Pearls from Dr. Neil Schluger
Atypical or nontuberculous mycobacterium
- most common that cause pulmonary disease are Mycobacterium avium complex (MAC, which encompasses M. avium and M. intracellulare) and M. kansasii
- organisms are thought to be ubiquitous in the environment, sometimes found in municipal water sources
- Classification of mycobacterial species
Posted 07/19/16 09:59:37 AM by Anna Krigel
Chronic pulmonary aspergillosis
- Aspergilloma – fungus ball composed of Aspergillus hyphae, fibrin, mucus, and cellular debris; arise in preexisting cavities that become colonized with Aspergillus
- Aspergillus nodule – occur in immunocompetent hosts, may be single or multiple, usually asymptomatic
- Chronic cavitary pulmonary aspergillosis – formation and expansion of one or more pulmonary cavities over months, can become fibrosing
- Chronic necrotizing pulmonary aspergillosis – slowly progressive form of invasive aspergillosis in immunocompromised hosts
Posted 07/19/16 10:03:01 AM by Anna Krigel
- Surgical resection - offered as treatment to prevent or treat life-threatening hemoptysis, generally well tolerated in patients with a single aspergilloma
- Bronchial artery embolization - used in patients with moderate to severe hemoptysis in order to stabilize prior to surgery
- Antifungals - itraconzole and voriconazole are used in patients with symptomatic, chronic pulmonary aspergillosis or may be used before and after surgery for aspergilloma
Posted 07/19/16 10:58:46 AM by Anna Krigel
For further reading...
Posted 07/19/16 11:14:46 AM by Anna Krigel
DDx for Upper Lobe Cavitary Lesions:
- Think TB and Sarcoid (Usually patients with Sarcoid have prominent disease on radiography but clinically look well)
Posted 11/17/16 11:22:28 AM by Adam Faye
- Laryngeal TB- Most infectious form of TB
- Smoking makes it:
- more likely latent TB --> active TB
- harder to treat
- more likely to relapse
- TB can cause SIADH as well (typically we think of SIADH from Small Cell Lung Ca)
Posted 11/17/16 11:30:37 AM by Adam Faye
- Smear has ~50-65% sensitivity; typically need 100,000 organisms to be positive.
- GeneXpert- detects DNA, also tests genetic mutations a/w rifampin resistance - higher sensitivity and can detect with only 150 organisms.
- Induced sputum can be as good as bronchoscopy in obtaining a sample.
Posted 11/17/16 11:36:30 AM by Adam Faye
- 100% non-infectious only when the Culture becomes negative.
- Once under going treatment, time to positive growth of culture should lengthen.
- Cavitary lesions and more organisms on smear lead to longer periods of time until Cultures clear.
Posted 11/17/16 12:12:48 PM by Adam Faye
Drug Sensitive TB - Do NOT need to give Ethambutol
Posted 11/17/16 04:59:20 PM by Adam Faye
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It is not meant to replace the advice of a health professional.