreness, acute symptoms, lasts about 7 days but fatigue can last 2-3 weeks P: Hemagglutinin (H) binds to receptor and fuses with cell membrane and Neuraminidase (N) removes receptor protein and allows dispersion during budding from cell D: Epidemiologic, ELISA for H and N T: symptomatic, Zanamivir (Relenza) is a nasal spray neuraminidase inhibitor, blocks viral adherence. Oseltamivir (Tamiflu) taken orally. If taken within 30 hours of onset of symptoms, shortens duration of illness. T: Amantadine or rimantadine for A, blocks uptake of the virus; for prophylaxis only. Influenza vaccine (trivalent (2 A’s and B), shot, killed; Flumist: aerosolized mist, attenuated). For high risk pateitns and health care workers. No universal vaccine because of 8 segment shift. Guillain-Barr in 1976 to HswN1 E: IVA is epidemic, URT, animal reservoir (birds and pigs); H1N1 ; IVB is endemic. Aspirin is contraindicated Reye’s syndrome E: antigenic drift and antigenic shift of H and N Histoplasmosis (Fungal Pneumonia) Histoplasma capsulatum C: dimorphic fungus S: differentiate from TB P: intracellular D: Xray, histoplasmin skin test, sputum culture, ID T: Itraconazole E: not contagious; bird or bats inhalation; geographic; 50M infected in USA Pneumocystosis (PCP) Pneumocystis jirovecii (carinii) C: obligate fungal lung flora S: pneumonia asphyxia 1
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Final Exam P: immunocompromised patients (decrease in CD4-Tcells) D:
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  • health care workers, Hepatitis C

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