• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

Card Range To Study

through

image

Play button

image

Play button

image

Progress

1/124

Click to flip

Use LEFT and RIGHT arrow keys to navigate between flashcards;

Use UP and DOWN arrow keys to flip the card;

H to show hint;

A reads text to speech;

124 Cards in this Set

  • Front
  • Back
What are bugs with Gram stain Limitations
These Microbes May lack Real Color

Treponema, Mycoplasma, Mycobacteria, Legionella, Rickettsia, Chlamydia

Silver for Legionella
Trep- dark field
what are the bugs you use Giemsa Stain for?
Certain Bugs Really Try my Patience

Chlamydia, Borrelia, Ricketssia, Trypanosomes, Plasmodium
What are the Obligate Aerobes
Nagging Pest Must Breathe

Nocardia, Psuedomonas, Mycobacterium
What are the Obligate Anaerobes?
Anearobes Can't Breath Air

Clostridium, Bacteroides, Actinomyces

(lack catalase or SOD)
What gives away an anaerobe?
Foul Smelling!
produce gas in tissue (normal in GI tract)
How do you treat Anaerobes?
Above Diaphragm: clindamycin
Below Diaphragm: metronidazole
What are the Obligate intracellular?
Stay inside when its Really Cold

Ricketssia and Chlamydia

can't make their own ATP
What are the Facultative Intracellular?
Some Nasty Bugs May Live FacultativeLY

Salmonella, Neisseria, Brucella, Mycobacterium, Listeria, Francisella, Legionella, Yersinia pestis
What are the Encapsulated bacteria?
SHiNE SKiS

Strep pneumo, Heamophilus influenza, Neisseria, E. Coli, Salmonella, Klebsiella, GBS

SHiN (Vaccines)
Catalase +
PLACESS for your cats

Pseudomonas, Listeria, Aspergillus, Candida, E.coli, Staph aureus, Serratia

Inc. Risk with CGD
Urease + bugs?
PUNCH KidneyS

Proteus, Ureaplasma, Nocardia, Cryptococus, H.pylori, Klebsiella, Staph Saprophyticus
How do you perform a gram stain?
Cyrstal Violet
Iodine
EtOH wash
and then a sufranim (counterstain?) for the gram - to turn red
What is the PAS stain good at staining?
PASs the sugar (glycogen)
Whipple disease (Tropheryma Whipplei)
Who stains well with Silver stain?
Fungi, Legionella, H.Pylori
What are the bugs with special culture requirements?
H. influenza- chocaloate agar with Factors V/X (NAD, Hematin)

Neisseria- VPN (Thayer Martin Media)- vanco, polymyxin, nystatin

B. pertussis- Bordet-Gengou (Bordetta and Bordet)

C. Diphteriae- Tellurite, Loffler medium

M. Tuberculosis- Lowenstein-Jensen

M.pneumoniae- Eaton Agar (Eat to get your cholesterol)

Legionella- Charcoal with cystein and Iron

Fungi- Sabouraud (Sabs a Fun Guy!)
What makes Staph so bad?
Protein A
Catalase +
Beta Hemolytic
Toxins: TSST, SSS, Enterotoxin
MRSA- altered PBP, resistant to methicillin and nafcillin
What are the most common infections with Staph. Epidermidis?
Infects prosthetic valves and IV catheters- forms an adherent Biofilm

Normal skin flora- can contaminate blood cultures
Novobiocin Sensitive (NO StRESs)

UREASE +
What are the common infections with Staph. Saprophyticus?
Second most common cause uncomplicated UTIs- women

Novobiocin Resistant (NO StRESs)
UREASE +
What are the common infections caused by Strep. Pneumo
Meningitis
Otitis media (Children)
Pneumonia- rusty colored sputum
Sinusitis
What are the characteristics of strep pneumo?
Gram + diplococci, lancet shaped, Catalase -, alpha hemolytic, Optochin sensitive (OVRPS)
Capsule and IgA (SHiN organism) are virulence factors

Increased risk of sepsis in sickle cell and splenectomy (Not able to clear capsule bugs)

There is a Conjugated and non conjugated (For elderly) Vaccine (Alone with other SHiN organisms)
What are the illnesses caused by Strep. Viridans? What are the characteristic of the bug?
Dental Caries (S. mutans) and subacute endocarditis with S.sanguinis (means blood)

S. sanguinis makes dextrans which bind to fibrin-platelet aggregates on damaged valves

Optochin resistant, alpha hemolytic, normal part of oral pharynx
What are the illness caused by GAS, strep. pyogens? What are the characteristic of the bug?
Pyogenic: Pharyngitis, cellulitis, impetigo
Toxin: Scarlet fever, TSLS, necrotizing fasciitis
IM: Rheumatic fever (M-protein mimicry), acute post strep glomerulonephritis

GAS, Bacitracin Sensitive (B-BRAS), M protein prevents phagocytosis, but can cause RF due to mimicry

ASO titer used to detect post infection (beta hemolytic, destroys RBCs)
What are the characteristics of Scarlet Fever?
Scartet (red) Rash
Sandpaper-like texture
Strawberry tongue
Circumoral (around the mouth) pallor
What can cause post strep glomerulonephritis?
PSGN: Impetigo and Pharyngitis

RF: only Pharyngitis (JONES) m-proton mimicry of epitope similar to our cells in joints, heart, skin, basal ganglia
What are the illness caused by strep. Agalactiae? What are the characteristic of the bug?
PMS in babies (pneumonia, meningitis, sepsis)
It colonizes the vagina, so think of mom suffering from PMS and giving it to her baby

Bacitracin resistant (B-BRAS), beta hemolytic, found in vagina

Makes CAMP factor to increase hemolysis of S.Aureus
Hippurate Test +

Screen pregnant women 35 wks and treat intrapartum with penicillin propholaxis
What are the illness of enterococci?
UTI, Biliary tree infections, subacute endo following GI/GU procedure

VRE (vanco resistant)
Can grow in 6.5%NaCl and bile

Normal GI tract colony, Pen G resistant, very competent bugs and pick up resistance

Tx with Ampicillin, (not cep halos),Vanco or even amino glycoside
What do you need to think about if S. Bovis = subacute endocarditis?
Colon Cancer! Give Penicllin Propho
What are the S/Sx of C. Diptheriae
Psuedomembran pharyngitis, lymphadenopathy
Myocarditis, arrhythmias

AD-ribosylates EF2, beta phage

club shaped, Metachromatic blue/red granules and Elek test for toxin (black on Tellurite agar and Loffller)

GIVE TOXOID vaccine to prevent
How do you kill spores?
Autoclave at 121C for 15mins
B. anthracis, C. perfringens, C. Tetani (soil)
B. cereus, C. botulinum, Coxiella burnetti
What are the findings in Closridia infections? What are the characteristic of the bug?
Gram +, spore forming, obligate anaerobe (Anaerobes can't breath air)

C. Tetani: SNARE, dec. Glycine/GABA ranshaw nucleus, spastic paralysis

C. Botulinum: preformed, heat labile, inh. ACh (babies not preformed, produced after eating spores in honey)

C. Perfringens: alpha toxin (Lecithinase, phospholipase) myonecrosis (gas gangrene) and hemolysis. Think- its an anaerobe= hates blood because of O2

C. Diff: Toxin A- entero, binds to brush boader
Toxin B- disrupts cytoskeleton, killing cell (actin depolymize) psuedomembrane and diarrhea- after clindamycin or ampicillin (tx with metro or vanco)
What are the characteristic of the Anthrax?
Bacillus anthracis, gram + rod, spore forming, Aerobic
Anthrax Toxin: Edema factor inc. cAMP, lethal factor kills cell (MAPK)

Unique- has polypeptide capsule (D-glutamate)
Serpentine/Medusa head (long chains) cultured
Cutaneus Anthrax, characteristics? Pulmonary?
Boil-like ulcer with black eschar (painless and necrotic)

Pulm: inhaled spore-flu like progressing to fever, pulm hemorrhage, mediastinitis (wide on CXRAY), and shock
WOOLSORTERS: inhaled from wool
What are the characteristic of the Bacillus cereus?
Food poisoning, reheated/warm rice (spores germinate)

Emetic: rice and pasta, N/V within 1-5hrs caused by cereulide preformed toxin

Diarrheal- watery and GI pain 8-18hrs

nothing you can do, preformed toxin
What are the characteristic of the Listeria? Illnesses?
Facultative intracellular (Some Bugs May Live FacultaiveLY), gram +, beta hemolytic, likes COLD TEMP (4C)
Unpasturized MILK, deli meats, Transplacental, vaginal during birth

Actin rockets thru cytoplasm, avoid Abs
Tumbling motility
Only Gram + with LPS

Amnionitis, septicemia, spont. abortion during pregnancy

Granulomatosis infectiseptica
Neonatal meningitis
IM compromised meningitis
mild GI in healthy patients

Tx: mild GI- self limited
Ampicillin in infants, compromised, and elderly
What are the Ms of Listeria?
Monocytogens
Milk
Meningitis
iM compromised
Mommies to babies
Actinomyces vs. Nocardia?
Actin: anaerobe, normal oral flora, oral/facial abscess, sulfure granules, penicillin (SNAP)

Nocard: Aerobe, Acid Fast, soil, Pulmonary infxns compromised, cutaneus in competent. sulfa drugs (SNAP), UREASE +
What are the extra pulmonary TBs?
Potts: TB in vertebral body
CNS: paranchymal TB or meningitis
Adrenals, LN, GI, Renal

Primary= Ghon focus (mid lung) and Hilar Node (Ghon complex)
What are the characteristic of the TB?
TB: Acid fast, high lipid content, mycolic acid
Cord factor in virulent strains inhibits macros maturation and induces release TNF-alpha (causes symptoms)
Sulfatides inhibit phagolysomal fusion

MAC: intraceulluar, AIDS, disseminated, propho with Azithromycin, grows 41C, inc. LDH/ALK phosph

S/Sx: Fever, night sweats, weight loss, hemoptysis
What are the characteristic of the TB leprosy?
Cool Temps
Skin/Superficial nerves- Glove-Stocking sensation loss
No growth in vitro
Armadillos in Us

Lepromatous: diffuse skin, leonine face, communicable
Low cell-mediated IM
Relies on Th2 and humoral response
Dysfiguring, blindness, nodules, amputation from loss of feeling and trauma

TBoid: limited to hypo pigmented hairless plaques
High T-cell immunity- Th1

TX: DAPSONE and rifampin (TBoid)+ Clofazimine (Lepro)
What are the Gram - comma shaped Oxidase + bugs?
Camp. Jejuni- 42C
Vibrio Cholerae- Alkaline pH
H. Pylori- UREASE +
What are the Gram - Diploccoci?
Neisseria Meningitidis- Maltose ferm
gonorrhoeae- non-maltose

Meningitis plus patechia=N.Meningitis
Waterhouse syndrome too!
What are the Coccoid gram -?
Bruce lee and his crew of He man, fought at the border of the pasture with their cock and balls

Heamopholis influenza
Pasteurella
Brucella
Bordetella pertussis
What are the Gram -, lactose fermenting rods?
KEE, McConKEE agar, grow PINK
Klebsiella-UREASE +
E.Coli- Capsule
Enterobacter

SLow: City Slickers
Citrobacter
Serratia-red
What are the gram -, non lactose fermenting rods?
SSPPY
Oxidase -
Shigelle- Actin rocket
Salmonella- capsul (SHiNE SKiS)
Proteus- UREASE +
Yersinia

Oxidase +
Pseudomonas- obl. aerobe
What bugs are resistant to Penicillin and Vacno?
Gram - Rods
The outer membrane inhibits entry (also the periplasma space has beta lactams)
What are the characteristic of the Neisseria Gonocci?
Gram - diplococci, ferment glucose, IgA
GoNOcocci- intercellular within neutrophils
no capsule
no maltose fermentation
no Vaccine (rapid antigenic variation pilus protein)
Sexually
Gonorrhea, septic arthritis (sexual active most common), neonatal conjunctivitis, PID, Fitz-hugh-curtis (adhesions to liver)

Tx: Ceftriaxone, (Azithromycin/Doxy for Chlamidia)
three Macro axis to cut your balls off
What are the characteristic of the Neisseria Meningococci?
Gram - diplococci, ferment glucose, IgA, capsule (SHiNm)
Maltose ferm
Vaccine type B
Transmitted by respiratory secretions
Meningococcemia meningitis, Waterhouse-Friderichson syndrom (adrenal insufficiency, shock, DIC)
Patechial skin rash (vasculitis, even palms and soles) with meningitis!

tx: cetriaxone (you'll want three axes and a pen in your eye to stop this headache)

Propho: your friends will also want a rifle, three axes, and to flock away from you)
H influenza characteristics
SHiN- capsule (PRP), IgA, vaccine
gram -, coccobacili, small, Chocolate agar (V/X)

nontypable= Otitis media, conjunctivitis, bronchitis (mucosal, tx with amoxicillin+ clavulanate)

haEMOPhilus
Epiglottitis (cherry red glottis with thumbprint sign)- horse and stridor, Emergency airway
Meningitis
Otitis media
Pneumonia

tx: Ceftriaxone, rifampin for proph close contacst
The He man will chase, you kill him with three axes
your fiends can help with a rifle
What are the characteristic of Legionella?
Silver stain, poor gram (These Microbes May Lack Real Color)
Chorcoal with cysteine and iron
Detected in urine

Hyponatremia
no person to person
Water source (air conditioning, hot water tanks)

S/Sx: Hyponatremia
High Fever
severe Pneumonia, unilobe
Watery Diarrhea
Sputum- lots PMNs, few organisms

tx: Macrolide or quinolone
The MACRO legionnaire won't be a cinch to take down
Pontiac fever- mild flu like illness
What are the characteristic of Psuedomona?
Aerobic, gram -, non lactose fermeting, Oxidase +, pyocyanin=blue green color, grape like odor
Water sources (hot tube folliculitis)
Endotoxin-LPS
Exotoxin A=inactivates EF2
BURN VITCOMS

PSEUDO
Pneumonia (CF with biofilm)
Sepsis
External Otitis (Swimmers ear, water!)
UTI
Drug use and DM Osteomyelitis

hot tub Folliculiltis
malignant otitis externa in diabetics
Ecthyma gangrenosum- necrotic skin lesion in bacteremia (compromised)

Tx: Aminoglycosides plus ES penicillins (piperacillin, ticarcillin, cefepime, imipenem, meropenem)

This mean pseudo mona is in her prime and won't come down easy, we will have to rope, ti, and pip her down.
E. Coli virulence factors?
Fimbriae- cystitis and pyelonephritis
K capusle- pneumonia, neonatal meningitis
LPS endotoxin- septic shock
ETEC
EIEC
EHEC
EPEC
ETEC: travelers diarrhea, cAMP/cGMP
EIEC: invasive, necrosis, dysentary
EHEC: O157:H7, most commong, shiga-like toxin (HUS) dysentary (DOES NOT FERM. SORBITOL)
EPEC: adheres to apical surface, flattens villi, prevents absorption- PEDIATRIC diarrhea
What are the characteristic of Klebsiella?
4 As
Aspiration pneumonia
Abscess in lungs and liver
Alcoholics
diAbetics

Lobar pneumonia, mucoid produces currant jelly sputum

Nosocomial UTIs
Salmonella vs. Shigella
Salmonella: capsule (SHiNE SKiS), facultative intracellular (Some Nast Bugs May Live FacultativeLY)
Flagella (salmon swim)
Hematogenous dissemination
Animal reservoirs (reptiles)
H2S
Invades mucosa and causes MONOcytic response
Blood diarrhea
Non-lactose

Shigella: No flagella
Cell-Cell transmissiong by actin rocket, no heme spread
Human only reservoir
Abx help to shorten course (vs. Salmonella)
Invades mucosa and has Neutrophil response
Bloody poop
Non-lactose ferm.
What is unique about Salmonella Typhi?
Typhoid fever, only in humans
ROSE SPOTS on the ABDOMEN, fever, headache, and Diarrhea

can remain in carrier state within gallbladder
S/Sx: high fever, rose spots abdomen, dec. HR, delirium, diaphoresis
What are the characteristic of Camp. Jejuni?
Blooy dirarrhea in kids
fecal-oral thru poultry, meat, milk
S-Shaped, oxidase +, grows at 42C
Guillain-Barre syndrome and reactive arthritis
What are the characteristic of Vibrio Cholera
Rice water diarrhea vie exotoxin-Gs, inc. cAMP
Comma shaped, oxidase +, Alkaline media
ORAL REHYDRATION
What are the characteristic of Yersinia Enterocolitica
pet feces transmission (puppies)
contaminated milk or pork
Mesenteric Adenitis- can mimic Crohns disease or appendicitis (swollen abd LN)
What are the characteristic of H. Pylori?
Comma shaped, gram -, oxidase +, UREASE +, catalase +
Creates alkaline envir in stomach
Inc. risk Ulcers (esp. duodenal), adenocarcinoma stomach, and lymphoma (MALT)

Triple Therapy: PPI + Clarithromycin+ amoxicillin or metro
MAC attack the stomach
What are the characteristic of Leptospira interrogans?
BLT (spirochetes)
Water contaminated with animal urine

s/sx: flu like (fevers, malaise, chills), JAUNDICE, photophobia with conjunctiva suffusion (red w/o exudate)
Surfers in Hawaii or tropics

Like peeing in salt water (Red eyes from the salt and yellow skin from the pee)
What is Weils disease? What causes it?
Leptospira Interrogans!

Icterohemorrhagic leptospirosis- severe Jaundice, azotemia from liver and kidney dysfunction; fever, hemorrhage, and anemia

Really yellow skin, kidneys hurt because you peed so much, bleeding-> anemia
What are the characteristic of Borrelia Burgdorferi?
Lyme disease- Ixodes tick (Babesia), reservoir is the mice
Visualize on Giemsa stain (Certain Bugs Really Try my Patience)

BAKE a key Lime pie
Bells Palsy (bilateral)
Arthritis (mono large, then migratory and poly)
Kardiac block (AV node)
Erythema migrans

Neurologic (Encephalopathy, polyneuropathy)
tx: Doxycyclin, ceftriaxone
The Doxy (dog) riding a cycle will juggling 3 axes, just to get a piece of Key Lime pie
What are the characteristic of Syphilis?
Painless chancre
Dark field to visualize
VDRL/RPR (Rapid plasma reagin- cardiolipin cholesterol, lecithin with aggregation is +), confirm with FTA-ABS

2= Systemic
maculopapular rash (Palms and soles)
Condyloma lata

3= Gummas (chronic granulomas)
aortitis (vasa vasorum destruction)- Aortic regurg/root Dilation
neurosyphilis (tabes dorsalis, general paresis)
Agryl Robertson pupil (accommodates, not reacts)
Broad based ataxia, + Romberg, Charcot joint, stroke w/o hypertension

Tx: Penicillin G
What are the characteristic of Congenital syphilis?
Saber shins, saddle nose, CN VIII deafness, Hutchinson teeth, mulberry molars,

Tx: treat mother early in pregnancy- transmission early 1st tri
How do you do a VDRL?
nonspecific Abs to beef cardiolipin

FP= mono (EBV), hepatitis, SLE
VDRL (Virusis, Drugs, Rheumatic fever, Lupus)
What is the Jarish-Herxheimer reaction?
Flu like after Abx use- killing a lot of bacteria and releasing pyrogens

think of the jaraco missile from iron man- released a lot of bombs when it went off
What infection with a dog or cat bite?
Pasteurella multicocida
cellulitis or osteomyelitis
What are the characteristic of Garnerella Vaginalis?
gram variable
rey vaginal discharge
Fishy smell
nonpainful (vs. vaginitis)
Clue Cells- eli cells covered with bacteria

Tx: metronidazole or clindamycin (anaerobes)
How do you treat the Ricketsial Diseases? What are they?
Doxycicline (tetracyclin)
Ricketssia Ricketsii- tick
Rickettsia typhi-endemic (fleas)
r. prowazekii-epidemic (human body louse)
Ehrlichiosis (Lone star tick)
Anaplasmosis (Ixodes)
Q fever (cow placenta spores)
What are the characteristic of Rocky Mountain spotted fever?
south atlantic (dumb name)
Rash WRISTS and ANKLES then spreads to trunk, palms, soles

Obligate intracellular organisms (Stay inside when its Really Cold)
need CoA and NAD+ (cannot make ATP)

Triad: Headache, Fever, Rash (vasculitis)

Remember Palms and Soles rashes: CARS
(Coxscacki A, Rocky mountain, Syphilis)
What are the characteristic of Thyphus?
R. Typhi and R. prowazecki (epidemic)
rash CENTRALLY than spread out, sparing palms and soles

Headache, fever, rash
What are the characteristic of Ehrlichiosis and Anaplasmosis
Ehrlichiosis and Anaplasmosis= morulea (berry like inclusion) in monocytes and granulocytes, respectively

Vector is the tick
What are the characteristic of Q fever?
Cow placenta, spores, pneumonia, fever
What are the characteristic of Chlamydia?
Intracellular (Stay inside when its Really Cold)
cannot make their own ATP
EB form- infectious, enters cell
RB form- replicates in cell

C. Trachomatis: reactive arthritis (Reiter syndrome), follicular conjunctivitis, urethritis, PID
C. pneumonia and C. psittaci (birds) atypical pneumonia transmitted by aerosol

Tx: Azythromycin
The CLAMS make macro cyclins (big pearls)

Giemsa stain (Certain bugs really try my patients)
Cell Wall lacks muramic acid
What are the characteristic of Chlamydias subtypes?
ABC: you can't see
causes blindness due to follicular conjunctivitis in africa
D-K: my dick to your kilt
Urethritis/PID (ectopic pregnancies), neontal pneumonia (staccato cough from mom), neonatal conjunctivitis (from mom during birth)
L1,L2,L2: Lymphogranuloma venereum: small, painless ulcers on the genitals, swollen, painful inquinal lymph nodes that ulcerate (bubuoes) treat with doxycycline
Whats a good drug for intracellular infections?
Doxycycline
What are the characteristic of Mycoplasma Pneumoniae
Atypical Walking Pneumonia
(insidious onset, low fever, headache, nonproductive cough, patchy or diffuse interstitial infiltrate)

Higher titer of Cold Agglutinins (IgM)- agglutinate or lyse RBCs

Grow in Eaton Agar (contains cholesterol)

tx: Macs and doxycycline, or fluoroquinolone
Common pts<30, military recruited and prisons
What are the Atypical Pneumonias?
Legionella
Mycoplasma
Chlamydia pneumoniae

Tx: Macrolide's
What are the characteristic of Systemic Mycoses? What are they?
Cause Pneumonia and can disseminate, dimorphic (mold cold, yeast heat- except coccidioid is a spherule in tissue)
tx: Fluconazole or itraconazole for local
Ampho B for systemic (which can mimic TB due to caseating granuloma formation)

Granulomas can increase Ca due to act. of 1,25 hydroxy in act. macros

No person to person transmission!
What are the systemic mycoses?
Histoplasmosis: Histo Hides
Hides within Macros, very small, red inclusions, bird droppings, spelunking, Midwest

Blastomycosis: Broad bast buds, Bone
East and Midwest
Inflammatory lung disease and skin/bone; granulomatous nodules
double reflective capsule, about the size RBC

Coccidioidomycosis:
Southwest, California, New Mexico
Pneumonia, Meningitis, Bone, Skin spread
Seen after Earthquakes from soil
Spherule in body= filled with endospores*
Skin lesions- erythema nodosum, arthralgias, fever

Paracoccidioidomuycosis: Latin America
Budding yeast with Captain Wheel, much larger than RBC
Paracoccidio parasails with the captains wheel in latin america
What are the characteristic of the Cutaneous mycoses? What are they?
Tinea Versicolor: malassezia furfur (on the skin, furry)
makes acids from degrading lipids, damaging melanocytes and cause hypo/hyperpigmented patches
Hot, humid weather

Spaghetti and meatball appearance
tx: topical miconazole, selenium sulfide
What are the characteristic of other Tineae?
Pedis, cruris, corporis (ringworm on the body) capitis, unquium

Pruritic lesions with central clearing resembling a ring, caused by dermatophytes (microsporum, trichophyton, epidermophyton)
See mold hyphae on KOH prep, not dimorphic
What are the opportunistic fungi?
Candida, aspergillus, cryptococcus, Mucor/Rhizopus, pneumocystic jirovecii
What are the characteristic of Candida Albicans?
Dimorphic: Pseudohyphae (looks like mold, but new cells just fail to separate from previous cell) forms branches

Germ tubes at 37C

Oral and esophageal thrush (compromised, neonates, steroids, diabetes, AIDS)
vulvovaginitis (Diabetes, ABx)- curd, white discharge
Diaper rash
Endocarditis in HIV drug users
Disseminated
Chronic mucocutaneous candidiasis

Tx: azoles for vagina
fluconazol or caspofungin for oral/esophageal + amphotercin B for systemic
What are the characteristic of Aspergillus?
Non Dimorphic: septate hyphae that branch at 45 degrees, conidiophore (dandelion like)
Invasive in compromised and those with CGD (CATALASE +, PLACESS)
The A's of Aspergillus
Acute angle branching- 45 degrees
Allergic Bronchopulmonary aspergillosis
Aspergillomas- lung cavities fungus ball
Aflatoxin- liver HCC
AIDS invase
Air crescent sign on fungi balls
Azole

Allergic Bronchopulmonary aspergillosis- Asthma and cystic fibrosis- bronchiectasis and Eosinophilia (ABPA)

tx: Azoles
What are the characteristic of Cryptococcus neoformins?
Not dimorphic
Narrow Based Bud
Heavily encapsulated
Soil and PIGEON droppings
India Ink and Mucicarmine stain capsule well
Latex Agglutination test detect polysacc. capsule Ag
Soap bubble lesions in the brain
Cultures Sabouraud agar

Cryptococcal meningitis (HIV)
also Pneumonia
Hematogenous spread
What are the characteristic of Mucor and Rhizopus?
Wide Angle non-septate (no clear distinction between one cell and another- no lines) hyphae-irregular and broad (only a mold)

Diabetic Ketoacidosis or Leukemia Patients
Fungi proliferate in blood when xs ketone and glucose
penetrate cribiform plate, Rhinocerebral,frontal lobe abscess

S'Sx: Headache, facial pain, black necrotic eschar on face, cranial nerve involvement

tx: ampho B
What are the characteristic of Pneumocystis jirovecci?
pneumocystis pneumonia (PCP)- diffuse interstitial pneumonia in AIDS (compromised)
Diffuse, bilateral infiltration on Lung (XRAY)

Disc- shaped Yeast- inhaled.
Methenamine Silver stain

Tx: TMP-SMX propho
pentamidine, dapsone (propho), atovaquone (propho) when CD4<200
What are the characteristic of Sporothrix schenkii?
Dimorphic
cigar shaped budding yeast
lives in vegetation- rose gardeners disease
local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis)

Tx: AZole or POTassium iodide (A roZe in a POT)
What are the characteristic of Giardia Lamblia?
Transmission: Cysts in Water
Disease: Bloating, Foul smelling, fatty diarrhea
Dx: Trophozoites (pear shaped with 2 eyes) or cysts in stool
Tx: Metronidazole

Think Fatty Ghirardelli chocolates
Campers and hikers drinking bad water, incr. risk in Gays, travelers, and compromised
What are the characteristic of Entamoeba histolytica?
Transmission: Cysts in Water
Disease: Dysentery, LIVER Abscess (anchovy paste exudate), RUQ pain. Flask shaped ulcer if submucosal abscess of colon ruptures

Dx: Serology and/or Trophozoites (w/ RBCs in cytoplasm) or cysts with <4 nuclei in the stool) more round, larger, eat RBCs or have many nuclei in them

tx: Metronidazole; iodoquinol for asympt cyst
What are the characteristic of Cryptosporidium?
Transmission: Oocysts in water
Dx: Oocyts on acid fast stain (pink, round)
Disease: Severe diarrhea in AIDs, mild otherwise
Tx: prevention (Filter water) nitazoxanide in incompetent host
What are the Protozoa infections of the GI tract? What do you see in the stool?
Giardia, Entamoeba, Cryptosporidium

Cysts and Oocysts (Acid fast for sporidium)

Protozoa GET CraP
What are the CNS protozoa infection?
Toxoplasma, Naegleria Fowleri, Trypanosoma Brucei

TNT makes your CNS explode
What are the characteristic of Toxoplasma?
Transmission: Cysts in meat, or Oocysts in cat feces
Brain Abscess in HIV- ring enhancing lesions on CT/MRI
Dx: Serology or Biopsy (Tachyzoite a crescent shapped cells that is dark pink/blue)
tx: Sulfadiazine and pyrimethamine


S/Sx HIV: seizure, ring enhancing lesions, Headache
What is Congenital Toxo?
Triad: Chorioretinitis, hydrocephalus, and intracranial calcifications
Vision issues, large head with inc. ICP, and calcifications

oocysts can cross placenta and infect baby (avoid CAT poop)

TORCHES infection
C's
Chorioretinitis
hydroCephalus
intracrantial Cacification
What are the characteristic of Naegleria Fowleri?
Transmission: Swimming in fresh water lakes (Nalgene with fresh water in it)
Naegleria enter the cribiform plate= Rapidly fatal meningoencephalitis
Dx: Amoebas in spinal fluid (round, pink with clear halo)
Tx: Ampho B (most die)
What are the characteristic of Trypanosoma Brucei?
Transmission: Tsetse fly, painful but
Disease: African sleeping sickness: Enlaged Lymph Nodes, recurring fever (antigenic variation), somnolence, coma
Dx: blood smear (red, waxy looking protozoa)
tx: Suramin (if in blood)
Melarsoprol for CNS
(it SURE is nice to sleep, MELAtonin helps)

Take a tryp to africa to get knocked out by Bruce Lee and the tsetse
What are the Protozoa Hematologic Infections?
Plasmodium (Malaria) and Babesia (Ixodes, like lyme disease!)

Giemsa stain for Plasmodium (Certain Bugs Really Try my Patience)
What are the characteristic of Plasmodium Vivax/Ovale?
Fever, headache, anemia, splenomgaly
Fever- 48 hour cycle
Dormant form- hypnozoite (hypnotized to sleep)
only reticulocytes

Transmission: Anopheles mosquito
Dx: blood smear, trophozoite ring form within RBCs, schizont containing merozoites

tx: chloroquine (blocks heme polymerase; if resistant use mefloquine/atovaquone/proquanil

life threatening: quinidine (check for GSPD fist!)
Primaquine for hypnozoite (G6PD first!)
What are the characteristic of Plasmodium Falciparum?
Fever, headache, anemia, splenomegaly
severe, irregular fever patterns; parasitized RBCs occulde capilaries in brain (cerebral malaria) kidney and lungs

reticulocytes and mature RBCs

Transmission: Anopheles mosquite
Dx: trophozoite ring form in RBCs
Schizont containing merozoites

tx: chloroquine, if resistant, use quinine/doxycycline
What are the characteristic of Plasmodium Malariae?
Fever, headache, anemia, splenomegaly
72 hour fever cycle, infects only mature RBCs

chloroquine, quinidine
mefloquine or atovaquone/proguanil
What are the characteristic of Babesia?
Fever and hemolytic anemia
Northeastern US
Asplenics increased risk of sever disease

Transmitted by Ixodes tick (lyme disease) and may co-infect

Dx: blood smear, ring form or maltese cross, PCR

Tx: Atovaquone + azythromycin
a baby seal loves to catch the zzzz atop the quarry
What are the characteristic of Trypansoma cruz
Trypansoma cruzi (CHAGAS)- chagas disease
Dilated cardiomyopathy, megacolon, megaesophogus (just a dilated GI tract and heart)
South America

Transmission: Reduviid bug (Kissing big) feces, deposited in a painless bite
tx: Benznidazole or nifurtimox

Take a cruz in my red benz, wear your nice fur tim
What are the characteristic of Leishmania Donovani?
Visceral Leishmaniasis
Spiking fevers, hepatosplenomegaly, pancytopenia

Transmission: Sandfly
Dx: Macrophages contain amastigotes (several blue inclusions)

Tx: Ampho B, Na Stibogluconate

Leishmania is like the tasmanian devil, just ampho terrible and want him to stay bug!
What are the characteristic of Trichomonas Vaginalis?
Vaginitis: Foul smelling, green discharge, ITCHING, BURNING

Sexually transmitted
Dx: trophozoites (motile) on wet mount
Strawberry cervix!

tx: Metronidazole and propholax partner
What are the Nematodes (Round worm)
Enterobius Vermicularis
Ascaris Lumbricoides
Strongyloides Stercoralis
Ancylostoma Duodenale, Necator americanus
What are the characteristic of Enterobius Vermicularis
pinworm
Transmission: fecal-oral, often self
Disease: Intestinal infection causing anal pruritis
Dx: scotch tape test
tx: Bendazoles oyr pyrantel pamoate
Bendazoles because worms are bendy
What are the characteristic of Ascaris Lumbricoides
Giant roundworm
Transmission: fecal oral, eggs visible in feces under microscope

Disease: Intestinal infection
Tx: Bendazole or pyrantel pamoate
What are the characteristic of Strongyloides Stercoralis
Transmission: Larvae penetrate skin from soil
disease: intestinal infection causing Vomiting, Diarrhea, epigastric pain (may feel like a peptic ulcer). EOSINOPHILIA

Tx: Ivermectin or albendazole

Flariform larvae penetrate skin, blood, lungs, resp. tract, swallowed into stomach- mate and lay eggs in GI tract

Diarrhea, gastroenteritis
Strongy-loides= Stool Larvae (vs. Ancylostoma & nectar which eggs are in stool)
What are the characteristic of Ancylostoma Duodenale, Necator americanu?
Hookworms
Transmission: Larvae penetrate skin
Disease: intestinal infection causing anemia by sucking blood from GI tract
Tx: Bendazoles or pyrantel pamoate

Skin-blood-lungs (may cause pneumonia with eosinophilia)- GI tract where adult mature and attach to mucosa with teeth

Diarrhea, anemia
Eggs in stool
What are the characteristic of Onchocerca volvulus?
Transmission: female blackly bite
Disase: hyper pigmented skin and river blindness (black flies, black skin nodules, black sight)
Allergic reaction to microfilaria (move thru skin) possible

Tx: Ivermectin (IVERmectin for rIVER blindness)

Vulva is like a black hole
What are the characteristic of Loa Loa?
Transmission: Deer fly, horse fly, mango fly
Disease: Swelling in skin, worm in conjunctiva
Tx: diethylcarbamazine

Angioedema of extremities, if in the eye, patients can sense it moving around
dx: microfilariae in blood
What are the characteristic of Wuchereria Bancrofti?
Transmission: Female MAsquito
Disease: Adult worm Blocks lymphatics: ELEPHANTIASIS
takes 9mo-1yf to become symptomatic
tx: Diethylcarbamazine
What are the characteristic of Toxocara canis?
Transmission: fecal oral from frogs
Disease: Visceral larva migrans
Tx: Albendazole or mebendazle

Larvae hatch in GI and go to Liver, Lung, other places
Eosinophilia, dry cough, fever, night sweats and a skin rash. Can also cause ocular issues
Nematode routes of infection
Ingested- Enterobius, Ascaris, Toxocara (EAT)
Cutaneous- Strongyloides, Ancylostoma, Necator ( into feet from the SANd)

Bites: Loa Loa, Onchocerca vulvulus, Wuchereria bancrofti (lay LOW to avoid being bitten)
What are the Tapeworms- Cestodes?
Taenia Solium
Diphyllobothrium Latum
Echinococcus granulosus
What are the characteristic of Taenia Solium
Transmission: Ingested larvae encysted in undercooked pork or eating the eggs
Disease: (larvae ingesting cystercerci) Intestinal infection- abd pain, nausea, diarrhea and change in appetite

Cysticercosis, neurocysticercosis- musclar pain and swelling, seizure, intracranial hypertension, psychiatric disturbances

Adult worms secret proglottids into feces
if you ingest the eggs, they hatch and spread to muscle, brain, and liver

Dx: stool for eggs and proglottids

tx: Praziquantel for intestinal
Praziquantel and albendazole for neurocysticercosis
What are the characteristic of Diphyllobothrium Latum
Transmission: Ingested larvae from raw freshwater fish
Disease: Vit. B12 deficiency and anemia
Tx: Praziquantal
What are the characteristic of Echinococcus granulosus
Transmission: Ingestion eggs from dog feces, sheep, cattle
Disease: Hydatid cysts in Liver
Anaphalaxis if Ags are released during surgery (pre inject with ethanol to kill cysts)
mass and eosinophilia
eggshel calcifications on CT of liver

Tx: Albendazole
What are the trematodes?
Schistosome and Clonorchis sinensis

Eosinophilia, eggs in stool, travel history
tx: praziquantel
What are the characteristic of Schistosoma?
Trasmission: Snail is host, cercariae penetrate skin of humans
Disease: Liver and spleen granulomas, fibrosis, and inflammation

Chronic: squamous cell carcinoma of the bladder (painless hematuria)

tx: praziquantel

Eosinophilia, portal hypertension
What are the characteristic of Clonorchis sinensis
Liver Fluke
Transmission: undercooked Fish
Disease: Biliary tract inflammation and pigmented gallstones (brown stones)-RUQ pain
Associated with Cholangiocarcinoma

tx: Praziquantel
Parasite hints
Biliary tract disease, cholangiocarcinoma= Clonorchis sinensis

Brain cysts, seizures= Taenia solium (cysticercosis)
Hematuria, bladder cancer (SCC)= schistosoma haematobium

Liver (Hydatid cyst): echinococcus granulosus

Microcytic Anemia= Ancylostoma, Necator
Perianal Pruritus= enterobius
Portal HTN= Schistosoma mansoni/japonicum
Vit B12 def.= Diphyllobothrium Latum