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133 Cards in this Set
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Bacillus anthracis?
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toxin-producing, encapsulated, facultative anaerobe.
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Anthrax Means of Infection?
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a)Through the skin (contact with anmals or animal hides)
b)Ingestion of contaminated meat with break in GI mucosa c)Inhaling spores, |
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Anthrax What kind of toxins?
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1)Edema toxin (massive local edema)
2)Lethal toxin (massive release of cytokines from macrophages, sudden death common in anthrax infections) |
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Anthrax Sx?
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-Piainless, cutaneous balck eschar on exposed areas of skin with marked surrouding edema and vesicles
-NOn specific flu like Sx, rapidly porgress to dyspnea and shock |
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Anthrax Dx?
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cultures and Gram stains from clinically identified sites, including cutaneous lesions, pleural fluid, CSF, or stool, Chest x-ray (or CT) PCR , ELISA
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Diphtheria?
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acute pharyngeal or cutaneous infection by Corynebacterium diphtheriae, some strains: exotoxin.
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Diphteria Sx?
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-Tenacious gray membrane at portal of entry and pahrynx, can detahc and cause airway obstruction
-sore throat, nasal discharge, hoarseness, malaise, fever. -bullneck edema -Mycarditis, neuropathy -skin ulcers is EXOtoxin present |
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Diphteria Dx?
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-culture
-clinical presentation |
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Diphteria Mode of transmition?
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-respiratory droplets from humans
-respiratory secretions -skin lesions, - rarely by fomites |
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Listeria monocytogenes?
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Facultative, motile G+ rod, capale of invading several cell types and causes intracellular infx
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Listeria mode of trnasmission?
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-ingestion of contaminated dairy products, raw vegetables, or meats and
-grows at refrigerator temperatures. |
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Listeria Disease Sypmtoms?
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*Primarily Listeremia is RARE with HIGH FEVER & NON-LOCAL SXS.
bacteremia, meningitis, cerebritis, dermatitis, an oculoglandular syndrome, intrauterine and neonatal infections, or rarely endocarditis |
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Listeria Dx?
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By laboratory isolation
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Streptococcus pneumoniae?
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gram-positive, aerobic, encapsulated diplococcus
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Pneumococcal Dz?
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-otitis media,
-pneumonia, -sepsis, -meningitis -sinusitis -endocarditis -deaths. |
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Pnumococcal Sx?
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-Productive cough, fever, rigors, dyspnea , early pluritic chest pain
-Consolidated lobar pneumonia (X ray |
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Staphylococcal infxs and species??
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gram-positive, aerobic organisms.
-Staphylococcus aureus: virulent and antibiotic resistant. -S. epidermidis hospital-acquired infections, -S. saprophyticus causes urinary infections. |
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S aureus Sx?
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-Localized erythema wiht induration
-possible abscess -folliculitis -gastroenteritis, food poisoning -scalded skin syndrome (toxin) -toxic shock syndrome (TSS) -endocarditis -osteomyelitis -pneumonia |
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S aureus Dx?
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Gram stain and culture,X-ray
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Staph mode of transmission?
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Direct invasion thorugh skin
-vesicular pustules and crusting (impetigo) or - cellulitis - focal and nodular (furuncles and carbuncles). |
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Streptococcal and Enterococcal Infections ?
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S. pyogenes: group A β-hemolytic, gram-positive aerobic organisms
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Streptococcal and Enterococcal Dz?
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pharyngitis, pneumonia, wound and skin infections, sepsis, and endocarditis.
Sequelae :rheumatic fever and glomerulonephritis -Scarlet fever -strawberry tongue (diff from TSS) |
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Streptococcal and Enterococcal Sx?
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-Abrupt onset of sore throat
fever, malaise, nausea, headache -Thoat red and Edematous, w/ or w/o exudate -cervical nodes tender |
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Streptococcal and Enterococcal Dx?
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-Throat culture
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S. pyogenes Dz?
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-Erysipelas is a particular form of streptococcal cellulitis.
-Necrotizing fasciitis due to S. pyogenes is a severe dermal (or rarely muscular) infection that spreads along fascial plane -pneumonia and ampyema -endocarditis -Arthritis -TSS |
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Enterococcal Infx?
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-Enterococcus faecalis
and E. faecium cause: endocarditis, UTI, intra-abdominal infection, cellulitis -wound infection -concurrent bacteremia. |
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Toxic Shock Syndrome (TSS)causing organisms ?
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staphylococcal or streptococcal exotoxins.
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TSS Sx:
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high fever, hypotension, diffuse erythematous rash, and multiple organ involvement, shock
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TSS Dx?
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clinically and by isolating the organism.
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Campylobacter and Related Infections?
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Gram-negative bacilli
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Campyobacter Sx?
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diarrhea (loose, watery or bloody)relapsing fever
bacteremia, with: endocarditis, osteomyelitis, or septic arthritis. |
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Cholera?
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Vibrio cholerae
acute infection of the small bowel , toxin that produces copious watery diarrhea, leading to dehydration, oliguria, and collapse. NO FEVER |
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Cholera Dx?
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by stool culture or serology.
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Cholera mode of Transmission
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Traval to endemic area (crowded, war, famine) or contact with infeced person
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Escherichia coli Infections ?
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inhabitants of the large intestine. strains produce toxins that cause diarrhea, and all strains produce infection when they invade sterile tissues.
Sometimes fever, abdominal cramps |
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Different kinds of E.coli?
(name 3) |
ETEC: travellers diarrhea (_T_C = Travelling Countries)
EIEC: bloody diarrhea, dysentery (_I_C = Intensive Care Unit for bleeding) EHEC (O157:H7): aSx carrier, non-bloody diarrhea,(CMTD) (or bloody in her notes) hemorragic colitis, hemolytic uremic Syndrome, TPP (_H_C = Helen Carney, my little sister always bugged me) |
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Haemophilus Infx?
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numerous mild and serious infections, including bacteremia, meningitis, pneumonia, otitis media, cellulitis, sinusites, bronchitis, arthritis, endocarditis and epiglottitis
H influenzae is teh most common -Colonize the Upper respiratory tract in COPD patients |
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HAmophilus Dx?
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culture and serotyping.
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Klebsiella, Enterobacter, and Serratia Infections (Hospital acquired)
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-closely related normal intestinal flora
-immunocompromised -infections in the respiratory or urinary tract that present as pneumonia, cystitis, or pyelitis and may progress to lung abscess, empyema, and septicemia -Red Jally sputum (klebsiella) |
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Legionella Infections ?
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pneumonia, with extrapulmonary features
-immunocompromised, smokers or lung Dz -scant sputum production, pleuritic chest pain, toxic appearance. -Dx |
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Legionella INfx?
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requires specific growth media, serologic testing, or PCR analysis
X-ray: consolidation, patchy infiltrates -Assoc with contaminated water sources. |
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Bordetella pertussis?
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Pertussis (Whooping Cough)
(a small, nonmotile, gram-negative coccobacillus) |
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Pertussis Dx?
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nasopharyngeal culture (leukocytosis), PCR, and serologic assays.
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Pertussis Sx?
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Infant before 2
Prodromal 2 week catarral stage, malaise , cough coryza , anorexia URI followed by paroxysmal or spasmodic coughing that ends in a prolonged,high-pitched, crowing inspiration (the whoop). |
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PErtussis transmission?
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Reservoir adolescents and adults: REspiratory droplets
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Yersinia Infections(Bubonic Plague; Pestis; Black Death)
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short bacillus bipolar staining G- rod
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Yersinia Sx?
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Sudden onset of high fever, malaise, muscular pains, prostration, axyllary or inguinal lymphadenitis. pneumonia, bacteremia or maningitis
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Yersinia Dx?
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Positive smear and blood culture of bubo
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Mode of transmission?
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Esposire to rodent in endemic areas or fleas. repiratory droplets via pneumonia
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Pseudomonas and Related Infections?
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aeruginosa and other members of this group of gram-negative bacilli are opportunistic pathogens
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Pseudomonas DX?
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by culture (hospital aquired mostly)
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P aeruginosa?:
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G- bacilli , opportunistic infx (HIV, ICUs)
Dx by culture, resistance is common, Many anatomic sites like heart valves, 1st Sign is G-SEPSIS |
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Salmonella infx?
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a lot of serotypes A, (S typhi) B and C, also infect animals, TYPHOID FEVER Dx clinical, culture
Tx Cipro, |
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Salmonella S&S
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incubation 8-14 d
Onset: gradual (fever, headache, arthalgia, pharyngitis) Temp rises (40C) stays high for 10 day, lowers 3 weeks, prostration, CNS Sx, 10% pt w/pink blanching lesions (rose) Intestinal perforation may occur, 2ndary pneumonia |
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Salmonella Dx:
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Similar diseases: rickesttsias, leptos, TB, malaria, Yersinia,
etc, influenza, Lymphoma and other infxns DO CULTURES even bone marrow |
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Shigellosis?
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intestinal infection, bloody diarrhea, nausea
Dx clinical/stool culture, Abx + rehydration |
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Shigella mech of disease?
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penetrate mucosa of large intestine, toxin,
1-4 days incubation, watery diarrhea (may confuse with protozoal infxs), electrolyte loss, dehydration circulatory collapse, death |
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Tularemia?
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Febrile disease by Francisella Tularensis, Sx: local ulcerative lesion, lymphadenopathy, systemic Sx. Dx: EPIdemilogic and clinic, Tx Abx
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Tularemia, Who and more Sx?
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Hunters, butchers, farmers, and fur handlers winter. Contact wth animals, rabbits, NO human to human
Bioterrorisim 1-10 days, h/a, Nausea, vominting 40 C fever, weakness sweats, inflamed papules. regional lymph nodes enlarge, delirium |
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Pathogenic Protozoans:
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Entamoeba histolytica, Cryptosporidium sp, Giardia lamblia, Isospora belli, Cyclospora cayetanensis, and members of the phylum Microsporidia
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Non-intestinal Protozoan ifx
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malaria, babesiosis, eishmaniasis, toxoplasmosis, trypanosomiasis. Extraintestinal Protozoa: nematodes in Nematodes (Roundworms), flukes in Trematodes (Flukes), and tapeworms in Cestodes (Tapeworms).
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Intestinal Protozoa transmission?
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fecal oral route, poor hygiene, sexually. Dx: STOOL specimen (G, lamlia, Cryptosp and E histo)
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Entamoeba Dz?
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asymptomatic, but sometimes mild diarrhea, severe dysentery, liver abscesses
Dx: stool, serologic Tx: metronidazole or tinidazole |
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Entamoeba species and forms?
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E. histolytica is pathogenic,but E. dispar harmless
trophozoite in liquid stools and cyst in formed stools (resistant to the external environment) |
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Eh trophozoites?
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adhere and kill colonic epithelial cells and PMNs,
degrade the extracellular matrix, invade intestine wall spread necrotic liver other organs |
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Eh Sx?
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ASk Barbara: asymptomatic, chronically pass cysts, diarrhea and constipation, flatulence, cramping, liver tenderness referred to the right shoulder
Sx similar to appendicitis (no SURGERY!!) or IBS skin and lungs |
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Eh ddx
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misdiagnosis IBS, UC, salmonellosis, shigellosis (but Eh low WBC),
diff from other hepatic dz EXAMINE STOOL b4 doing anything else proctoscopy, Biopsy |
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Cryptosporidiosis?
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C. parvum and C. hominis
watery diarrhea, GI distress, persistent and severe in those with AIDS |
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Cryptosporidia?
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coccidian protozoa
ingestion by another vertebrate, the oocyst releases sporozoites that transform into trophozoites in epithelial cells, incubation period is about 1 wk, excretion/shedding of oocysts, immunocompromised big fluid loss |
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Crypt Dx, Tx?
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Acid fast in stools, antigen essays, self-limited. Nitazoxanide (children and immunocomp),
Stools slightly infectious, follow BIOSAFETY |
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Giardiasis?
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Giardia trophozoites or cysts, fecal-oral route,
Giardia cysts remain viable in surface water and are resistant to chlorination, lots of boiling |
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Giardiasis signs Sx?
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Ask Alexis to describe: 1 to 2 wk after infection, watery malodorous diarrhea, abdominal cramps and distention, flatulence, eructation, intermittent nausea, epigastric discomfort
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Giardiasis Dx?
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trophozoites or cysts in stool, enzyme assays
Tx Meronidazole, Flagyl |
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Microsporidiosis?
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obligate intracellular spore-forming protozoan parasites,
many ways to acquire, inoculate host cell with infective sporoplasm, inflammation when spores liberate. |
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Microsp Sx, Signs
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AIDS related diarrhea, disseminated infection, and corneal disease.
DX fluorecense, PCR etc. |
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African Trypanosomiasis? (African Sleeping Sickness)
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protozoa T. brucei transmitted by the bite of a tsetse fly, Mechanism to escape immune defense by changing surface proteins,
Trypanosomiasis Sx: skin lesions, intermittent fever, headache, rigors, transient edema, generalized lymphadenopathy, meningoencephalitis |
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Trypanosomiasis Dx?
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identifying the organism in blood,CSF, lymph
serologic, clinically: Chancre sore, papule becomes dusty red nodule |
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Trypanosomiasis Tx?
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pentamidine, melarsoprol, or eflornithine
Avoid endemic areas, clothing DEET |
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Babesiosis ?
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Babesia microti from rodents and deer ticks invad RBCs
NE US |
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Babesiosis S&S?
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Ask Shawn C
asymptomatic, malaria-like illness with fever,hemolytic anemia. immunocompromised, may hepatoslenomegaly |
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Babesiosis Dx?
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peripheral blood smear, serology, or PCR
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Babesiosis Tx?
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azithromycin plus atovaquone or with quinine plus clindamycin.
no if asymptomatic |
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Chagas' Disease (American Trypanosomiasis)?
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Trypanosoma cruzi, transmitted by kissing bug,
bugs deposit feces containing metacyclic trypomastigotes |
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Chagas' Disease S&S?
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Cells of the reticuloendothelial system, myocardium, muscles, and nervous system, skin lesion, unilateral periorbital edema, fever, malaise, generalized lymphadenopathy, and hepatosplenomegaly, chronic cardiomyopathy, megaesophagus, or megacolon. May be asymptomatic
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Chagas' Disease Dx?
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trypanosomes in peripheral blood, PCR, serologic tests,
Chronic disease develops in 20 to 40%, after a latent phase that may last years or decades. |
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Chagas' Disease Tx
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nifurtimox or benznidazole
in chronic, Tx is symptomtomatic |
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Leishmanias?
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Vector flies Phlebotomus sp are infected by biting humans or animals, survive in the vertebrate host as intracellular amastigotes
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Visceral leishmaniasis Sx
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irregular fever, hepatosplenomegaly, pancytopenia, and polyclonal hypergammaglobulinemia, high mortality if untx
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Cutaneous leishmaniasis Sx
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painless nodular skin lesions that enlarge, ulcerate centrally, and persist for months to years but eventually heal. Dx smears or cultures of splenic or bone marrow aspirates
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Mucocutaneous disease Sx
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following cutaneus nasopharyngeal tissues and can cause gross mutilation of the nose and palate.
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Leishmaniasis Tx ?
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pentavalent antimony compounds, liposomal amphotericin B, amphotericin B deoxycholate, or miltefosine,
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Malaria?
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4 species of Plasmodium. (falciparum, vivax,
ovale, malariae), Transmited by: Anopheles mosquito, Life cycle: gametocytes, sporozoites, schizonts, marozoites |
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Malaria Sx
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jaundice, hepatomegaly, Fever (periodic), chills, sweating, hemolytic anemia, and splenomegaly.
P. falciparum causes microvascular obstruction (he is the bad one to have) |
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Malaria Dx.Tx
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Plasmodium in peripheral blood smear; Tx: chloroquine, quinine, check for hypoglycemia and hydration.
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Toxoplasmosis
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Toxoplasma gondii, Sx from none, to benign lymphadenopathy, a mononucleosis-like illness (rash hepatosplenomegaly, retinochoroiditis, confusion) or life-threatening CNS ,disease in immunocompromised people. (CNS mass lesion)
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Toxop tranmsision
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Human exposure to toxoplasmosis is common wherever cats are found, oocysts from cat feces, crosses the placenta
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Toxop infection:
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usually asymptomatic but may cause mild, self-resolving cervical or axillary lymphadenopathy
Acute toxoplasmosis may mimic infectious mononucleosis with lymphadenopathy |
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Types of toxoplasmoisis
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Severe disseminated toxoplasmosis is rare in immunocompetent people,
CNS toxoplasmosis can cause focal neurologic deficits, Congenital toxoplasmosis (pregnancy), Prognosis is poor (if the fetus survives until birth) |
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Toxop:
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serologically (Ig G antibodies)
If CNS involvement head CT , brain biopsy |
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Anaerobic Bacteria?
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Infections suppurative, abscess formation tissue necrosis
in gas formation in tissue |
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clostridial diseases
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rare but can be fatal, Abdominal disorders, such as cholecystitis, peritonitis, ruptured appendix, and bowel perforation
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Clostridial other symptoms?
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Sudden onset of pian and edema in wound, prostration and systemic toxicity, brown to blood tinged watery exudates with skin discoloration, gas and tissue
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Clostridia Dx:
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Gram positive rods in culture
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Leprosy (Hansen's Disease)
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chronic infection by the acid-fast bacillus Mycobacterium leprae
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Leprosy Sx
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have pale anesthetic macular nodular or erythematuous skin lesion, superficial nerve thickening with associated anesthesia, Rash is non pruritic
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None
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Leprosy Dx
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Clinical and lab biopsy
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M leprae reservoirs
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Armadillos and humans
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Leprosy trnasmission
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nasal droplets and secretions
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Tuberculoid leprosy
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mildest form, intact cellular immunity, more benign, asymmetric nerve involvement.
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None
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Lepromatous leprosy
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Defective cellular immunity , progressive malignant nodular skin lesions, slow symmeric nerve involvement
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None
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Borderline leprosy
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most common , numerous lesion that resemble turbeuloid leprosy
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Complications
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peripheral neurites, distal hypoestesia and weakness
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Other Mycobacteria?
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Present in soil and water, less virulent than TB, except elderly get M. avium
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What is MAC?
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Mycobacterium avium complex
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MAC pulmonary dz affects whom?
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mid to older pts with preveious lung problems, AIDS pts
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MAC sx?
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cough, expectoration, slowly progressive, fever, weight loss
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MAC cutaneous dz from what organisms?
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M. marinum (pools), M. ulcerans, M. kansasii
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MAC cutaneous dz sx?
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lesions, reddish bumps in upper extremities or knees
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MAC disseminated dz affects whom?
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AIDS, immunocompromised
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MAC disseminated dz sx?
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fever, anemia, thrombocytopenia, diarrhea, abd pain (like Whipples)
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MAC disseminated dx:
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culture of blood, bone marrow, SI
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Mycobacterium tuberculosis sx?
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fatigue, weight loss, fever, night sweats, productive cough, dyspnea, chest pain, hemoptysis with cavitary TB
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TB dx?
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sputum culture/smear, pulmonary infiltrates on chest radiograph, blood test of gamma IFN
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None
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TB organism is?
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acid fast bacilli
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TB transmission?
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inhale droplets
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Who is at risk for TB?
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elderly, HIV, homelessness
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TB positive PPD?
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> 10mm induration
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TB tx?
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isoniazid, rifampin, pyrazinamide, ethambutol together for initial tx; second line: aminoglycosides (streptomycin) and fluoroquinolones used for MDR-TB
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TB vaccine?
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BCG vaccine - 50% effective
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Extrapulmonary TB is from?
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hematogenous dissemination
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Miliary TB sx?
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lungs and bone marrow most often affected, children, imunocompromised, elderly
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Miliary TB sx?
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fever, chills, weakness, malaise, progressive dypspnea, anemia, thrombocytopenia, leukemoid reaction
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Extrapulmonary TB can give you what other conditions?
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pyelonephritis, meningitis, peritonitis, pericarditis, lymphadenitis, liver infx, bone/joint problems
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